I Was Told I Was Too Fat to Freeze My Eggs

My partner and I were about to step into the elevator when a nurse at the fertility clinic came rushing out to stop us. We had just been given the go-ahead and all the prescriptions to begin hormone injections for egg retrieval and freezing and were about to head home to see my mother for Thanksgiving. It had been a tough year. My father had died just the month prior, after a long illness, which turned my attention to the big questions and lent a sense of urgency to preserving my fertility.

“There’s a problem,” the nurse said. “It’s your BMI.”

She looked genuinely sorry as she ushered us back into the office, through the waiting area, and into a small private room. We stood looking at my chart as she underlined numbers. To undergo egg retrieval at their clinic, she explained, you must have a BMI under 45. Mine was 47.

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I had been attending appointments at this clinic for months. This was the first time I had been weighed, much less told that my weight could be an issue. The nurse apologized but said that the BMI cutoff was a “state law” (this turned out not to be true) and that it was out of her hands, as it was imposed by the hospital where I would actually have the procedure. Couldn’t I go to another hospital? I asked. No, she said, they worked with only one. I explained to the nurse that the insurance covering this procedure, provided through a short-term contract with a university, would end in a matter of weeks; otherwise I was a self-employed novelist. Without coverage, egg freezing can cost $10,000 to $20,000, including the medications. In other words, this was our only shot.

Egg retrieval is tightly timed to your menstrual cycle, so the nurse suggested I lose 12 pounds in a week to achieve a BMI of 45. I asked if she felt this was a safe thing to do. She acknowledged it was not. 

I was soon speaking with the doctor at the practice. She blamed the surgical facility, saying it was their rule, not hers. I told her that imposing BMI cutoffs for access to fertility treatments was discrimination. I explained my insurance time crunch and the fact that I had begun the egg-freezing process more than a year prior but had to switch providers because of fatphobic treatment at the previous clinic. But she already knew about my experience.

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At our first consultation, I had told her about the doctor who had met me over Zoom and, based solely on my BMI, with no knowledge of my medical history, A1C level, or physical fitness, recommended that I lose weight before having the egg retrieval because, he said, there could be therapeutic and maternal-fetal challenges associated with trying to conceive. When I asked for scientific evidence of these challenges, he sent me only a pamphlet distributed by the American Society for Reproductive Medicine, which seemed to contradict this approach. “Obesity should not be the sole criteria for denying a patient or couple access to infertility treatment,” it said. Also: “Weight loss intervention trials in women with obesity and infertility have not shown an improvement in the outcome of live birth after treatment. However, weight loss may improve the chance of unassisted conception.”

My partner and I are queer. We would not be able to achieve “unassisted conception,” but that fact seemed not to have registered. Then again, perhaps this should not have surprised me. The practice had also misgendered my nonbinary partner, who uses the pronouns they and them, and insisted that they undergo blood testing for STDs despite the fact that they would not be contributing any genetic material to a pregnancy.

My new doctor had assured me that nothing like that would happen at this clinic. Yet, with the clock ticking, she proceeded to make a remark that cut me to my core, as both a fat person and a queer person.

“There are other ways to have a family,” she said. 

Floored and insulted—yes, I am aware of adoption—but also unwilling to give up, I called the surgical facility. They told me that the information the fertility clinic had given me was incorrect. Their BMI cutoff was 50, not 45, meaning I’d just squeaked in under the line. But anyone with a BMI over 40 had to come in for a consultation with the anesthesiologist. This turned out to consist of only two things: A nurse took my height and weight again, which now found that my BMI was 44, not 47. (Who knew why? They didn’t ask me to remove my shoes this time, unlike at the clinic, but as we know, weight fluctuates.) And an anesthesiologist asked me to open my mouth and say ahhh. “It has to do with your airways,” the anesthesiologist told me. “Heavier people tend to have larger tongues.”

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It turns out that doctors weren't concerned about a fat person undergoing the egg retrieval procedure itself but rather potential complications related to the anesthesia that would be used during the surgery. And yet that reasoning deserves scrutiny. The American Society for Anesthesiologists (ASA) states on its website that people who are overweight are more likely to have sleep apnea, a condition that causes us to stop breathing briefly, which can add risk to sedation. But there are no standardized guidelines, leaving doctors, practices, and hospitals to implement their own idiosyncratic BMI cutoffs. I later learned that had I sought fertility treatment at another local hospital I never would have faced these barriers, as it doesn’t apply a BMI cutoff. Meanwhile, in talking to other fat women who have been denied care in other states, I’ve heard about BMI cutoffs as low as 35.

Inconsistencies aside, medical literature suggests that the increased risk may not be all that substantial. According to a 2022 article in the ASA Monitor, outpatient surgery, where the patient is sedated only briefly and discharged the same day, as is the case for egg retrievals, now makes up the majority of surgeries in the U.S. Although obesity has been linked to a higher risk of other medical conditions, the authors write, “it has not been found to be an independent risk factor for perioperative complications.” A study published by the American Society for Reproductive Medicine in 2019 found that patients with a BMI over 40 who were undergoing egg retrieval had greater anesthetic requirements and more frequent minor complications, like needing supplemental oxygen, but “serious complications related to oocyte retrieval are uncommon.” Authors of a 2010 study on fertility treatments and BMI warned about the impact of using this metric as a determining factor for who can and can’t access treatment. “With changing demographics over half the reproductive-age population is overweight or obese,” they wrote. “Restricting fertility treatment on the grounds of BMI would cause stigmatization and lead to inequity, feelings of injustice and social tension.”

Almost 74% of people in the U.S. are considered overweight or obese, meaning a significant portion of the population is affected by BMI cutoffs for fertility treatment. But not all groups are affected equally. About 80% of Black women are overweight or obese, compared to about 64% of non-Hispanic white women. And lesbian and bisexual women are more likely to be overweight or obese than heterosexual women. This makes a strong case that imposing BMI cutoffs also has the effect of being anti-Black and anti-LGBTQ, limiting the reproductive options for certain populations.

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There is also the issue of patient autonomy. Given that the evidence that fat people would experience complications under anesthesia or be unlikely to have a baby through fertility treatment is hardly unequivocal or overwhelming, isn’t it dangerously paternalistic for doctors to restrict what kinds of elective procedures patients can and can't have? Would we prevent a straight, thin, white couple from doing another expensive round of IVF if they were fully informed that the chances of success were slim and still consented? Further, people with high BMIs undergo surgeries every day for things like broken legs, arterial blockages, and yes, bariatric surgery. Why are we more worried about the safety of fat people under anesthesia when the goal is having a family than when the goal is weight loss? The authors of the 2019 study recommended “the presence of adequate personnel, training, and equipment to perform basic and emergency airway management,” not turning people away and telling them to consider alternatives. Medical procedures, especially ones involving fertility and the emotional desire to have children, rest on a core value of choice. This value is being denied to fat people in America.

In the end, I had my egg-retrieval procedure, which went smoothly and was over in less than 45 minutes. The most significant complication I had was a very dry mouth afterward that prevented me from enjoying my post-surgery bagel with cream cheese. But I am acutely aware every time I think about these events of all the people who are still shut out by BMI cutoffs. The door swung my way this time, but I feel the shadows of all those on the other side. There are undoubtedly people there who long for kids more than I do, and it is deeply unjust that they may be denied access to procedures they desperately want because of a single number that is, at best, of questionable relevance.

I don’t know what, if anything, I’ll do with the eggs. But in a way that’s the point. These procedures exist to give people the opportunity to build a family if and when we so desire. I, and so many other fat people, deserve the same choices as everyone else.