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

Abstract

Purpose: To identify provider-level differences in the role of body mass index (BMI) in in vitro fertilization (IVF).

Methods: A cross-sectional survey was distributed electronically to Society of Reproductive Endocrinology and Infertility members (n = 827). Analysis implemented descriptive statistics and Fisher's exact tests.

Results: One hundred eighty-seven responses were received from practices across the USA (22% response rate). Eighty-four percent of responders turned away at least one patient, in the past year, due to either BMI (82%) or a medical comorbidity other than obesity (68%). Eighty-six percent of respondents implement a cutoff. Implementation of cutoffs did not differ significantly by practice setting or geographic region. The most common reported BMI cutoff was ≥ 40. 95% cited anesthesia requirements as the primary reason for cutoffs. Only 11% of respondents perform hospital retrievals, where all 20 providers were academically affiliated. Those not performing retrievals cited lack of access to a mobile embryology lab (60%), patient cost (39%), and scheduling difficulties (55%) as common barriers.

Conclusions: Most surveyed REIs said they had excluded a patient due to BMI or a medical comorbidity in the past year, likely due to surgical and anesthetic concerns. Very few providers have access to hospital retrievals, but even outpatient retrievals for women with BMI ≥ 40 are considered safe. We agree with avoidance of a universal BMI cutoff; rather, we advocate for streamlined referral systems for otherwise excluded women, and further work in weight loss management interventions and cost effectiveness of IVF.