6
votes
The medical ethics of fertility clinics refusing to treat prospective mothers they consider too large
Link information
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- Title
- When You're Told You're Too Fat to Get Pregnant
- Published
- Jun 18 2019
- Word count
- 4924 words
When it comes to people wanting to be pregnant, I'm far more concerned with outcomes for the child than outcomes for the mother, tbh. One can consent, one can't.
Now that does hit the woman harder than the man (nobody is going to ask Dad if he smokes or drinks before they freeze his tadpoles) - and that sucks, but I still can't be against gatekeeping fertility treatments based on what is likely to increase the risk of disability or other issues for the child.
Of course, that opinion would mean nobody gets IVF in the first place, ever... so it's rare that someone agrees with me. We're coming up on 8 billion people though, I'd like to see adoption take over from IVF wherever possible.
This article is so weird.
i) If you have a BMI of 50+ you're not going to lose weight by diet and exercise. You need a gastric bypass (not gastric banding). I'd agree that this surgery is too difficult to access, and that the moralising around weight doesn't help people lose weight.
ii) An obese mother poses a significant risk of a macrosomal child. People always talk about needing to "eat for two" when a woman is pregnant, but that's nonsense. A woman needs only about 200 extra calories a day. Being overweight is more risky than being underweight. A macrosomal baby has significant risks to itself but also to the mother.
iii) HAES is bullshit. It's bullshit because people use it to deny the increased risks that obesity and morbid obesity and super obesity bring. They'll complain about musculo-skeletal pain, but refuse to lose weight or exercise. The best treatment we have for musculo-skeletal pain that we have, no matter what size you are, is exercise.
iv) We know weight does have a significant impact on fertility, but it also has wide ranging impacts on other aspects of health. It's important to rule out this factor (and also greatly improve the health of the patient) before trying other methods that carry risks.
Two women i work with got pregnant. Both in a good weight and were young. One was fit and did exercise, the other did not, but didn't eat a lot so she was at a healthy weight (but she has a side job making cakes, sweets and other things).
As soon as they got pregnant, the one that did not exercised just exploded in size. It was another person really. And she kept saying that she needed to eat for two. Totally ignoring the other one that just grew a pregnancy belly, had the baby and stayed absolutely the same. It was weird to see, she didn't grew an inch. Of course the fact that she was fit and did exercise means that she was more healthy-conscious.
The one that became obese stayed that way for years after the pregnancy. She lost now, but she lives in a battle. Gaining, losing, gaining, losing. The habit is hard to lose.
I have no specific knowledge in the field, but this surprised me simply because of an article I read the other week suggesting that pregnancy is at the upper limit of human endurance (I actually thought I saw it here on Tildes but I can't seem to find it with search). Am I misunderstanding something fundamental here?
While I understand that the article can't present complete medical histories, it doesn't mention polycystic ovarian syndrome, which may be a precursor to both obesity and infertility.
There's potential to treat the condition by improving insulin response with metformin and other drugs, or blocking androgens. The problem is, doctors in general see women after they've gained the weight, and assume that obesity caused PCOS, so losing weight will solve the problem.
Leaving aside the fact that untreated PCOS makes it very difficult to lose weight, failing to provide compassionate care and adequate diagnostic investigation is inexcusable regardless of the cause of the obesity.
I say this as someone who's weighed anywhere from 40 - 110 kg (BMI 15 - 43) as an adult woman - the difference in quality of medical care for underweight-to-normal versus overweight-to-obese is astonishing.
Would anyone be willing to copy the text? I got paywalled
FYI, the New York Times paywall is fairly soft - you can generally just open the articles in a private window and they'll be fine.
Not anymore :(
They detect if you're using incognito mode and tell you to turn it off.
Perhaps it's geographical, or even some more granular restriction, in that case - I'm paywalled in non-private on desktop, can view fine in private Chrome/Firefox windows, and fully viewable in both normal and private Chrome windows on my phone.
You probably shouldn't post whole articles in comments like this, the length isn't a problem but there's a copyright concern with essentially rehosting content without permission, especially with tildes being publicly visible now.
Good point. I’ll avoid doing it in the future and leave the fate of my earlier comment to @Deimos’s discretion
Yeah, please don't do that (and I removed it). Paywalls are annoying, but we can't just copy their writing onto a different site.
Got it, and I totally understand. Won't do it again.