Episode 5: Myth: Fertility treatment isn’t for fat folks
Episode Summary:
In this episode of Fat and Fertile, we explore the ideas that fertility treatment is more risky and less effective for fat folks.
We dive into where these ideas come from, why they are rooted in anti-fat bias and how you can use the research to advocate for your care.
What to Expect from the Podcast
Looking at anti-fat bias in healthcare, noting that IVF procedures were originally tested on smaller bodies. Addressing safety concerns, particularly around anesthesia risks, citing studies that show no increased risk for those with the highest BMI. Importance of informed consent and advocating for ourselves.
Highlights
Challenges in Accessing Fertility Treatment for Fat Folks
Efficacy of IVF for Fat Folks
Anti-Fat Bias in Healthcare
Safety Concerns and Anesthesia Risks
Other Potential Risks and Evidence
Links and Resources
Nicola’s book, Fat and Fertile
Get Involved
Nicola would love to hear from you! If this episode resonates, share your story, ask a question, or leave a review.
Support the Podcast
If you’re enjoying Fat and Fertile, please share this episode on social or leave a review! Every share helps make this info more accessible to everyone who needs it.
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Hey, my lovely Welcome to fat and fertile the podcast. I'm Nicola salmon, fat positive fertility coach and author of The look fat and fertile. I'm obsessed with helping folks navigate getting pregnant in an anti fat world. On this podcast, we'll explore the complexities that fat folks face when you want to grow your family. If you want to support this podcast, I would love for you to share it on social media or leave me a review on your podcast app. And if you're looking for fertility support without a side of shame, and I would love to chat with you about how we can work together. Check out the link in the show notes for more information. Are you ready? Let's dive in.
Hey, loves, welcome back to fat and fertile the podcast. It's been a little while since I recorded the last episode because I've had one bug after another in our house, and I am not yet a podcast pro who has all their episodes recorded months in advance. So apologies for the lack of episodes, but I'm super excited to chat with you today, and we're going to be talking all about the myths around fertility treatment for fat folks, mainly because it can be so bloody difficult for folks to access fertility treatment when they need it. It's really important that we recognize that folks of all different types of bodies might need to access fertility treatment. It's far from the case that all fat folks need IVF, but it is the case that it is a lot more difficult for fat folks to access IVF, and that is a huge problem. One of the main reasons why many clinics deny access to IVF and other fertility treatments is that they deem it too risky to do on fat people, and they also claim that it is not as effective. So we're going to explore both of these topics, and I hope that once you've had a listen to this episode, you'll have a clearer idea, both for your benefit and to help you advocate with a clinic. So first of all, let's explore the big question, why? Why on earth are fat folks told that IVF is more risky and not as effective for them? Let's start with efficacy, or how well IVF will work for folks in bigger bodies. Now there's a big divide within the research around IVF for folks with higher weights. In the first camp of research, what we have is we have studies that show that as BMI increases, the likelihood that IVF at other fertility treatments will work decreases in these studies, everyone is given the exact same medicine at the exact same time, and this is really great in a study, because we are kind of reducing the variables of things that are different for each person, and we treat the population of people in exactly the same way. And when we do that, IVF and other facility, treatments are less effective for fat folks. But when we look at the second camp of researchers who treat the subjects of their studies as individuals, we see something different happening. What happens then is that they can modify the treatment protocol based on how the patient is responding. The results of this is that generally, but not for everyone, fat folks just need higher doses of medication, and when they're given those doses, then the outcome of the treatment is the same regardless of your BMI. So it's really important to highlight that point. If you are given a personalized dose of medication, whether that's IVF drugs, whether that's ovulation induction medications like letrozole or Clomid, if that is personalized and tailored to your body, depending on how you are responding, then the outcome is the same. IVF procedures and protocols were created and tested on smaller bodies. They are taught to doctors and surgeons using smaller bodies as the norm. So it makes total sense that when we treat fat people in the same way as thinner folks and expect them to respond in the same way, that we don't get the same result, that it appears to be an outlier, because not all. Bodies respond in the same way, and it's not your body's fault that it may respond differently through treatment to what your doctor expects. What's at play here is the anti fat bias that is built into our healthcare system. IVF procedures and all other healthcare procedures should be created and tested on bodies of all shapes and sizes. Doctors, as they are going through their clinical residencies and learning should be learning on all sized bodies. It is not your fault that that's not what happens right now. It's the anti bias that is built into our healthcare system, and it's not inherently a bad thing that your body may need higher doses of medication in order to achieve the same results. We accept. This is a totally normal practice in children's medicine, that we need to give a higher dose of medication based on weight. So why isn't this a normal practice in healthcare? It's really important to put the blame of what is going on here where the blame needs to sit, and that is with the systems of healthcare that don't take into account what your body might need and how your body might respond in a given treatment. Okay, so now let's talk about safety. In order to