August 31, 2006

Obesity and IVF: what do you think?

Writing about web page http://news.bbc.co.uk/1/hi/health/5296200.stm

Yesterday the British Fertlity Society announced recommendations for all seriously obese and underweight women to be refused IVF on the NHS, something that some Primary Care Trusts already practise, in an attempt to homogenise the availability of treatment throughout the country.

Why is it that obese women are being refused IVF? A representative from the BFS has cited a reduced chance of falling pregnant and an increase in complications during the pregnancy itself. Why, then, are women smokers allowed IVF so freely? According to one news report yesterday smokers do have an equal chance of falling pregnant as completely healthy women, but the increased chance of complications is significant. If the mother has a medical condition that causes or at least exacerbates her obesity should she be treated any differently? Should we merely consider the probability of conception or also bear in mind the long-term health of the mother and child?

Or is this starting to infringe on our civil liberties?

The BFS also recommended that single women and same sex couples should be given the same priority as heterosexual couples.

Some PCTs are reported to take into account social factors when deciding if IVF is permitted, including whether either parent has already had children from a previous relationship and whether they have undergone IVF privately before turning to the NHS. Should these factors be taken into account? What if the couple have already had children together and want more?

Should the NHS fund IVF at all? Is having children a right? Is it equal to the right to life-saving treatment of injuries and diseases, bearing in mind that the money for all treatments comes from the same budget, and that the NHS has been beleaguered with many much-publicised financial strains? Or is it a luxury that the parents themselves should fund? Or do you agree with Dr Gillian Lockwood of the BFS ethics committee, that “the fourth richest country on earth should be able to afford effective fertility care for its citizens”.

What do you think?


- 26 comments by 2 or more people Not publicly viewable

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  1. Bosa

    Should the NHS fund IVF at all?

    To the extent that the NHS is here to remedy and help overcome significant physical faults, I don’t see why IVF shouldn’t be provided. We can argue over over/under population but in my mind the inability to reproduce is a significant infirmity given that much of our body has evolved for just that purpose. There are clear hierarchies of need but to ignore non-life threatening problems seems perverse. People can function without toes, fingers and whole limbs, yet money is spent on prosthetics and joint/limb reattachment. Bipolar disorders, schizophrenia and other mental maladies may not be life threatening bit wouldn’t it be extreme to end the provision of counseling and drugs? Fertility treatment is expensive so it’s not feasible to give prospective patients free reign over the NHS budget. Still, something should be available.

    31 Aug 2006, 15:10

  2. Lee Davis

    I’m always a little dubious about the benefits of IVF, Often there is a good reason why reproduction is difficult, if it is genetic then all we are actually doing is producing more people who are likely to have difficulty reproducing naturally.
    Of course there is the problem that these days it is stupid people who tend to reproduce more, whereas intelligent, educated people are more likely to concentrate on getting a career etc before having children.

    I think having children is a choice for the individuals, however the costs associated with that choice should be down to the individuals not the state.

    31 Aug 2006, 15:14

  3. I may comment about this in more detail when I have more time, but I would like to put here what I said in my text to BBC News the other day (summarised)

    – I think people should concentrate more on raising the profile of adoption rather than concentrating on IVF. There are hundreds of thousands of children who don’t have parents, and if you can’t conceive naturally, I believe consideration should automatically be given to adoption. I think it would be rather selfish not to consider this as an option.

    xx

    31 Aug 2006, 16:11

  4. The NHS was based upon the same principles as an insurance provider (and on the idea of the failings of the free market, but lets ignore that). It wasn’t based upon any such principles of natural rights (indeed principles of natural rights and that government ‘stealing’ our money is the biggest factor working against the NHS). Nor was it based upon any such quasi-religious/nationalistic principles of what our nation ‘should be like’, this is just sentimentality for people who do not have the responsibility for actually working out details in NHS policy.

    Treating an obese person is revealed to be more expensive then treating a normal sized person. Plus there is less of a risk of one becoming obese (one choices to become obese, and even then it takes years of hard work to finally achieve the distinction of an ‘obese person). Consequentially the cost of providing free IVF treatment to obese people is higher and the expected benefit is lower then it is for normal sized people. This society obviously thinks that as a consequence it’s socially profitable to provide this service to normally sized people but not to obese people, and so they think a distinction needs to be made. Unaware of the figures I couldn’t make any firm opinion on the matter, but it sounds like they are probabally right.

    05 Sep 2006, 15:17

  5. James

    I have always thought it ironic that we are very careful about who we allow to own cars and firearms but having children is permitted to all. Of course I’m being flippant; the state can remove children at risk but that still leaves much scope for unsuitable parents who fall short of posing an actual physical threat.

