Recommendations for HAES-literate REs or fertility doctors/practices?

[Anonymous]

Whether or not data supports the idea that obesity is not correlated with health, it certainly is correlated with fertility. I’m obese too. Not here to shame you. I just don’t think it’s wise to change doctors for raising a proven factor in fertility. That’s what you want them to do.

[Anonymous]

Anonymous wrote:Whether or not data supports the idea that obesity is not correlated with health, it certainly is correlated with fertility. I’m obese too. Not here to shame you. I just don’t think it’s wise to change doctors for raising a proven factor in fertility. That’s what you want them to do.

+1. Infertility is it’s own beast, and you are NOT guaranteed a successful outcome. As someone who was unsuccessful with IVF, I’d do everything I could do maximize the odds of success. Even including fast weight loss. It could be the difference between OP never becoming a mother. That’s not something I’d argue about.

[Anonymous]

No recs on doctors, but I think a lot of the responses are missing OP’s point: she’s asking for dr recs, not a trial on weight and fertility.

FWIW, this study found no significant impact of high BMI and IVF outcomes: https://www.ideiafertil.com.br/files/downloads/body-mass-index-and-fertility.pdf

[Anonymous]

Anonymous wrote:

Anonymous wrote:Whether or not data supports the idea that obesity is not correlated with health, it certainly is correlated with fertility. I’m obese too. Not here to shame you. I just don’t think it’s wise to change doctors for raising a proven factor in fertility. That’s what you want them to do.

+1. Infertility is it’s own beast, and you are NOT guaranteed a successful outcome. As someone who was unsuccessful with IVF, I’d do everything I could do maximize the odds of success. Even including fast weight loss. It could be the difference between OP never becoming a mother. That’s not something I’d argue about.

I don’t even think this is something OP can just do or is as simple as people in this thread are suggesting. It’s just that 1) the data supporting losing weight to become pregnant is strong and 2) a doctor who did not raise it wouldn’t be providing you with the best possible care. I’d worry what else they might not tell you the blunt truth about. A fertility doctor who can’t be blunt because it isn’t what you want to hear can cost you time and money.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I mean, observational studies do show a BMI cut point around 27 (you said above 30 but not your actual BMI) and a fertility benefit of losing even 5% of bodyweight. It might not be the most prognostic factor but it is the easiest one to modify

OP again - agreed, yes, such can often be modified through things like lifestyle changes. Or not, if that is the size and BMI that your body naturally is.

Also if time is a factor - which in my case it is because I am AMA - taking ‘a few months to lose some weight’ may not be an option. In fact, my doctors and even SGF specifically recommend NOT doing this, rather, encourage me to keep focusing on the healthy habits such as balanced eating and regular exercise. I would love if taking the time needed to healthily lose weight was an option, and had very much been working on this prior to TTC. Nor am I interested in quickly and unhealthily losing weight.

With my specific case, though (which is all I can speak to), my health and hormonal metrics indicate that I am extremely healthy. Given that, I was not presented any data, studies, or analysis on why my weight or BMI might be the issue, as such issues frequently present as hormonal imbalances, which I do not have. The Dr’s response when I asked that question: “we don’t know why, then, but it may be.” Not a great answer, and fell into the realm of fertility fat shaming for me.

Info below may be helpful + offer different perspectives:

Harvard Health Publishing, June 2020: How useful is the body mass index (BMI)? https://www.health.harvard.edu/blog/how-useful-is-the-body-mass-index-bmi-201603309339
From article above: “Research suggests that BMI alone frequently misclassifies metabolic health, which is linked to how much fat a person has and how it is distributed. And, BMI may be particularly unreliable during pregnancy, for athletes, and the elderly.“

NYTimes, June 2019: When You’re Told You’re Too Fat to Get Pregnant
https://www.nytimes.com/2019/06/18/magazine/fertility-weight-obesity-ivf.html

Re the bolded (Dr saying we don't know why), this is true of a lot of fertility stuff. I went to SGF with "unexplained" infertility. I don't see how this statement is "shaming"

[Anonymous]

Try Dr. Frankfurter at GW. We received treatment for a male factor issue when I had a BMI. I don't recall discussing weight - though sure we would have if relevant. Overall a good experience

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I mean, observational studies do show a BMI cut point around 27 (you said above 30 but not your actual BMI) and a fertility benefit of losing even 5% of bodyweight. It might not be the most prognostic factor but it is the easiest one to modify

OP again - agreed, yes, such can often be modified through things like lifestyle changes. Or not, if that is the size and BMI that your body naturally is.

Also if time is a factor - which in my case it is because I am AMA - taking ‘a few months to lose some weight’ may not be an option. In fact, my doctors and even SGF specifically recommend NOT doing this, rather, encourage me to keep focusing on the healthy habits such as balanced eating and regular exercise. I would love if taking the time needed to healthily lose weight was an option, and had very much been working on this prior to TTC. Nor am I interested in quickly and unhealthily losing weight.

