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ss triple helix - autumn 2006,  Obesity and IVF – National guidelines should be fair, evidence-based and in children's best interests

Obesity and IVF – National guidelines should be fair, evidence-based and in children's best interests

The media recently reported that moves were afoot to stop obese women receiving invitro fertility (IVF) on the National Health Service (NHS).[1] The broadsheets were less hysterical but many larger women received the message that the NHS was not going to help them fall pregnant.[2]

Behind the headlines was a report by the British Fertility Society (BFS), recommending that women with a BMI of more than 36 should not receive IVF.[3] Their 2005 survey revealed that, despite NICE recommendations less than ten percent of 37 centres were funding three IVF cycles. Furthermore, individual PCTs had varying social exclusion criteria - including smoking, obesity and existing children. According to lead author Mr Richard Kennedy, the report was an attempt to reduce disparity: 'Having PCTs come up with their own criteria is creating a postcode lottery that is, frankly, unacceptable'.[4]

Other experts have crossed swords with the BFS: Dr Taranissi, holding the UK's highest IVF success rate, took issue with using BMI alone as an exclusion criterion: 'These recommendations do not have a medical basis.They are financially driven'.[5] Ironically though, by deciding on a BMI of 36 as the cut off, these guidelines may actually increase the numbers of larger women obtaining assisted fertility.

Obesity is rapidly increasing and its causes run deeper than a couch potato lifestyle. It's been suggested that maternal obesity preconditions fetal eating preferences, and research is underway.[6] Meanwhile though, of what about the report's recommendations that smokers, lesbians and women with existing children be given the IVF go ahead? Why is the BFS not concerned with the effects of smoking on fetuses and children? Where is the report's review of evidence pointing towards the need for father figures in children's lives? And what about justice for the childless woman with severe polycystic ovarium syndrome, watching her slim second-marriage neighbour going off for IVF?

We take our cue from the Great Physician in being concerned for each individual we come across. Jesus did not discriminate against people because they lived in a poor area or had socially stigmatising health conditions.[7] On the other hand, he was not afraid to give individuals advice that, although in their best interests, was perhaps unwelcome at the time. National IVF guidelines should be fair, evidence-based and in the best interests of the potential children.

  4. Baines E. Should GP 2006; 8 September:14-15
  5. Ibid
  7. Luke 17:11-19
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