Obese women should have fertility treatment withheld, according to a report from a leading group of Scottish doctors. Their recommendation is an attempt to reduce growing costs within the NHS, where resources are already over-stretched. According to the Scottish Committee of the Royal College of Obstetricians and Gynaecologists, women with a body mass index (BMI) higher than 30 should be placed on a waiting list until they achieve a healthier weight, while those with a BMI greater than 36 should be banned from even joining the waiting list.
BMI is a measure of body fat based on height and weight. The BMI categories used clinically are normal (18.5-24.9), overweight (25-29.9) and obese (greater than 30). Richard Fleming, director of the Glasgow Centre for Reproductive Medicine, expressed surprise at the recommendation. ' 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', he said, adding 'between BMI 30-35, the evidence is much weaker'.
Another cause for concern is the use of BMI as the sole method of measuring obesity, as its accuracy in relation to an individual's actual levels of body fat is easily distorted by factors such as fitness level, muscle mass, bone structure, gender, and ethnicity. Sheena Young, spokeswoman for the National Infertility Awareness Campaign said: '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'.
Meanwhile, clinicians and campaigners have criticised the Scottish Executive's failure to tackle 'unacceptable' waiting times for fertility treatment, following a major review of NHS services in Scotland. Dr Mark Hamilton, chair of the British Fertility Society, said: 'It is completely unacceptable that patients are still facing long waits, up to four years in some cases, to receive treatment that the Expert Advisory Group on Infertility Services in Scotland (the Eagiss report of 1999) highlighted as appropriate more than half a decade ago'. A spokesman for the Scottish Executive said they would issue further guidelines on fertility and examine the reasons for waiting time differences, adding 'we hope to issue a further response in summer 2007'.