With my specific case, though (which is all I can speak to), my health and hormonal metrics indicate that I am extremely healthy. Given that, I was not presented any data, studies, or analysis on why my weight or BMI might be the issue, as such issues frequently present as hormonal imbalances, which I do not have. The Dr’s response when I asked that question: “we don’t know why, then, but it may be.” Not a great answer, and fell into the realm of fertility fat shaming for me.

Info below may be helpful + offer different perspectives:

Harvard Health Publishing, June 2020: How useful is the body mass index (BMI)? https://www.health.harvard.edu/blog/how-useful-is-the-body-mass-index-bmi-201603309339
From article above: “Research suggests that BMI alone frequently misclassifies metabolic health, which is linked to how much fat a person has and how it is distributed. And, BMI may be particularly unreliable during pregnancy, for athletes, and the elderly.“

NYTimes, June 2019: When You’re Told You’re Too Fat to Get Pregnant
https://www.nytimes.com/2019/06/18/magazine/fertility-weight-obesity-ivf.html

Re the bolded (Dr saying we don't know why), this is true of a lot of fertility stuff. I went to SGF with "unexplained" infertility. I don't see how this statement is "shaming"

I completely agree. And honestly OP, if you are going to go through IVF you’re going to have to find some more resolve.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Whether or not data supports the idea that obesity is not correlated with health, it certainly is correlated with fertility. I’m obese too. Not here to shame you. I just don’t think it’s wise to change doctors for raising a proven factor in fertility. That’s what you want them to do.

+1. Infertility is it’s own beast, and you are NOT guaranteed a successful outcome. As someone who was unsuccessful with IVF, I’d do everything I could do maximize the odds of success. Even including fast weight loss. It could be the difference between OP never becoming a mother. That’s not something I’d argue about.

I don’t even think this is something OP can just do or is as simple as people in this thread are suggesting. It’s just that 1) the data supporting losing weight to become pregnant is strong and 2) a doctor who did not raise it wouldn’t be providing you with the best possible care. I’d worry what else they might not tell you the blunt truth about. A fertility doctor who can’t be blunt because it isn’t what you want to hear can cost you time and money.

PP here and I totally agree. You don’t want an RE that will tell you what you want to hear. You need one who will tell you the blunt truth and be upfront with what they know or don’t, and your odds. It’s the same care any of us should be looking for, and weight is a red herring in the situation.

[Anonymous]

You’re all missing the point — OP does not care whether you think she should lose weight. She asked whether anyone could recommend an RE. Stick to the question.

Also, rapid weight loss is not going to be the answer here. Say she has ~40 lbs to lose. The fastest pace to safely lose weight is ~5 lbs/month? And we all know that slows down as you get closer to goal weight. So that pushes things 8-10 months down the road, which is a long time if you’re AMA.

so stop fat shaming. If you don’t have a rec, don’t say anything at all

[Anonymous]

Anonymous wrote:You’re all missing the point — OP does not care whether you think she should lose weight. She asked whether anyone could recommend an RE. Stick to the question.

Also, rapid weight loss is not going to be the answer here. Say she has ~40 lbs to lose. The fastest pace to safely lose weight is ~5 lbs/month? And we all know that slows down as you get closer to goal weight. So that pushes things 8-10 months down the road, which is a long time if you’re AMA.

so stop fat shaming. If you don’t have a rec, don’t say anything at all

She asked for someone to recommend a "HAES literate" doctor or practice. Implying that if doctors believe the well-documented scientific evidence that obesity impacts both baseline fertility and the success/ safety of fertility treatments (because it is definitely a safety issue as well-- anesthesia risks are higher for obese people), they are somehow "illiterate" in... what? Science as OP wishes it were, instead of what it actually is? She's getting pushback, because no respectable doctor or clinic I know of promotes itself as "HAES-literate" and/or doesn't have BMI restrictions. They'd get sued if they didn't have restrictions and/or warn patients about the risks of obesity in this process.

So, sure, I can recommend an RE, but not a "HAES-literate" one. I've been to a lot of REs, but none who fit that description, because they believe in scientific evidence.

[Anonymous]

Anonymous wrote:

Anonymous wrote:You’re all missing the point — OP does not care whether you think she should lose weight. She asked whether anyone could recommend an RE. Stick to the question.

Also, rapid weight loss is not going to be the answer here. Say she has ~40 lbs to lose. The fastest pace to safely lose weight is ~5 lbs/month? And we all know that slows down as you get closer to goal weight. So that pushes things 8-10 months down the road, which is a long time if you’re AMA.

so stop fat shaming. If you don’t have a rec, don’t say anything at all

She asked for someone to recommend a "HAES literate" doctor or practice. Implying that if doctors believe the well-documented scientific evidence that obesity impacts both baseline fertility and the success/ safety of fertility treatments (because it is definitely a safety issue as well-- anesthesia risks are higher for obese people), they are somehow "illiterate" in... what? Science as OP wishes it were, instead of what it actually is? She's getting pushback, because no respectable doctor or clinic I know of promotes itself as "HAES-literate" and/or doesn't have BMI restrictions. They'd get sued if they didn't have restrictions and/or warn patients about the risks of obesity in this process.

