BMI ceilings for fertility treatments may block access for Black, Hispanic women

ANAHEIM, Calif. — BMI thresholds for fertility care may prevent some non-Hispanic Black and Hispanic women from accessing IVF treatments, according to study data.

In the United States, there is no universal BMI threshold at which fertility treatment is denied, although about 65% of clinics in the country self-impose a threshold between 35 kg/m² and 45 kg/m², according to a presenter here.

“It should be acknowledged that the withholding of fertility treatment due to BMI is controversial,” Olutunmike Kuyoro, MD, of Northwell Health Fertility at the Zucker School of Medicine at Hofstra/Northwell, said in a presentation at the ASRM Scientific Congress & Expo. “Unfortunately, the presence of obesity varies by race and economic status, with higher rates of obesity in non-Hispanic Blacks, Hispanics and those of lower socioeconomic status.”

Kuyoro and colleagues retrospectively analyzed the sociodemographics of new patients who presented to an academic infertility clinic from 2020 to 2021. The clinic accepted patients for IVF treatment if they had a BMI lower than 40 kg/m². The researchers evaluated fertility treatment initiation based on race and BMI.

Among 3,350 new patients, the overall racial and ethnic makeup of the cohort was 43% non-Hispanic white, 18% Asian, 15% non-Hispanic Black, 8% Hispanic and 16% unknown ethnicity.

Of the new patients, 149 (7%) had a BMI of 40 kg/m² or greater. Within this group, there were greater proportions of non-Hispanic Black (22%) and Hispanic (17%) patients compared with the whole cohort.

Additionally, 13 (9%) of women who presented with a BMI of 40 kg/m² or greater initiated IVF during the study period; one woman was non-Hispanic Black, one was Hispanic, one was Asian and 10 were non-Hispanic white.

“By limiting access to fertility treatments based on BMI cutoffs, doctors may be discriminating against underrepresented minorities and denying care to otherwise eligible Hispanic and non-Hispanic Black patients,” Marcelle I. Cedars, MD, immediate past president of ASRM, said in a press release.

References:

• Kuyoro O, et al. On race, BMI thresholds, and infertility treatment - Examining the outcomes of patients who exceed BMI thresholds at first visit. Presented at: ASRM Scientific Congress & Expo; Oct. 22-26, 2022; Anaheim, California.
• On race, BMI thresholds, and infertility treatment - Examining the outcomes of patients who exceed BMI thresholds at first visit. Published Oct. 24, 2022. Accessed Nov. 1, 2022.