    Fertility treatment, pace Dr Lockwood, will always be a limited resource (she’s wrong about fourth richest, but never mind). If you have a limited resource you have to discriminate. Grounds of race, martial status and, now, sexuality are out, thanks to the all pervasive human rights culture we have. There are two grounds that seem to me to be still in. The first is the prior question of the phsyical suitability of the patient, namely are they healthy enough to conceive in the first place and carry a child if they do, and secondly considerations of their ability to be a parent. The former is a question for medical experts, and if it is the case that obese people are far less likely to have a successful round of treatment (and also if they were less likely to be able to carry a child full term, though I don’t think that’s much of an issue), then I don’t see the objection to discrminating against them in the provision of IVF.

    The second question, that of parental suitability, is much more difficult, and you would wonder how an IVF clinic would be able to form a view on any prospective parent’s abilities. Still, if someone had a raft of criminal convictions (there was a case about this before the European Court a while ago, which didn’t like the UK’s rules against serving prisoners being denied IVF) I have no problem in them being denied IVF.

    06 Sep 2006, 15:18

  6. Boris

    I’m with James, I think that you should have to pass a test before you’re allowed to have children. I have three kids and believe me it is the hardest thing you will ever undertake with the least training. For a start you will spend at least their first year seriously sleep deprived – they use that as a form of torture in some countries! It goes without saying of course that it is also one of the most rewarding things you can ever do.

    However (steps onto soap box) you have to invest the time in children often to the sacrifice of anything you want to do. Amongst our kids peers I see some terribly badly behaved kids, where parents have not invested the time. Know doubt will get shot down in flames not but my personal view is that one of the problems is too many single parent families. I’m sure the majority of single mums (as it generally is) are doing a great job but I think kids need a male role model as well in the first 5 years of life, that’s when they learn their behaviour and perception of what is right and wrong. Going hand in hand with this of course is the current benefits systems which seems to favour the “get knocked up and get more benefits” approach. I speak as one who has recently had a year unemployed and spent more time in Benefits offices than I wanted to.

    Dons metal helmet and awaits flack

    06 Sep 2006, 16:19

  7. James

    Funnily enough I posted a guest column on my blog today by a friend with views almost as forthright on the subject of parenting as those of Boris. She takes Steve Irwin to task for performing risky activities when he has two young children; they of course now being fatherless thanks to his ultimately unwise decision to mix with dangerous creatures.

    06 Sep 2006, 17:25

  8. I don’t think anyone has a “right” to have children; surely it’s the case in any species that not every one of them reproduces, only that enough do to (barring other factors) avoid extinction? I don’t really see why humans should be considered different. If you want to have kids and are biologically capable of doing so, go ahead. If not, hard luck – put up with it, or, as Lorna suggests, consider adoption.

    06 Sep 2006, 20:15

  9. I have loads of random thoughts on this subject, so here goes… I agree with Boris, having seen way too many children whose parents don’t invest enough time in their children and it’s really sad. The benefits system here bugs me. I’d be better off if I was unmarried and didn’t live with my husband, but anyway…. as it is I’m seriously considering being a stay at home mum, to make sure I can have enough of a positive influence in my son’s life rather than letting him be brought up by strangers at a nursery and also because nearly seven eighths of my measly salary would go on childcare.

    On the subject of fertility treatment, it is a tricky one. In many ways I think you only understand how hard it is once you’ve been there. Wanting to conceive and being unable to is completely heartbreaking and can put an alarming amount of emotional strain on the couple in question. I myself had to have fertility drugs to kick-start ovulation. Granted, I didn’t have IVF, which is a lot more expensive, but we were discussing that as the next step. I think parental suitability assessments (much like the ones done for parents wishing to adopt) should be carried out if people wish to have IVF on the NHS. Though it’s true that obesity does hinder the chances of success, so obviously weight loss should be encouraged before IVF is done. The fact that they will allow smokers to have IVF is beyond me though!

    07 Sep 2006, 09:16

  10. Boris

    I’ve been thinking about this a bit more overnight. On balance I think that couples (in the traditional sense) who want to have children should be assisted where possible, on the basis that if they want them and are an established couple they are more likely to prove good parents. I don’t think that IVF should be provided to same sex couples or single parents on the basis that I think that raising children needs a mum and dad.

    Its very easy for me to say tough luck if you can’t have kids, as I have kids, but a close friend can’t and I’ve seen the problems as a result. Unfortunately resulting in the couple breaking up. Hence my re-considered view that couples should be allowed IVF.

