Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Monday, May 05, 2014

The Baby-Making Industry

"Right now, many of us are confused as to whether or not we should restrict treatment by weight. We think there are more adverse outcomes if you do have a higher BMI. But whether or not that actually says you shouldn't treat somebody who is heavy, I think that's a very complicated issue and will ultimately require a lot of input from the stakeholders before we formalize that kind of guideline."
"In Calgary, at our clinic, we don't have a BMI cutoff above which we won't treat a patient with IVF. We're not at a point where we think it's fair or ethical to limit access to treatment based on a person's weight."
Dr. Jason Min, chair, clinical practice guidelines committee, Canadian Fertility and Andrology Society

"There is no doubt -- there is going to be bun fights over this one. The guidelines are not going to be easy. Those that feel that there's no reason for a cutoff think that, if you can manage to do the procedures safely, then why should there be a cutoff?"
"To me, it's a medical issue. It is not a discrimination issue. (Obese) women are running risks in pregnancy, and if they're running risks in pregnancy, why should you be helping them get pregnant?"
"When I do see women with BMIs that are high, I work with them. I don't think it's right to say, 'you're too heavy, go away and lose X amount of pounds and then call me'. I work out a plan for them. I say, 'this is who you want to see, these are the options you can look at to lose weight, yes, you may have been there before but now you have a bigger reason for it. I give them all the risk factors and then I bring them back every three months until they are in a range that I believe is safe."
Dr. Carl Laskin, fertility specialist, past president of the CFAS
Super-ovulation fertility drugs need better monitoring, doctors warn
This file photo shows a doctor performing in vitro fertilization (IVF). Both procedures use the same hormonal drugs. But there is less control when the drugs are used outside IVF.    Photograph by: Michal Cizek , AFP/Getty Images
According to Statistics Canada, 23 percent of Canadian women of child-bearing age fall into the obese range of body-weight. Any woman is considered obese when she has a body mass index of 30 or over. In-vitro fertilization is a difficult enough procedure to successfully help an infertile woman carry a foetus to delivery. If they do become pregnant they then are at higher risk of complications during delivery.

"Surgically, when you have to do a caesarean section, it's very difficult and very dangerous because the blood loss, infections -- all your complications are more common. You're operating through a much more challenging operating field", explained Dr. Mark Walker, a high-risk obstetrician at The Ottawa Hospital.

And BMI at 30, though considered obese, is by no means the top weight that is encountered among pregnant women. Some women presenting in pregnancy have BMIs into the 60s, 70s and 80s, according to Dr. Walker. Necessitating that obstetricians re-fit their weigh-in rooms with scales capable of accommodating women whose weight may ring in at over 350 pounds. Maternity wards now have to equip themselves with extra-wide chairs, beds, and strengthened operating tables.

Research that saw recent publication involving almost 7,000 women who gave birth at The Ottawa Hospital confirmed the heavier the woman, the greater her risk of pregnancy-related complications, including a potentially life-threatening rise in blood pressure; (pre-eclampsia), along with gestational diabetes and emergency caesarian sections. Premature birth and still-births are some of the risks to babies, along with spinal abnormalities and a variety of other birth defects.

IVF becomes technically more difficult to achieve successfully. The procedure where eggs are retrieved from the woman's ovaries through an ultrasound-guided needle becomes fraught with problems..."You may have difficulty getting to the ovary", explained Dr. Laskin. Excess fat in the abdominal cavity means the ovary tends to be pushed higher up in the woman's anatomy, and more difficult to visualize on ultrasound.

"You have to use a lot more drug to get a reasonable response", since obese women tend to respond poorly to fertility drugs, said Dr. Laskin who uses a BMI cut-off of 35. "Mine is a brick wall", he said, whereas other clinics will go as high as 40, and some recognize no cut-off platform at all. In British Columbia, private IVF clinics are not permitted egg retrievals in woman with a BMI over 38. Alberta, on the other hand, has no restrictions whatever.

So while fertility experts are struggling with the vexing problems of growing obesity among women seeking IVF treatment to enable them to become pregnant and deliver a child, there is yet another problem related to the medical ethics practised in private fertility clinics. That of implanting multiple eggs by patient insistence, hoping to offset the heavy costs of the procedure, gambling that at least one of the eggs may become fertilized, and the result sometimes of multiple births and babies requiring additional care resulting from related birth defects.

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