High BMI and Risks in IVF
With the increasing prevalence of obesity in the United States, and with the associations between obesity and infertility (ovulation dysfunction, insulin resistance, androgen excess), more and more patients with obesity are seeking infertility care. With the obesity epidemic in this country the question of “When do surgical risks outweigh benefits?” must be asked. Perhaps an easier question to answer, however, is “To what degree are high Body Mass Index (BMI) patients at risk in the IVF (egg retrieval) setting?” A study just published from Harvard Medical School by Romanski and colleagues on class III (BMI 40-49.9 kg/m2) and class IV (BMI 50 or greater kg/m2) obesity attempts to answer the latter question.
This was a five plus year-long study of 144 patients with BMI at 40 kg/m2 or greater compared to 1,016 age-matched women with normal, overweight, and obese BMIs. Serious complications were uncommon across all BMI groups, although minor complications (oxygen desaturation, requirement for oral/nasal airway, etc.) were more common among class III and class IV patients. As expected, obese patients in these two groupings also had more frequent diagnoses of gastroesophageal reflux disease, hypertension, diabetes, asthma, and sleep apnea. These patients were also more likely to require more intravenous sedation medications, have longer egg retrieval procedures and require transabdominal egg retrieval.
The authors conclude that egg retrieval procedures can be safely performed in the outpatient setting for patients with BMI greater than 40 kg/m2; however, with the increased anesthetic requirements, longer procedure times and frequency of minor complications there should be “the presence of adequate personnel, training, and equipment to perform basic and emergency airway management.”