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BMI Limit for IUI and IVF at AART


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#1 AvoidAARTClinic

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Posted 07 March 2018 - 08:35 AM

I just wanted the community to know that there is a new policy at AART that will deny IUI or IVF treatments to any woman that is above a certain BMI limit. 

 

If you are experiencing delays "moving forward" with physicians that are insisting on waiting another 6 months to try naturally, or with Clomid, or with metformin, the issue could be that AART may not treat you at your current BMI. It might be worthwhile asking your physician at your next appointment. I wasted too much time trusting AART would be straight with me and this was not the case. 



#2 mouse

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Posted 07 March 2018 - 09:11 AM

Hi, so sorry that happened to you.  Unfortunately that is not all that unusual at lots of clinics out there, many have cuts offs at either end of the BMI spectrum.  One would hope that, as they are when they have age limits, the clinic staff is up front with that policy though and not string people along. It's certainly something to check when starting a clinic search.

 

Fingers crossed for you!


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#3 Dalmareliz

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Posted 08 March 2018 - 10:01 PM

I am so sorry that happened, and most especially that they weren't forthcoming with you.  What is their BMI threshold? Do you know?

 

It is one of the most devastating things to hear (in my experience) that they won't perform IVF based on your weight/BMI.  When my clinic told me this at the beginning of 2016 I was so upset.  In fact I also was in disbelief.  How could that be? Why wouldn't they do it? Women with weight challenges have babies ALL the time.  I came to find out that it really just come down to data.  Statistically the likelihood of successful IVF over a certain BMI is just very low.  All clinics wants their stats of success to be good and they know that they are setting you and them up for likely failure if they do IVF at a certain BMI.  In addition the college of physicians also has a regulatory threshold that anesthetic cannot be used on people above a certain BMI and egg retrieval requires that anesthetic. 

 

One of the main reasons I am sharing this is because when I was first "rejected" due to my BMI I absolutely felt not only horrible but in such shock.  I thought we needed a second opinion ASAP this was ridiculous.  The more I came to learn the more I came to realize its really just facts not opinion or willingness.  Especially for women paying for IVF out of pocket, in a way the clinic would be doing a disservice by going ahead with such a low rate of return/success.   


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#4 AvoidAARTClinic

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Posted 09 March 2018 - 06:42 AM

Hey Dalmareliz. Thanks for the support and understanding. I'm sorry that you were denied access to care. I was also devastated and I immediately sought a second opinion. The second opinion was actually the one that provided me with this information, while I went and sought out the links on my own. 

 

BMI and IVF Outcomes:

 

I just wanted to bring up that the idea that IUI or IVF is less effective at higher BMI's is considered "old" medicine. Recent medicine dictates that this is in fact little correlation between the effectiveness of IVF and BMI, where effectiveness is measured as a fetal heartbeat. This can be seen in many studies, only a few which are outlined below:

 

*  https://www.ncbi.nlm...les/PMC3017329/ (2010) with the conclusion stating:  Increase in body mass index in women does not appear to have an adverse effect on IVF outcome. However, preconceptual counselling for obese women is a must as weight reduction helps in reducing pregnancy-related complications.

 

https://www.ncbi.nlm...les/PMC5405646/ (2017) with the conclusion stating:  This study showed marginal/no effect of BMI on oocyte quality/endometrial receptivity and, subsequently, on the pregnancy outcome. However, well-designed, larger prospective studies are needed to clarify the role of BMI in pregnancy outcome in women undergoing IVF/ICSI.

 

https://www.ncbi.nlm...les/PMC4922730/ (2016) with the conclusion stating:  The present study evaluated obesity and clinical pregnancy rates in IVF cycles in PCOS patients according to age groups, and particularly in the obese group, the clinical pregnancy rates were observed to be lower in the age group ≥35 years than in the other BMI groups; however, this difference was found to be statistically insignificant.

 

http://o.canada.com/...normal-weight-2 Halifax clinic in this actual in 2010 also stated that: " that there may be insufficient justification for placing these arbitrary BMI restrictions on IVF treatment access.” The major shift in focus for AART after 2014 and 2016 when this policy was enacted was a change in Medical Directorship. 

 

BMI and Complications due to anesthesia:

 

The College of Physicians in each province don't dictate a BMI cutoff but warn of complications in higher BMI individuals. However, these complications are significantly less given the group of anesthesia that is used during egg retrieval. It is often used just in the Emergency Room actually to drain cysts. There are also other diseases that cause similar complications during anesthesia that are still being treated at fertility clinics, including patients who smoke, have frequent seizures, and diabetes. 

 

___________________________________________________________________

 

For natural conception, BMI is highly correlated to success. For miscarriage, BMI over 30 is correlated to higher chances of miscarriage. But for the actual effectiveness of IVF, there is little statistical, peer-reviewed, recent research that shows that BMI has a correlated effect on negative IVF outcomes. FOr the actual complications of anesthesia, other similarly risky diseases are treated while obesity is not. 

 

Now there are other reasons why clinics deny treatment based on BMI, and those reasons may or may not be reasonable or scientifically proven. However, the idea that clinics are "saving" patients from losing money due to the effectiveness of IVF is not statistically or scientifically proven.  

