Saturday, April 09, 2016

Why are we so unkind to overweight infertile women?

Being overweight and infertile often go hand in hand.  Obesity reduces fertility, and it's well known that a high BMI reduces IVF pregnancy rates.  This is why many IVF specialists refuse to treat obese women until they get their BMI into the normal range. Now this may seem to be a sensible thing to do - after all, we do want our patients to get pregnant, which means this advice is in their best interests, correct ? However, the problem is more complicated than it appears at first blush,.

No one wants to be fat  ( there, I used the  dreaded "f" word) , and most women who are overweight have already  tried their best to lose weight and to get in to shape - after all, fat people don't need a doctor to tell them that they need to lose weight - this is something they already know. However, ( as most of can vouch from personal experience) , it's very hard to lose weight.  For most of us, every time we lose a kilo, we end up putting on two.  This can be extremely frustrating, and then having people go on and on telling you that you are fat just adds insult to injury.

Now, if you happen to be infertile as well, the problem gets compounded. A lot of people will look at you and say - Oh, you're not getting pregnant because you're too fat, and you feel even worse about yourself. Not only can't you lose weight, you can't even have a baby ! Even doctors can be unkind , and will refuse to treat infertile women until they can bring their BMI down to the magic number recommended by medical guidelines.

I think this is extremely unfair and unkind. Fat women don't like being fat.  A lot of them have done their best to try to lose weight , but they just haven't been able to. It's common for doctors to blame their lack of will-power for their inability to lose weight, but this makes a bad situation worse , because it just adds to their guilt. When doctors refuse to treat them because they're overweight, they feel trapped and hopeless. They've already tried everything possible to lose weight and failed - and telling them to lose weight doesn't really help. They need concrete  solutions, which most IVF doctors are not able to provide, because this is not their area of interest.  The truth is that they've tried most of these solutions , but these have not worked . The trouble is that most doctors blame the patient's poor will-power for their inability to lose weight - an attitude which is unfair and untrue.

Infertile fat women find themselves in a catch-22 situation  when doctors refuse to treat them because they're overweight. This often causes them to put on even more weight ! They don't feel like going out, they don't want to exercise , and because they feel sorry for themselves, they stay at home and eat more , and can't figure out what to do about it. Their infertility and their inability to lose weight makes their self-esteem even worse , and this becomes a negative vicious cycle.

Infertility doctors need to learn to be a little bit kinder to women who are overweight. Telling her to lose weight is very easy to do, but if she says she's tried and she's failed; or if you've given her a concrete solution and she implements it faithfully and yet she doesn't lose weight, you shouldn't refuse to treat her infertility. By fobbing her off , you make her infertility even worse, because she loses valuable time in her futile pursuit of trying to lose weight - and this is precious time which is never going to come back.

So how do we tackle infertile women who are overweight ? We need to offer them concrete solutions with  a well-defined weight-loss plan , and help them to implement it, in partnership with dieticians, bariatric physicians and gyms. We also need to be empathetic, and appreciate that if they've done their best to lose weight  and failed , there's no reason to refuse to treat them just because they are fat, no matter what the guidelines say.  Instead of focussing on the BMI , we  need to learn to focus on the patient !

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1 comment:

  1. Anonymous5:00 PM

    Infertility doctors refuse to treat overweight patients not because they are fat or ugly. There is a very strong scientific proof behind such a decision. Overweight women are less likely to respond in a good way to stimulation drugs ; they are lese likely to get pregnant ; and even if they do get pregnant , there is a greater chance of losing the pregnancy. Even if they carry the baby , there is a greater chance of other complications like gestational diabetes and eclampsia. A good doctor will definitely ask an overweight patient to not start the treatment before losing weight. In many young , overweight patients , losing weight is enough to get them pregnant naturally. So a doctor who refuses to treat overweight patient is ethical and has the best interest of the patient in mind. Patients must understand this. It is the duty of the patient to take steps to get back to a healthy weight. Instead of this , getting angry with the doctor or cribbing that the doctor's attitude towards them is wrong is not so pleasant on the part of the patient. Any doctor who treats such patients is erring against his knowledge and conscience - don't you think so ! What is kindness here ? Sometimes you have to be unkind to be kind.


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