Should access to fertility-related services be conditional on body mass index?

Guidelines for the clinical management of obese, reproductive age women with reduced fertility in the USA are limited. Clinical professional organizations have yet to publish practice guidelines on this topic. Thus, treatment decisions are made at the provider and/or clinic level and the variation in clinic policy regarding fertility treatment for obese women is not readily available. Globally, there is an ongoing discussion among reproductive endocrinologists that practice in countries with government-funded health care about whether treatment should be restricted to women under a certain body mass index. Our analysis of a representative US population identified that differences exist in the utilization of fertility-related services according to female body mass. Women with class II/III obesity were the group reporting the highest percentage seeking medical attention to become pregnant, but the lowest percentage receiving medical or surgical fertility-related services, although these differences were not statistically significant. As the prevalence of obesity among women of reproductive age increases both in the USA and abroad, it is critical to consider the medical, social and ethical issues involved in allocating resources for fertility treatment. Ongoing monitoring of trends in service utilization in light of the obesity epidemic and delayed childbearing will provide further insight into this clinical health policy issue.