Special considerations in assisted reproductive technology for patients with obesity

Obesity rates are increasing, and patients with obesity may disproportionately seek fertility preservation and fertility treatment because of a higher risk of related disease. At the same time, in vitro fertilization centers across the United States are increasingly setting body mass index (BMI) cutoffs above which treatment will not be provided. Patients experience these limits as another example of stigma in healthcare as well as an access challenge, exacerbating the distress of infertility. A healthy lifestyle in the long term should be the focus rather than an arbitrary BMI, which is a flawed measure of health. Tailoring in vitro fertilization treatment to patients with larger bodies, including patient-specific medication dosing, approach to oocyte retrieval, and anesthesia support for optimal safety, has demonstrated equal success and complication rates to patients who fall under typical BMI cutoffs. Many infertility treatment programs can and should access the resources needed to safely and effectively treat patients across the full range of BMIs.