So, sure, I can recommend an RE, but not a "HAES-literate" one. I've been to a lot of REs, but none who fit that description, because they believe in scientific evidence.

I think there's probably a happy medium here, which I assume is what OP is looking for. Yes, women with excess weight can have more trouble getting pregnant. But if you take PCOS out of the picture or other ovulation disorders, it's not really clear whether there is a negative impact for someone like OP. Plus losing weight is a tricky business and it doesn't always make sense to wait for some anticipated weight loss that may never come. And if a doctor is going to just discuss your weight as a "bad thing" without proposing an evidence-based plan, that's just stressful and not helpful.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You’re all missing the point — OP does not care whether you think she should lose weight. She asked whether anyone could recommend an RE. Stick to the question.

Also, rapid weight loss is not going to be the answer here. Say she has ~40 lbs to lose. The fastest pace to safely lose weight is ~5 lbs/month? And we all know that slows down as you get closer to goal weight. So that pushes things 8-10 months down the road, which is a long time if you’re AMA.

so stop fat shaming. If you don’t have a rec, don’t say anything at all

She asked for someone to recommend a "HAES literate" doctor or practice. Implying that if doctors believe the well-documented scientific evidence that obesity impacts both baseline fertility and the success/ safety of fertility treatments (because it is definitely a safety issue as well-- anesthesia risks are higher for obese people), they are somehow "illiterate" in... what? Science as OP wishes it were, instead of what it actually is? She's getting pushback, because no respectable doctor or clinic I know of promotes itself as "HAES-literate" and/or doesn't have BMI restrictions. They'd get sued if they didn't have restrictions and/or warn patients about the risks of obesity in this process.

So, sure, I can recommend an RE, but not a "HAES-literate" one. I've been to a lot of REs, but none who fit that description, because they believe in scientific evidence.

I think there's probably a happy medium here, which I assume is what OP is looking for. Yes, women with excess weight can have more trouble getting pregnant. But if you take PCOS out of the picture or other ovulation disorders, it's not really clear whether there is a negative impact for someone like OP. Plus losing weight is a tricky business and it doesn't always make sense to wait for some anticipated weight loss that may never come. And if a doctor is going to just discuss your weight as a "bad thing" without proposing an evidence-based plan, that's just stressful and not helpful.

THIS!! well said.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You’re all missing the point — OP does not care whether you think she should lose weight. She asked whether anyone could recommend an RE. Stick to the question.

Also, rapid weight loss is not going to be the answer here. Say she has ~40 lbs to lose. The fastest pace to safely lose weight is ~5 lbs/month? And we all know that slows down as you get closer to goal weight. So that pushes things 8-10 months down the road, which is a long time if you’re AMA.

so stop fat shaming. If you don’t have a rec, don’t say anything at all

She asked for someone to recommend a "HAES literate" doctor or practice. Implying that if doctors believe the well-documented scientific evidence that obesity impacts both baseline fertility and the success/ safety of fertility treatments (because it is definitely a safety issue as well-- anesthesia risks are higher for obese people), they are somehow "illiterate" in... what? Science as OP wishes it were, instead of what it actually is? She's getting pushback, because no respectable doctor or clinic I know of promotes itself as "HAES-literate" and/or doesn't have BMI restrictions. They'd get sued if they didn't have restrictions and/or warn patients about the risks of obesity in this process.

So, sure, I can recommend an RE, but not a "HAES-literate" one. I've been to a lot of REs, but none who fit that description, because they believe in scientific evidence.

I think there's probably a happy medium here, which I assume is what OP is looking for. Yes, women with excess weight can have more trouble getting pregnant. But if you take PCOS out of the picture or other ovulation disorders, it's not really clear whether there is a negative impact for someone like OP. Plus losing weight is a tricky business and it doesn't always make sense to wait for some anticipated weight loss that may never come. And if a doctor is going to just discuss your weight as a "bad thing" without proposing an evidence-based plan, that's just stressful and not helpful.

No, an RE will just decline to treat you as a patient if your BMI is too high. You’re not guaranteed care at a fertility clinic, so OP is setting herself up for frustration if she’s not aware of that going in.

[Anonymous]

Ok i’ve never had an RE (albeit i moved to nyc 6 years ago) even discuss BMI (and I am obese) in 6 cycles with 3 different clinics. Not a once. I’m so confused about who is turning you down or making you feel less. I would concentrate on finding the right RE for AMA first, as time is not on your side and you need an RE that can zig and zag with potential egg quality/protocols for AMA. Stay far away from the factories that will just pump you with high dose stims because that’s what they do for everyone.

Signed 7 cycles and two DD’s with AMA/DOR

[Anonymous]

I worked with Dr Widra at SGF, similar BMI and gained some weight during treatment, and he never mentioned anything about it. I had success on my first transfer, delivered a few months back, no issues with the pregnancy.