    As others have pointed out, I would like to see more made of adoption so that perhaps people who want kids can look after those children who aren’t wanted. Although then that starts the whole nature v nuture debate.

    I do have strong views on parenting, nothing shocking I hope perhaps more traditional than many. On the subject of Steve Irwin, I have to get back on my soap box. Another of the problems with many kids today (parents fault) is that they are wrapped in cotton wool and not allowed to take risks, as such they don’t learn to recognise danger and learn their limits. Kids have to fall out of trees, fall of their bikes etc – no family holiday is complete without at least one visit to A&E ;-) Steve Irwin knew the risks and what was acceptable, I’ve no doubt his kids are pretty well adjusted and will follow in his footsteps. What happened by the accounts I have seen was an accident – despite what seems to be PC at the moment accidents happen sometimes and no-one is to blame. That’s why they are called accidents. Should I stop driving to work as it is an unacceptable risk that I will leave my kids without their dad as I die in a car crash?

    07 Sep 2006, 09:33

  11. Well, IVF is wrong of course. It shouldn’t be in place at all, much less state funded, and it should certainly be refused to fat or stupid people.

    07 Sep 2006, 11:28

  12. Michael

    What about bolshie people?

    08 Sep 2006, 08:47

  13. James

    Are the issues regarding IVF for obese people distinct from those concerning old people, such as the 62 year old grannie who managed to give birth thanks to Italian IVF a while ago? There was no great outcry from the BFS ethics committee about the fact that she had to go to Italy for the treatment. It seems to me that the objection would be that she would be physically impaired when carrying and then caring for the child. Such might also be the case for obese people, whose life expectancy at age 40 might be similiar to a non-obese 60 year old.

    Incidentally Sarah I know that you are a Metallica fan, so I’m pleased to be able to say I worked the One video into a blog about the rather startling news about patients in a persistent vegetative state this morning:

    http://cricketandcivilisation.blogspot.com/2006/09/persistent-vegetative-state.html

    Fellow blogger Yank in London has already given me some further info on the the film used in the video. Any further Metallica info or views gratefully received!

    08 Sep 2006, 14:02

  14. mick

    The probability of getting pregnant is significantly reduced if you are either clinically obese or underweight. Given that there is a limited pool of cash in the NHS, why not direct it at those who have the highest chance of benefitting from the treatment?

    10 Sep 2006, 15:49

  15. Hero

    I think (since you arsked) that there is nothing more depressing than watching an irresponsibly fat mother stuffing chips into her irresponsibly fat child.

    It is perfectly acceptable for people to be asked to get rid of colds and flu before operations, to not eat before biopsies, and to get fit before doing things like extreme sports, so to ask a person who is fat to shape up before they have a baby is fine in my opinion – of course there will always be fat rich people who can breed but fat poor people can whistle for it.

    I must admit that I would actually prefer that childbirth was restricted for many reasons – the junkie girl who lives near me who hits her stomach and shouts ‘stop kicking my fucking cunt’ to her baby in the chemists whilst picking up the methadone is a case in point.

    13 Sep 2006, 12:08

  16. michelle

    i have been reading all of your comments and after being a nurse working with children and seeing the joy, warmth and love they give people, i only wish that everybody has the opportunity to have children. why should ‘stupid,’ obese or homosexual couples, and indeed single women be treated any different?? every women has a maternal instinct! if need be, i would definitely have IVF, but would go privately, to avoid people criticising myself for reliance on my employer- the NHS. then again, with reference to the earlier comment regarding adoption, every child deserves a second chance- a warm, loving environment, whether with an obese, homosexual, single parent family- why discriminate??

    16 Oct 2006, 22:52

  17. Lisa Cosham

    I personally have undergone IVF (first cycle funded by the state producing my beautiful 8 year old daughter and five further failed attempts paid for by me at a cost of £3000 per attempt).

    I think the point that a lot of people are missing are the guidelines to which people are offered IVF. I suffered an ectopic pregnancy resulting in an operation to remove both of my falopian tubes thus leaving me totally unable to ever get pregnant naturally again. IVF is offered to people with ‘unexplained’ infertility and probably too soon when really time should result in a pregnancy. IVF should not be considered as a ‘get pregnant quick’ scheme. It is emotionally and physically demanding. I have known several people endure IVF only to get pregnant naturally afterwards. This is a waste of limited funds and gets IVF the bad name as do 62 year olds conceiving through IVF.

