National Health Care in action.
Ban IVF for the obese, say doctors
KATE FOSTER (kfoster@scotlandonsunday.com)
OBESE women should be automatically barred from NHS fertility treatment until they lose weight, a leading group of Scottish doctors has said.
Any woman with a body mass index (BMI) higher than 30 should be placed on a waiting list until she has dieted to an agreed weight, according to the Scottish Committee of the Royal College of Obstetricians and Gynaecologists.
Women with a BMI of 36 or higher should be banned from even joining the waiting list, it says. The college wants the policy implemented because obesity reduces the chances of conceiving with IVF, and says that providing the £3,000-a-time treatment to overweight patients amounts to squandering NHS resources.
But the college's position was last night denounced as "draconian" by critics, and the Scottish Executive said it had no plans to introduce any such restrictions. The provision of IVF has proved massively controversial in recent years because the decision whether to give treatment is left to the discretion of individual doctors and health boards.
The upper age limit for NHS treatment, waiting times, and the number of procedures allowed, vary widely across Scotland. The Executive recently consulted on the introduction of national guidelines for treatment, in a bid to eradicate this postcode lottery. It has already decided to set a nationwide upper age limit of 40.
The response from the obstetricians and gynaecologists, signed by nine leading consultants, states: "Women with a BMI in excess of 30 must agree to enter an appropriate weight reduction/lifestyle advice programme with an agreed target for weight loss, before their names can be added to NHS waiting lists for treatment. Women with a BMI in excess of 36 should not be treated."
Dr Tony Harrold, a consultant gynaecologist at Ninewells Hospital in Dundee, and a member of the committee, said: "The recommendation is made on the basis of clinical effectiveness because we know that for those with a high BMI, the chance of treatment working is greatly reduced.
"Those with a high BMI could achieve a good pregnancy rate by being appropriately managed. It would be irresponsible of us to know that there is a significant risk to the patient without trying to take appropriate steps to reduce it.
"We can only make this recommendation. It's up to the Executive how they tackle it."
But Richard Fleming, director of the Glasgow Centre for Reproductive Medicine, a private fertility clinic, said he was surprised at the recommendation. He said: "I do feel that having a
cut-off at BMI of 30 is rather draconian. In women with a BMI of more than 35 there are medical reasons related to the risks to the pregnancy and the offspring."
Fleming, who is also an honorary professor of reproductive medicine at Glasgow University, added: "Between BMI 30-35, the evidence is much weaker. There is a slightly reduced pregnancy rate but there are other factors like smoking which are just as damaging.
"However, these patients need more drugs to achieve the same effects, and pregnancies are more problematic, so it does cost more. I suspect this is simply a way of restricting budgetary demands."
Body mass index is a measure of the weight of a person scaled according to height. A BMI of less than 18.5 is considered underweight, while a BMI greater than 25 is considered overweight and above 30 obese.
But its accuracy in relation to an individual's actual levels of body fat is easily distorted by such factors as their fitness level, muscle mass, bone structure, gender, and ethnicity. Some experts say the BMI calculation is too blunt an instrument to use for measuring everyone.
Ken MacEwen, the national fitness co-ordinator for the Scottish Rugby Union, said: "As a general rule of thumb it's OK, but you have to be more specific when it comes to international sport or any medical condition.
"We don't take BMI as an index at all. We use body fat percentage and girth measurements to keep a check on lean body mass.
"As a general guide, if you are using BMI for medical conditions, you would want to be a lot more specific because you can have a lot of inaccuracies. "
Despite the Executive's recommendations, campaigners are gravely concerned the measures will fail to tackle poor provision of fertility services and long waiting lists, because they fall short of recommending any further action.
Sheena Young, spokeswoman for the National Infertility Awareness Campaign said: "Ministers have badly let down people with fertility problems in Scotland. We will continue to campaign for equal access to treatment and acceptable waiting times, and call upon those in power in the next Scottish Parliament to ensure that a fair service is made available throughout Scotland.
"I understand that women with a BMI of over 35 are not acceptable for treatment. However, we would ask doctors to take other lifestyle factors into account alongside weight, such as general fitness, smoking and diet.
"You could have someone with a BMI of over 30 who did not smoke or drink alcohol, and led a healthy lifestyle with regular exercise."
SNP health spokeswoman Shona Robison welcomed the Executive's guidelines and called for an end to the "postcode lottery" of fertility treatment.
A Scottish Executive spokesman said it would issue further guidelines on fertility treatment in the summer.
news.scotsman.com
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