Weight and Fertility

[boiler717]

The NYT recently published an article detailing some of the issues with weight and fertility (https://www.nytimes.com/2019/06/18/magazine/fertility-weight-obesity-ivf.html)
It has some good info but is overall sensational and lacking in the details. There is a group of REI physicians on IG who are discussing the topic in greater detail as they are unhappy with how the NYT portrays the subject, and it’s super interesting. Start with @roohijeelanimd and view her stories, then you can cycle through all the physicians. Some key take aways:
- they will treat all patients
- weight and diet are important discussions to have with patients seeking fertility treatment
- based on the location of egg retrieval (clinic vs surgery center vs hospital) anesthesia may have BMI limits
- it is true that success rates decrease and pregnancy complications increase with as BMI increases, so in some cases weight loss may increase success of bringing home a baby (even 20 lb reductions are helpful!)
- there can be a really fine line between taking time for weight loss with some conditions and it needs to be a very patient-specific discussion
I was an obese IF patient, and I’m happy to share my experiences if anyone has questions. I found the REI discussions very interesting in helpful and wanted to share.

[boiler717]

Another good discussion topic I forgot to summarize was the balance between “do no harm” and reproductive autonomy. They don’t want to place a patient at undue risk from anesthesia and pregnancy complications, but at the same time they do not want impair someone’s reproductive autonomy because that is the foundation of REI. Anyways, very interesting! Love to hear other’s thoughts.

[joenali]

I’ve been following the discussion too!

[megstoo]

It's kinda funny you bring this up. The clinic I'm at will accept ANY size patient. You could be 400lbs and they'd probably take you. However that said the clinic I was at previously would not accept you for IVF if you have a BMI of 35 or higher. Both clinics do talk a lot about a weight and fertility. Also doing a keto "diet" is what I'm finding a lot of RE's are starting to bring up more and more.

[cherryvalance]

This is interesting because my weight never came up during any of my visits (except when talking to the anesthesiologist before my retrievals). I was probably about 200 lbs when we first went.

[red]

Neither of my REs ever pressed weight loss, I’m a good 40lbs overweight. They did recommend a KETO type diet though. My PCP was definitely not shy about telling me I’m fat though. When I first started fertility treatments I was a healthy BMI though, it never worked until now when I am heavier.

[msmerymac]

Neither of my REs have considered my weight to be a factor in my IF. My first clinic did twilight anesthesia due to BMI, but my current clinic has higher BMI limits for anesthesia (they also work with an anesthetist from the hospital across the street), so it's not an issue at all.

I did keto during my last egg retrieval, but it wasn't under my doctor's recommendation (I worked with a nutritionist). I also started the month of my retrieval, so the effect it had on egg quality may have been minimal.

I've spent time over the last 5 years trying to get healthier, and I've lost and gained and lost again 30ish pounds, but I'm still considered obese. I also don't like to push the diet and exercise too hard when I'm actually IN a treatment month, I use that time to relax and de-stress.

[joenali]

I liked the quote, “weight is a vital sign, not an identifier. “

[ilovecandy]

When I did my first IVF i was in the overweight  bmi. I am not a good 30 pounds heavier and i can't loose it. No matter how good i eat, how much i exercise this is just where my body is. My current RE never once mentioned my weight being an issue and they say my bmi is about 30.7 right now which is just over on the obese side.  My first RE also never mentioned my weight. 

[pooh8402]

Regarding keto diet, it's just plain good for fertility and IVF, regardless of patient weight. My RE put me on a strict diet (basically paleo/keto) even though I was at a healthy BMI. I started about 6 weeks prior to retrieval and had excellent quality embryos. She's done a LOT of original research on diet and fertility, and is published.