I saw a patient today who was in tears. She wanted a baby, but because she was obese, her doctor refused to treat her infertility until she lost weight. She already had low self-esteem because of her infertility - and this just made a bad situation even worse.
She said - Doctor, I have tried so hard to lose weight. I have joined a gym and spent a fortune on diet books, but nothing seems to help. I don't like being fat, but no one is able to help me lose weight. Should I be punished for something I cannot control ? My biological clock is ticking away - and I feel it's very unfair to refuse to treat me just because I am obese. It's not that I am lacking will-power - it's just that I cannot lose weight, no matter what I do. How does blaming me for my obesity help ? If I was diabetic, would you refuse to treat me ? Isn't obesity a medical problem too ? Life is so unfair ! My sister is even fatter than I am - and she has 2 kids . I am sure I can get pregnant with the right treatment - and I will make a good mom, so can you please help me doctor ?
It is true that being overweight reduces fertility and that reducing weight helps to improve fertility. However, blaming the victim does not help. Doctors need to take a constructive approach and try to help them, rather than refuse to treat them point-blank. It's a good idea to refer them to a dietitian for help - but we all know that the weight-loss industry has a terrible track record and that we really are not very good at helping our obese patients to lose weight.
This is actually our failing rather than the patients, and I don't think it's fair to reject them.
In any case, making a baby just needs 4 things - eggs, sperm , uterus and tubes. Where do calories come into the picture ?
I agreed to do her infertility workup , so that we could find out what medical problems were reducing her fertility and try to fix them. She was extremely grateful because she could finally see light at the end of the tunnel !