The television show “This Is Us” is spotlighting the issue of obesity and fertility this season.
The television show “This Is Us” has taken on a lot of emotional issues in its first two seasons, not the least of which was the death of husband and father Jack.
This season, the popular drama series is dealing with another controversial, important topic — obesity and fertility.
“This Is Us” follows the lives of five family members — including Kate, a woman who’s obese and has faced weight-related stigma throughout her life.
In the initial episodes of this season, Kate and her husband visit a fertility specialist to discuss the option of undergoing in vitro fertilization (IVF).
After struggling to overcome an emotionally devastating miscarriage in season two, the couple hopes that IVF will help Kate get pregnant again.
But the fertility specialist initially refuses to take Kate on as a patient.
“At your weight, the chances of a successful pregnancy are very slim, even if you go through in vitro,” the specialist tells Kate.
“At your BMI, going under anesthesia for an elective procedure is not advisable,” she added while discussing the risks of sedation during egg retrieval.
The specialist eventually changes her mind and agrees to treat Kate. But in real life, many clinics may be less willing to conduct IVF in women of the television character’s size.
“Most clinics will use some sort of regimen to provide sedation during the egg retrieval process,” Dr. Amanda Kallen, an assistant professor of obstetrics, gynecology, and reproductive sciences at the Yale School of Medicine and chair of the Connecticut Section of the American Congress of Obstetricians and Gynecologists, told Healthline.
“Those medications are generally considered less safe for someone who is overweight because there’s more of a chance of breathing problems during the procedure,” she continued, “so many clinics have a weight cut-off because of that safety concern.”
Before visiting a fertility specialist, Kate receives a diagnosis of a condition known as polycystic ovary syndrome (PCOS).
PCOS can cause irregular menstrual periods and make it more difficult to get pregnant.
In fact, the condition accounts for up to 30 percent of infertility cases in couples that seek treatment.
Although more research is needed to understand the relationship between weight and PCOS, up to 80 percent of women with the condition are obese.
Research suggests that excess weight might also negatively affect egg quality, which reduces the chances of a successful pregnancy even with IVF.
“We know that women who are obese might need higher doses of medication in order to stimulate eggs to grow,” Kallen said.
“There are studies that suggest that the rate of embryo implantation, the chances that an embryo that’s put back into the body will stick, are less,” she continued, “and the chances of a pregnancy with live birth, of actually taking a baby home at the end of the day, are less.”
According to a systematic review published in 2012, women with excess weight are 10 percent less likely to give birth to a live baby following IVF than women of average weight.
They are also at higher risk for pregnancy-related complications, including preterm birth, preeclampsia, and gestational diabetes.
Although it’s important for healthcare providers to inform patients of these risks, too many of them do so in a way that contributes to weight-related stigma, Sharon Bernicki DeJoy, PhD, MPH, an associate professor of public health at West Chester University in Pennsylvania, told Healthline.
“Providers tend to have a standard script for talking to ‘the fat person,’” DeJoy said.
“Providers also tend to conflate an increased risk for a condition with the inevitability of that condition,” she continued. “What some women heard was, ‘you are fat, therefore, you will get gestational diabetes, or you will have blood pressure problems, or you will need a C-section and that will put your baby in danger.’”
When healthcare providers make assumptions about patients’ health or habits based on their size alone, it may lead them to overlook problems or risk factors other than excess weight.
This might prevent patients from receiving the care or support they need.
It may also traumatize some patients and erode their trust in doctors.
To stop this from happening, it’s important for doctors and other healthcare providers to avoid stereotyping and stigmatizing patients with larger bodies, DeJoy said.
A common attitude among her research participants was: “Look, we’re not stupid. We’re aware there are risks. So just say what those risks are in a neutral matter-of-fact way: ‘Because of your BMI, you are at increased risk for X, so I would like to monitor you by doing Y and Z.’”
Similarly, Kallen emphasized the importance of providing individualized and nonjudgmental care.
“I see a lot of patients who are struggling with weight and often they’ve tried a lot of the things that are out there that people are suggesting. Often, they’re already calorie counting, they’re already watching their diets, or have been trying all their lives and watching other people eat whatever they want while they’re not having that same ease with weight,” Kallen said.
“So, I think it sounds trite and simple but really kind of hearing what the patient is telling you, what they’ve tried so far, and reassuring them that you’re going to be there for them and provide support during the process,” she added.
“Even if I have a patient who may be above our cut-off, where I can’t provide IVF, it doesn’t mean that I can’t provide other support,” she continued. “It doesn’t mean we can’t talk about ways to make the body as healthy as possible for pregnancy.”
In a recent episode of the television show “This Is Us,” Kate visits a fertility specialist who initially refuses to treat her with in vitro fertilization due to concerns about her weight.
Excess weight lowers women’s chances of getting pregnant and increases the risks of sedation during fertility treatments.
To effectively support large-bodied women, it’s important for healthcare providers to offer