A version of this article originally appeared in VICE Belgium.
A few years ago I went to a gynecologist for a checkup. That’s when she told me quite suddenly that she could never conceive in her current state, and that’s what she used. This conversation confused me. Mainly because I was very young and hadn’t discussed this topic at all. She hadn’t even run an actual test to identify my fertility level.
The condition she was talking about was my body size, usually referred to with a “plus” prefix. My experience with doctors is by no means uncommon among fat people, as confirmed by the countless messages I receive from followers of fat activist Instagram accounts.
“The OB-GYN forbade me from getting pregnant. She said it was ‘irresponsible’ to do so. did not like to reveal his last name. Another believer, her Gaëlle, was told to be infertile without an examination. “It really destroyed me…and in the end it turned out to be bullshit anyway. Got pregnant on her first try,” she wrote.
Gaëlle’s experience illustrates an unfortunate truth: As an overweight person, it can be difficult to trust a doctor to give helpful medical advice. spend less time with patients, fail to build rapport with patients, and perceive patients more negatively. These prejudices often lead physicians to view obese patients only through the lens of group averages rather than their individual health markers and needs.
UK fat positive fertility coach Nicola Salmon knows this all too well. She was also told when she was 16 that she could not conceive because of polycystic ovary syndrome (PCOS). Polycystic ovary syndrome is a condition that causes irregular periods and is often associated with weight gain and hormonal imbalances. “I was told if I lost weight it would heal, and that was the only treatment I received,” she says. “So I went through that whole cycle of losing weight, putting it back on, and going through my teens and 20s.”
Despite her diagnosis, Salmon said she had no problems with her pregnancy. [menstrual] cycle. It really planted a seed inside me. “Well, if the pregnancy went well, why are we being told this? What’s the evidence behind it?” That’s why she entered the field: Big Body Space have access to healthcare,” she explains.
Salmon said most of the medical research that health care professionals use to make decisions for obese patients is based on “the underlying belief that being fat is unhealthy and that we want to avoid it.” “It is from this idea that being fat is just body diversity that we need to start solving the many pieces of the puzzle when we look at the evidence from a weight-neutral perspective.” I have.”
So what does science know about fertility in overweight people? A higher BMI is associated with a higher chance of miscarriage and pregnancy complications, and is also associated with a lower effectiveness of IVF. It is often misinterpreted to mean that you have trouble conceiving and giving birth to a healthy baby, but in reality it all comes down to the individual.
BMI is an imperfect way of looking at someone’s health. It does not take into account muscle mass and does not distinguish between metabolically unhealthy and metabolically healthy obese people (who do not experience the health problems normally associated with being fat). Above, “Low fertility does not mean no fertility at all,” Salmon points out. For example, age is also a complicating factor for couples trying to conceive naturally, but alternative treatments such as assisted fertilization can help.
Science has not found a causal link between obesity and infertility. It is not known whether excess fat cells in the body are the cause of infertility, or whether both symptoms are due to different causes. That’s because even though fat loss is routinely prescribed as a fertility treatment, there’s little evidence that it actually helps obese people get pregnant.
A 2017 meta-analysis of 40 studies found that weight loss appeared to help obese people get pregnant naturally, but made no difference during IVF treatment, improving their chances of having a healthy baby. What’s more, “no studies have differentiated between the effects of dieting for weight loss and those produced by health-promoting behaviors such as eating well and exercising,” Salmon adds.
Another study published in 2022 looked at 379 infertile women with a BMI greater than 30. They divided the women into her two groups. One is a diet and exercise regimen aimed at weight loss, and her other focuses on increasing physical activity without a weight loss goal. All participants received fertility treatment after the lifestyle intervention. The study found no improvement in female fertility. This could mean that women’s problems are not weight related.
When asked what else could be causing the increase in infertility in overweight people, Salmon said multiple things could be involved. “One factor she doesn’t really consider in research is the stigma of weight,” she explains. “When we are under any kind of stress, our levels of stress hormones rise. [cortisol]have been found to affect our hormone levels and our functioning and physiology.
Weight cycling, which is common in people with a high BMI, is also associated with health risks, such as higher levels of inflammation and hormonal fluctuations that can upset the delicate balance necessary for pregnancy. Still, if an overweight person is having trouble conceiving, many doctors will refuse to send them for additional tests or to consider their individual circumstances. does not provide IVF treatment to more than 100,000 people and anti-fat discrimination is not illegal in the UK and EU.
For a devotee named Melody, assisted fertilization was the only route to conception. Her partner has a condition called cystic fibrosis that makes her infertile in 98% of her male patients. “I quickly developed a fat phobia. They told me, ‘I won’t start until I’m at least 45 kilos,'” recalls Melody. With time running out and her partner’s sperm quality declining, Melody eventually decided to undergo gastric sleeve surgery to remove her two thirds of her stomach. “I don’t regret what I did, but I am clearly sad that I had to,” she said. But most of all, I wanted a baby.”
And pregnancy is just the beginning of the story. Discrimination and humiliation continue for pregnant fat people. Another follower of mine, Sonia, told her obstetrician that he was hurting her during the visit, but added that she was surprised Celine’s fiancée wanted to marry her. He just replied, “I can’t see anything with your fat.”
“Pregnancy was painful. People talked more about my weight than they talked about my baby,” Anael wrote in a DM. It was so inhumane when I heard you talk like this.”
The same thing happened with Diane. I found her story particularly difficult to read. “Throughout my pregnancy, people were pestering me about my weight,” she said. Said the child would be born fat – he wasn’t. They told me I would have complications – I didn’t. They forced me to give birth prematurely so I wouldn’t be born “overweight.” They had organ problems – their fatphobia almost killed us.
Anna, who is currently pregnant, was also told by her doctor that she would have gestational diabetes. “Her midwife asked me for the results when I had the test,” she said. “I told her I was negative. She was like, ‘Really? I don’t believe you! Show me.’ I still can’t bring myself to tell her how humiliated I am.”
It’s no news that fat people are treated worse than others, but I’m still shocked that medical professionals are so hostile to us. Even though those who are are generally less fertile, they still deserve help and respect. However, society has decided that obesity is morally unacceptable. We sympathize with the infertility plight of skinny people, but tell fat people that being infertile is the right thing to do.
“It’s not that our bodies are wrong, it’s that the system around us is wrong, so it’s upsetting,” Salmon says. She found that treatment usually required a slightly more coordinated approach. We have clients who can’t get access to that kind of healthcare,” she adds.
Many have contacted Salmon because medical staff at IVF centers have rejected it, citing studies showing treatment success rates are lower in obese patients. “And we usually give every patient the exact same medication at the exact same time, without considering that an obese person may need more medication or a different protocol,” she says. We know that as children get older they will need more medication, but when we look at the biology of fat people, we don’t take that into account.”
For my part, I hope that this article has given you hope and helped you start a conversation with your doctor. No caregiver has the right to abuse you.