be able to fully consent to any kind of medical treatment, you need to be aware of the risks and the benefits to you, and you need to be able to weigh those up so you can make a fully informed decision. So let's explore what those risks really are so that you can decide if treatment is an option that you might want to pursue. The main risk given as to why fat people can't have IVF is a potential risk with anesthesia, and anesthesia is the medicine that's given to put you to sleep during a surgery or a particular, particularly painful procedure, in this case, so clinics claim that the risk of complication is too great When they give fat folks anesthesia, and this is especially true for standalone clinics that aren't attached to a hospital. So if a clinic is attached to a hospital, often, they could be a little bit more lenient, as they have other doctors and surgeons and people who could help potentially in an emergency. But when we look at the research around this, the problem is that the main study that looks at BMI and complications, and there aren't many of them during an egg retrieval, which is the part of the procedure in IVs that requires you to have an anesthesia, shows that there's absolutely no increased risk of Any major complications for folks in the very highest BMI category, and there's only a slight increase in minor complications. I'm going to link to the study in the show notes if you want to print it out and take it with you when you're advocating for care. This could be especially useful if this is the reason why a clinic or a doctor is saying that you can't access IVF or a different fertility treatment. A much bigger study that looked at egg retrieval and looked at all different types of bodies showed that the things that impacted the outcome the most is surgery time and surgeon competency. And those make total sense. The way that fat folks are excluded from the development of fertility treatments can explain some of why treatments seem to be less safe. After all, if you're not taught how to perform treatments on bigger bodies, and you never practice on bigger bodies, you're going to be less confident and less competent. Clinics routinely exclude fat folks, so the majority of doctors never learn how to safely perform these procedures on fat people. The most ridiculous thing about this, though, is that in the same breath of denying you treatment based on anesthetic, risk is that they'll recommend weight loss surgery which was cut, which requires the exact same anesthetic. So there are a few other risks that you might hear talked about when people talk about the risk of going through fertility treatment, something called Oh HSS or ovarian hyper stimulation Shock Syndrome,
is something that's commonly talked about, especially for folks with PCOS, but it's actually been shown to occur less often. In fact, folks when compared to folks in small. Bodies. Ectopic pregnancy is another one, but there's no evidence to show that this occurs at higher rates in fat folks. And finally, something else that I've seen people talk about, and I've had clients that have shared that this is a reason why their doctors have denied them care is around blood clots. And again, there is absolutely no evidence to show that this is more likely to occur in fat people as they navigate fertility treatment. The way that clinics refuse care for fat folks takes away their ability to make an informed decision about their health care, and it's absolutely not acceptable. You deserve to be able to make the decision around whether any potential risks are worth the benefit of growing your family. That is what patient centered care is, and right now, so many fat folks are denied the right to make the decisions around their own healthcare, and it's absolutely really important that you are fully aware of all the risks when you undergo any type of medical procedure. But when we look at the evidence for fertility treatment, there is nothing substantial that shows that fertility treatment is inherently more risky for fat people, and that they should therefore be denied them. On this basis, you deserve access to the same fertility treatments as anyone else. The two other main reasons that you might be denied fertility treatments are around pregnancy risk, which we're going to look at in a future episode, and that weight loss is effective, which we already covered in episode two. So if you haven't listened to that one, go ahead and have a listen to episode two. If you are struggling to find a clinic to support you. I've got an ever growing list on my website of clinics that other fat folks have recommended. It's a really good place to get started. And if you can't find a clinic for your country, for your state, just let me know. And I'm happy to put a shout out on my Instagram account at Fat positive fertility in my stories. So the more that we can find these clinics that will support fat folks, and there are lots out there, the better. If you want more information on this topic alongside a complete research resource, then I recommend enrolling in my IVF and IUI for fat folks workshop, and I'll share the link in the show notes. See you next time.
Thank you so much for joining me today on fat and fertile. I'm currently welcoming folks to work together, one to one with me, either weekly over 12 weeks, or there's a one off consultation. These coaching sessions are great for folks who want guidance on how to navigate getting pregnant as a fat person, need support in advocating for themselves around fertility, and want someone on their side who absolutely believes in their body's ability to get pregnant. Check out the link in the show notes for more information and to book a free consult. Call with me. See you next time, bye.
Get Involved: Nicola would love to hear from you! If this episode resonates, share your story, ask a question, or leave a review. You can also join the Fat and Fertile Alliance - a friendly space to connect with others on similar paths.
Support the Podcast: If you’re enjoying Fat and Fertile, please share this episode on social or leave a review! Every share helps make this info more accessible to everyone who needs it.
Apologies for any typos - transcribed byhttps://otter.ai - it can make mistakes! If you need clarification on anything - please get in touch!