Drink, Smoke or Overeat and You May Be Refused Fertility Treatment

Conceive Online carried an article by Medical News Today, 25/01/10, asking whether women who are obese, smoke or drink alcohol should be entitled to fertility treatment. It reported that the European Society of Human Reproduction and Embryology (ESHRE) had done a study of the effect of these lifestyle habits on conception, pregnancy and the life of the child.  

When women drink alcohol while trying to conceive, and/or during pregnancy;

• they have less chance of conceiving, and
• if they do become pregnant; there are higher miscarriage rates. 
• There may be slower development of the foetus in the womb,
• premature delivery and even foetal death.
• Children can be born with Foetal Alcohol Syndrome, manifested in physical anamolies and behavioural and cognitive difficulties.

Smoking:

• can reduce a woman's ability to conceive, perhaps by 50%. 
• Her eggs may be depleted more quickly, and
• if a smoker does become pregnant she has a higher risk of miscarriage. 
• Children born to a smoker may have a lower birth weight, cleft palate and Sudden Infant Death Syndrome.

Women and Weight: a sensitive subject.  Body Mass Index (BMI) charts assign the term "overweight" to women who score 25 - 29.9, "obese" 30 - 32 and morbidly obese at 33 and upward.  These numbers are approximate and variable. Risks include:

• Abnormal menstruation cycles and reduced chance of conceiving. (Weight loss raises the chance of conception in obese women.)
• Overweight women who do become pregnant have double the risk  gestational diabetes, and
• morbidly obese women (Body Mass Index of 33 and above) have eight times the risk. Their babies are at risk for neural and heart abnormalities. 

There is a clear implication that these are lifestyle choices which should counter access to assisted reproduction. In the case of alcohol consumption, ESHRE recommended that fertility doctors refuse treatment to women who drink moderately and are unwilling or unable to give it up.  They were less definitive in regard to smoking and obesity, but it seems that this Task Force on Ethics and Law is saying that women who make bad decisions about their health can be judged unfit or even undeserving of access to fertility treatment.  They recommend that doctors consider:

• the cost-effectiveness of fertility treatment for someone with reduced chance of success,
• obstetric risks,
• the respect for patient autonomy,
• the interests of society and
• the risk of serious harm to the future child.

In other words, balance the woman's right to live as she likes with a doctor's right to refuse treatment to someone who doesn't take care of her health. 

"The interests of society."  Whatever could they mean?  Is it anti-social to be a fat mother?  How fat?  If a woman is overweight but otherwise healthy, is BMI the only indicator that may keep her from getting access to fertility treatment?   I'm slightly afraid that there could be a moral judgement that women who overeat are guilty of the sin of gluttony and don't deserve to have children?  Judging fat people is sometimes the thin person's guilty pleasure.  By whose standards do they make that decision? Is it on a case by case basis, or all women 30 (40 or 50) pounds overweight?

How much alcohol does a woman have to drink before she is considered to be a danger to herself and her future child?  The article speaks of "more than moderate drinking," but I don't know what that means. Are they talking about a drink per day, a few units per week or a glass of something on a Saturday night?  My own specialist said that if a single glass of red wine every night made me feel relaxed and happy, he had no problem with that.  I travelled through France while pregnant, refusing cured meats, unpasteurized cheeses, foie gras, espresso and most shellfish, (that's another story) but sipping my "allowed" glass of wine.  Others warn women not to drink at all. Maybe I'm being picky.  These are only recommendations, after all.

It's easy to stand as an example of moral superiority when you don't indulge in one of these lifestyle choices. I don't smoke. I hate when others around me are smoking; the smell, the smoke, how it can ruin my otherwise lovely meal out, the potential of lung cancer, etc... Both the politically "correct" part of me and my conscience think that

1. if a woman is stupid enough to reduce her chance of getting pregnant for a daily pack of fags, she only has herself to blame, and
2. she has no right to bring a baby into the world with preventable conditions that could have negative impact on that child's health and life. 

On balance, while I believe that parenting may be fundamental to a woman's happiness ( I didn't say every woman)and even to the meaningfulness of her existence on Earth, I don't believe it is an absolute right.  If she conceives naturally, then she takes her chances with her child's health.  However, if she hasn't been able to conceive naturally, is she entitled to assisted reproduction?  Not necessarily. If she wants the NHS or her health insurance to pay her way, then she may have to fulfil their criteria. If she is paying her own way but the doctor of her choice uses ethical guidelines handed out by the ESHRE Task Force or by his/her own ethics to refuse her, she can try another doctor. It's medicine, but it's also a transaction between two parties.  To me, it's just the same as if a plastic surgeon turns away a patient who refuses to stop using sun beds.

What do you think?  Please leave a comment.  It would mean a lot to me to hear your views on this subject. 

Comments

[Olivia]

I belive personally that anyone who doesn't take care of their physical condition should be refused infertility treatments. The risk to the health of a baby is far more important