Welcome back to Manna Mostaghim, PhD student of Health Policy at the London School of Economics and Political Science! Last month, Manna wrote about weight loss drug Saxenda being improperly presented as a fertility aid. This guest blog post looks at the issues around egg freezing in the UK if you have a high BMI.
Scrambled, Poached, Fried or Frozen: If you have a high BMI what are your options for egg freezing in the UK?
Egg freezing is primarily understood to facilitate a delay in pregnancy due to economic or social circumstances. But it also provides an opportunity for women and other birthing people to still conceive with their own eggs after undergoing medical procedures that may compromise their fertility (i.e., cancer treatments, gender re-affirming surgery).
A recent article in the CUT suggests that women with a high BMI are being unfairly excluded from egg freezing services across the United States. However, there is little information on whether this issue is replicated in the U.K. for people electing to freeze their eggs in their own fertility journeys.
But what is the basis of restricting egg freezing for people with a high BMI? And are there restrictions for people with a high BMI to freeze or donate frozen eggs in the UK?
Egg Freezing in the UK for patients with a high BMI
Blogs for clinics that offer assisted reproductive technologies (not specific to the UK context) continue to affirm that being plus size impacts the quality of eggs. But as the CUT article indicates there is little medical evidence to suggest that the eggs of people who are overweight or obese are compromised by weight. Dr Nicole Noyes indicates that the basis of this is a “an abnormal hormonal environment surrounding the developing egg” but also acknowledges that researcher’s still don’t know why that occurs.
Articles that support Noyes theory concede their lack absolute clarity to the claim. For example, an article by Purcell and Molley in 2011, claims that “obesity negatively impacts the developmental competence of oocytes”. But the article, based on evidence from both human and animal studies, also concedes that the “how these various hormones and metabolites impact the oocyte is still being actively researched”.
But in the time that has elapsed since Purcell and Molley’s article, more research on the matter has occurred. For example, in 2022, an article by Leese et al cites and endorses Purcell and Molley’s premise that metabolism impacts egg quality. But similarly concedes that “There is clearly much still to learn”. In short, the science that says there is a likelihood that being overweight or obese will impact the quality of eggs, but it is not an absolute.
However, blogs, articles or information services from assisted reproductive technology clinics continue to affirm that the jury is out, and excess weight will compromise the quality of the eggs (here, here and here). The Elanza Wellness Coaching services even asserts that these sorts of claims should not be attributed to a lack of body positivity of the services but due to the cold hard facts: “Culturally, artistically and romantically, there’s no right or wrong. However, scientifically, we’re on different ground”.
Yet claims about egg quality being compromised by weight consistently conflate observations on how a high BMI adversely impacts successful IVF outcomes. A claim that is also subject to controversy and continued research.
It remains unclear whether clinics that offer assisted reproductive technology are restricting people in the UK to freeze their eggs on an elective basis. But women or people with the ability to donate eggs are restricted from doing so if they have a high BMI. The U.K. has a shortage of donor eggs for prospective parents. The HFEA explains that the shortage may be in part due to the extensive and stridently applied criteria to ensure that the eggs are “healthy”. Criteria for egg donors are based on CG156 of the NICE Guidelines and, “include clinical factors associated with increased fertility, such as a healthy body mass index (BMI), age restrictions, and other lifestyle factors (eg, alcohol intake and smoking)”. The HFEA does not decry this restriction but instead claims it provides a greater opportunity for people to get pregnant with more viable eggs.
This stance has been re-affirmed by a provider, such as ‘Manchester Donors’ which proclaims it isn’t discrimination to exclude egg donors with a high BMI, it’s science: “egg donation does exclude certain women, it’s for very good reason. It’s all about protecting the health and wellbeing of egg donors; whilst giving people who need donor eggs the best chance of a family”. This restriction extends to people who have been able to naturally conceive with their own eggs because according to Manchester Donors “Remember that donated eggs have to go through much more than a naturally fertilised egg”.
Restrictions on donor eggs from people with a high BMI are apparently due to scientific evidence. However, the basis of the scientific evidence remains subject to scrutiny and acknowledgments by researchers that significant gaps remain in their understanding of the fertility of eggs from people with a high BMI.
In short, although the extent of egg freezing discrimination is not understood in the UK for those seeking elective procedures – the NICE Guidelines are being extrapolated to unfairly restrict people with a high BMI donating frozen eggs.
So, once again there’s a shortage of real data. Are people in the UK having their choices restricted? What’s your experience? If you’ve got any insight, good or bad, please leave a comment below.