The American Medical Association recently adopted a policy acknowledging the harms and imperfections of utilizing body mass index, or BMI, as an indicator of health.
If you’ve been told you can’t get IVF or another fertility treatment because of your BMI, you may wonder how this news will change things, if at all. (For those who don’t know, some doctors and insurance companies have prevented certain patients from getting IVF treatment because of their BMIs, despite the measurement’s racist and sexist origins.)
With the new policy, there is some hope to be had. “While obesity has been linked to pregnancy complications and reduced IVF or other assisted reproductive technology procedure success rates, the studies to date have largely focused on weight or BMI alone, which we are starting to understand is not the best way to determine health risks,” said Dr. Kelly Culwell, a board-certified OB-GYN.
Sylvia Kang, CEO and co-founder of the women’s health company Mira, agreed. “It’s common for medical professionals to advise patients to lose weight before attempting pregnancy, but there’s very little evidence to support the idea that modest or significant weight loss improves outcomes,” she said. “This approach stems from misconceptions about body weight and overlooks the complex nature of fertility.”
However, AMA delegates still believe BMI has some benefits and should be used, though not as a sole measure of health. If you’re met with this stigma at the doctor’s office, try to remember you’re not powerless, even if you feel that way.
Below, doctors share some steps you can take to stand up for yourself.
Advocate for your bodily autonomy and rights.
You may feel nervous about speaking up or disagreeing with your doctor, since they’re basically the “authority figure.” But remember that you’re allowed to speak up for yourself, expressing your needs, lived experiences and your right to make decisions about your own body.
“In any case, decisions around a patient’s healthcare — particularly something as sensitive and personal as trying to become pregnant — should be based on shared decision-making with the doctor providing the best, evidence-based information on risks and benefits, and ultimately leaving the decision to the patient who understands their personal values and willingness to accept risks,” Culwell said.
Discuss your health history and boundaries.
Many factors go into fertility, meaning there may be lots of reasons why IVF could work for you. This is something else you can discuss with your doctor.
According to the Centers for Disease Control, excessive exercise, stress, smoking, diminished ovarian reserve, polycystic ovarian syndrome and extreme weight loss are a few other factors that can contribute to infertility. If you don’t experience those or are working on handling them, it may be helpful to note that.
Dr. Gregory Dodell, a physician and endocrinologist with Central Park Endocrinology in New York, agreed this is a good approach. He suggested that patients tell their doctors that “they are happy to listen in and engage in behaviors that will support the [fertility] process, but don’t want it to be about weight (which is not a behavior), and they deserve care and the opportunities that people in smaller bodies receive.”
“The fundamentals that are preventing egg retrieval based on an arbitrary weight cut-off [are] about stigma first.”
– Jennifer Gaudiani, Denver-based physician and eating disorder specialist
Present information that debunks old reasoning.
Along those lines, one “tool” you can bring is research that supports the fact that plus-size people can have success with IVF, as well as the fact that weight stigma is not only inaccurate but harmful.
“The fundamentals that are preventing egg retrieval based on an arbitrary weight cut-off [are] about stigma first, true medical/surgical/anesthetic risk second,” said Jennifer Gaudiani, a Denver-based physician and eating disorder specialist. She believes not allowing this procedure based on weight is (subconsciously for most, if not all) a punishment for what society unfortunately deems as the “sin” of living in a larger body.
Having studies with you that support your argument can help. For example, this 2016 study found that weight-loss attempts in larger-bodied women didn’t lead to any noticeable fertility advantages; in fact, those who didn’t try to lose weight had a higher healthy live birth rate within two years. This 2022 study reached a similar conclusion.
At the same time, remember that specific studies aren’t the only examples of valid information worth sharing.
“I think patients can levelly look their fertility doctor in the eye when a BMI cutoff is brought up, and clearly state that plenty of people with active health risks or active medical diagnoses are supported in getting fertility support through egg freezing without facing any stigma or boundaries,” Gaudiani said.
Some examples she gave include cancer patients who plan fertility-preserving care before chemo or radiation, as well as people with substance use disorder who aren’t flagged because they don’t self-disclose.
You might even know of someone personally who had success, and you could share their story (with their permission) or ask them to attend the appointment with you. Also, Nicola Salmon runs @fatpositivefertility on Instagram, where she posts lots of great information and resources.
Get a second (or third) opinion.
Just because one doctor is discriminatory about your weight doesn’t mean they all will be. While finding another doctor is extra work you shouldn’t have to put in, it may very well be worth it.
“My first piece of advice in this situation would be the same for anyone who feels disrespected or unheard by their health care provider, and that would be to find another doctor,” Culwell said.
Dodell agreed. “In medicine and really anything else, it is reasonable and can be a good idea to get a second opinion,” he said. “There is certainly an art to medicine and also different experiences/comfort levels with regard to patient care.”
Do research to find the best fit for you.
To help the process (hopefully) be easier and quicker, Culwell and Dodell advised looking for key terms, such as “weight-inclusive approach” or “Health at Every Size (HAES),” when searching for another provider. Getting online and reaching out to others are your best bets, they added, whether that’s getting a recommendation from a friend, finding an online support group or searching for doctors on social media.
Additionally, Moore encouraged picking a doctor who will “avoid assumptions and harmful stereotypes associated with higher BMI, ensuring every patient feels heard, respected and supported.”
As far as qualities to look for in the doctor, she mentioned empathy, supportiveness and an understanding that every patient will require individualized care. “By following these best practices, we can ensure that all patients receive the attention and care they need while embarking on their fertility journey,” she added.
If you go through these steps and the doctor still says no to IVF, remind yourself that it’s not because of anything you did wrong.
“I want to both honor the power of individual advocacy and respect the fact that no patient should feel they ‘didn’t say things well enough,’” Gaudiani said. “Sometimes the system is too powerful and too stuck for an individual’s impassioned and educated feedback. That’s a system problem, not an individual problem.”
Gaudiani and other providers empathize with people experiencing this discrimination and stand with them. “I share with these patients my sorrow and immense frustration that they are being stigmatized and that proper care is being denied.”