 

I don't want to come off as angry, I'm really not. I just think that people should know and be able to double check what physicians tell them. When I got my second opinion my new RE was the one that provided me with this information (including some of the links). This makes me believe that the idea of BMI being a universal issue in access fertility care seems to be clinic specific and very controversial



#5 mouse

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Posted 09 March 2018 - 08:52 AM

Everyone should most certainly do their due diligence in researching clinics before choosing one - we've all got challenges of one sort or another or we wouldn't be seeking ART in the first place.  That said,clinics that don't work with certain challenges may be playing to their strengths and there's nothing wrong with that.  I had consults and a couple of unsuccessful cycles (IUI and IVF) at several clinics in 3 countries before finding an RE that was not only open to, but liked the challenges my particular case brought.  I firmly believe his motivation and commitment were instrumental in our finding the right egg/sperm/cycle combo that brought success.   


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#6 AvoidAARTClinic

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Posted 09 March 2018 - 09:52 AM

~Mouse, I completely respect your opinion about:

 

>That said, clinics that don't work with certain challenges may be playing to their strengths and there's nothing wrong with that.

 

I just happen to disagree. I think that access to health care is paramount in healthy populations, and those healthy populations are directly linked to growing economies, more innovation, etc... It' s also why I believe in universal funding for fertility -- everyone deserves equal access to care.

 

I am very happy that you were able to find a great RE that would treat your particular scenario. That gives me hope that I will eventually find my RE that will treat my particular scenario.  



#7 mouse

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Posted 09 March 2018 - 12:28 PM

I get it but I also recognize that not everyone is equally good at (or interested in) everything and not every clinic is going to be equally good at addressing specific diagnoses or challenges. Some clinics are very much into alternative/adjunct therapy including supplements while others are not. Some REs support immunological testing and therapy, others think it's a load of hocus pocus. I think that's okay because a "one size fits all" approach is going to leave a lot of us out whereas playing to their strengths may allow REs and clinics to find a niche and permit us to find the sort of specialized approach we need.

 

Fingers crossed for you.


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#8 CdnHockeyGal

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Posted 09 March 2018 - 01:35 PM

Hi Ladies,

 

A gentle reminder of our Community Guidelines re Section C, Point 6 that we must avoid making statements which are unproven and potentially defamatory towards any person or entity.

 

https://ivf.ca/forums...tion=boardrules


In IVF there is a range of outcome and experience at any clinic and with any patient. We can absolutely feel free to say that we didn't have a positive experience, that you don't feel care is patient centric or you feel the institution should be more proactive in informing patients of policies and procedures. Statements that are not in keeping with Section C, point 6 will likely be moderated.

 

I've hidden a post but have pasted below the vast majority of the original post to continue the discussion above:

 

That makes sense for sure. The difference I think is choice: in your model, a patient would have the choice of care that is not best optimized for them or to refer to a clinic that was better optimized to a patient's scenario. This would allow people to have access to care while still providing personalized medicine. I 100% agree. 

 

 

Since obesity in Canada is designated as a chronic illness, this situation is similar to telling a person with seizures that they must stop having seizures before they can access care, because anesthesia causes complications in patients that suffer from seizures. However, this scenario does not happen. This denial of treatment is *only* applicable to high BMI patients.


It was long, awful & hard. We got very lucky and didn't run out of both emotional and financial resources. We saw some of the most beautiful of people in our lowest moments. Baby Girl arrived Apr 10/2018

#9 AvoidAARTClinic

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Posted 09 March 2018 - 01:40 PM

Hello,

 

Since many of my comments are being removed, I decided to include the factual list of events that happened to me. This has no opinions and is 100% my clinical case.

 

People can draw their own conclusions:

 

  • No Semen Analysis was ordered from Jan 2016 to October 2017 even though I told my physician, my husband and I could afford it and wanted all tests that would provide a better treatment plan. My doctor told me to keep losing weight and didn't prescribe any further treatments, like Clomid, or perform a Semen Analysis or internal ultrasound. 

  • A Semen Analysis was only ordered once I strongly insisted for it to be ordered. 

  • The SA discovered severe MFI. We were immediately referred to IVF + ICSI.

  • I was under the care of my RE from Jan 2016 to Oct 2017 without an SA trying to naturally conceive. 

  • It is impossible for my husband and I to conceive in any manner besides with IVF + ICSI

  • I was referred to a specialist, that was not related to fertility, by my RE. While I was with the referral physician, and informing him that I was there to get treatment to reach a BMI that would permit me to receive IVF from AART, he read aloud to me the reason for referral included by my doctor. It stated in the referral that I wanted this consultation in order to be at my healthiest weight before becoming pregnant. The referral did not mention that I was referred to lose weight to meet the BMI policy from AART, or that I would choose, if possible, to undergo fertility treatments at any weight at AART.   

  • There is a limited number of circumstances that I would consent to receive treatment at AART (Atlantic Assisted Reproduction Therapies), as I no longer had trust in the professionalism or integrity of the physicians on staff.



#10 CdnHockeyGal

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Posted 09 March 2018 - 01:46 PM

Hi Ladies,

 

This thread is becoming a little heated and I think it's always wise to take a step back and process before determining next steps.  In that vein I am temporarily hiding this thread for further discussion among the moderating team.  Once the team has had an opportunity to review we will either return the thread back to visible or edit and return to visibility.

 

Thank you!

 

CHG


It was long, awful & hard. We got very lucky and didn't run out of both emotional and financial resources. We saw some of the most beautiful of people in our lowest moments. Baby Girl arrived Apr 10/2018