Beyond the scale: navigating BMI, IVF candidacy, and retrieval settings through provider perspectives

Area of Science:

• Reproductive Endocrinology
• Infertility Treatment
• Obesity Medicine

Background:

• Body Mass Index (BMI) is a significant factor in reproductive health.
• In vitro fertilization (IVF) protocols often consider patient BMI.
• Provider-level variations in BMI management within IVF exist.

Purpose of the Study:

• To investigate provider-level differences in the application of Body Mass Index (BMI) criteria for in vitro fertilization (IVF).
• To understand the reasons behind patient exclusion based on BMI or comorbidities in IVF practices.

Main Methods:

• A cross-sectional electronic survey was distributed to members of the Society of Reproductive Endocrinology and Infertility.
• Descriptive statistics and Fisher's exact tests were employed for data analysis.
• The survey targeted 827 members, receiving 187 responses (22% response rate).

Main Results:

• Eighty-four percent of responding practices excluded at least one patient due to BMI or comorbidity in the past year.
• Eighty-six percent of providers utilize BMI cutoffs, most commonly ≥40, primarily due to anesthesia concerns.
• Only 11% of providers perform hospital retrievals; barriers include lack of mobile embryology labs, patient cost, and scheduling.

Conclusions:

• A majority of surveyed reproductive endocrinologists (REIs) exclude patients based on BMI or comorbidities, often linked to surgical/anesthetic considerations.
• Hospital retrievals are uncommon, but outpatient procedures for women with BMI ≥40 are deemed safe.
• The study advocates against universal BMI cutoffs, recommending streamlined referrals and further research into weight management and IVF cost-effectiveness.