BMI cut-offs for IVF inconsistent throughout UK clinics, study finds

BMI cut-offs for IVF care are inconsistent and may have discriminating implications, a new study of 32 UK fertility clinics has shown.

The research, conducted by the fertility clinic Ovom, focused on BMI as a treatment eligibility criterion and the thresholds across the UK.

It found that the imposed BMI cut-offs for IVF care were inconsistent between clinics, source of funding, other countries and different guidelines, raising concerns about violation of ethical principles of patient autonomy, beneficence/non-maleficence and justice, especially given that most BMI cut-offs only applied to women.

The study, entitled Discrepancies in upper body mass index (BMI) IVF treatment eligibility limits across UK clinics and international borders with implications for access to fertility services for women in particular, was led by MyFertility, Orchid Fertility and Ovom Care and included responses from 32 clinics throughout the UK.

The clinics were asked if they had a BMI limit to treat IVF patients and if so, what the limit was. Integrated Care Boards thresholds were collected and national and international standards were consulted for BMI cut-offs.

Researchers found inconsistencies when comparing UK clinics, Integrated Care Boards and international guidelines.

For UK clinics, the BMI cut-off varied from BMI 29.9 to 40, with most clinics having a threshold BMI<35, the research showed. Private clinics had a higher BMI cut-off compared to NHS clinics.

In all clinics that offered both NHS and private care, the cut-off for private patients was higher than that for NHS, despite the patients being treated in the same clinic.

Of the 42 British Integrated Care Boards, 35 published policies with treatment eligibility criteria, all stating BMI range between 19 and 30 at the time of referral and commencement of treatment, yet 44 per cent of the UK female population of reproductive age experience BMI>30, posing a real challenge for almost half of the female population unable to access fertility care because of their BMI.

This inconsistency was also seen internationally, with some countries like Australia and New Zealand having a BMI<35 threshold, while countries like the US and Israel having no BMI thresholds. Women with a BMI of over 50 had a 21 per cent chance of live birth per cycle.

“This is an important study as it sheds light on the labyrinth of obstacles and hurdles that are placed in front of people with a high BMI to have fertility care,” explained Dr Lynae Brayboy, co-founder and chief medical officer at Ovom.

“The imposition of arbitrary cut-offs not based on data for IVF is discriminatory and marginalises women, people with ovaries and couples unnecessarily.”