    For all those of you who have commented that you don’t agree with giving IVF through the state (mostly men!!) do you also agree that vasectomies should be paid for privately rather than given freely on the state – afterall condoms are far cheaper than surgery?? I do. I am not against having to pay for my IVF treatment but feel that there is a much wider issue of what should be paid for privately – afterall how many of you know people who have had varicose veins removed on the NHS??

    25 Mar 2007, 09:30

  18. suzie

    To the person who made comment number three: If health care was restricted to those who “deserve” it, probably none of us would. How many of us eat a perfect diet? How many of us are teetotal? How many of us avoid smoky pubs because of the health risks? If infertile people should be banned from IVF then perhaps people with other illnesses should be prohibited from obtaining treatment – after all, would they not breed and produce more people with that particular life threatening illness?

    Also, I think that if Sean Kelly was to ask any person with a weight problem, it is unlikely that they would say that they “chose” to be like that. Eating disorders are tragic, resulting in unhappy lives and even death. Most overweight people I know hate being like that and would give their right arms to be “normal”.

    I am tempted to agree that some people should be banned from being parents but that seems a little bit extreme – perhaps we should all be given parenting skills classes.

    01 May 2007, 15:19

  19. Angela

    I am an obese 39 year-old who has endured 3 cycles of IVF and am currently waiting to see if the last cycle has worked. I hasten to add that when I embarked on the IVF route 10 years ago I wasnt overweight – the highly potent drug regime of putting your body into an early menopause then hyperstimulating your ovaries is not a choice you take lightly! Also I am a highly sensitive individual and have reacted to this stressful situation by comfort eating. I am extremely annoyed and hurt by the majority of these comments (mainly by men!) about obese people not being allowed the chance of a much longed for baby. My husband and I have been married for 20 years and have tried to remain “strong” throughout this awful process but it is extremely hard to deal with. I suggest that until you have all the correct information to hand or have dealt with the issues of infertility personally you are NOT at all qualified to comment on such things. YOU HAVE NO IDEA!!!

    12 Jun 2007, 13:46

  20. K

    To Michael Jones – due to an NHS error, my husband’s brain tumour was left untreated for 6 months. Result = infertile before we could have children. Don’t tell me to ‘put up with it’. Use your imagination.Surely no one can judge unless they have been in a situation.

    04 Jul 2007, 16:22

  21. Sarah

    Anyone who pays for IVF should be entitled to it. The NHS should pay for cycles for everyone determined suitable parents. More people should be monitered to ensure they will ptrovide a suityable environment.

    23 Jul 2007, 12:00

  22. Dee

    I have to say that the comments that some people have posted i.e. “if you cant have kids then hard luck” is cold hearted and rude. I am 32 years old, have been in a good stable relationship for 7 years and after years of trying for a baby its looking as though I am unable to :( My boyfriend and I are both working, we own a small flat in London and have always paid our taxes etc. I agree that IVF should be provided on the NHS to those who dont have children already though… its a little unfair to give IVF free when someone already has three children, when some of us would desperately love just the one child. Its easy to say “go and adopt” but we all know that that can take a lot of time and paperwork and isnt an easy process. I just hope (to those of you that think if you cant have kids its just “hard luck to you”) that you are NEVER in a position where you desperately want a child and are in a good position to do so that you cant as then you will realise exactly how heartbreaking it is. I have attempted to save up over the past 10 years and have a little money put aside for IVF treatment, however if the first attempt fails then I am left with no money and will have to turn to family members for help. At least having a choice to use the NHS is there for us, why should only people with more money be able to benefit from this procedure. This is just my opinion though… and to Angela (21.) I sympathise with you and really wish you the best of luck :)

    14 Nov 2007, 10:32

  23. Lela

    To all of you who have been through or are going through IVF – all the best through the ups and downs! I am 26 and overweight and going through IVF. I save up every penny needed to do the procedures, but if I received funding…they shouldn’t reject me just because I am overweight. A woman could be overweight but because, as in my case, my bottom is big…big legs and bum! I get my cycles on time, ovulate and all the things that they say overweight women don’t do…so it is A CASE BY CASE BASIS!

    Like people have commented above, DO NOT COMMENT ON THIS ISSUE IF YOU HAVE NEVER BEEN THROUGH IT BEFORE BECAUSE YOU HAVE NO IDEA! YOUR OPINION, TO ME, IS BOGUS! When you or a family member goes through what some families have to go through to have a child…then you can comment!

    Trying to conceive with IVF and not adopting is far from selfish…having a child is giving 110% of yourself to raise a human being. I may be overweight…but it’s not because I eat bad or “stuff chips down my throat”...so again when you want to make a harsh comment about something you have no clue about…think twice!

    29 Nov 2007, 03:45


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