Tuesday, June 18, 2019
Home Health Oxford teaches that obese people wrongly rejected IVF through the cost-saving NHS

Oxford teaches that obese people wrongly rejected IVF through the cost-saving NHS

Overweight people are unfairly dismissed by NHS bureaucrats, who see them as "easy targets" for refusing expensive treatment, according to research at the University of Oxford.

An article by health researcher Dr. Rebecca Brown said that unfounded assumptions that people are overweight by choice and as a result become infertile make decisions that reject their applications unopposed.

She argues that high-quality data from clinical trials – which the NHS naturally demands for other treatments – are scarce or lacking for IVF.

What studies are available has shown that fertility and pregnancy success rates have fallen in people who are obese, but the success rates of the fertility method are less clear.

"There's no evidence for the effectiveness of IVF on anyone," Dr. Brown The Independentand added that this was Partly because rigorous data collection would result in some couples receiving placebo treatment.

In England, the National Institute of Health and Care Excellence (Nice) evaluates treatments’ cost effectiveness. Despite previously saying it would be “illogical” to try to calculate the value of a live birth through IVF, it did produce a report which aimed to do just that and specified that women who are obese, based on their BMI, may not meet this threshold.

However, Dr Brown said it made a number of “rough and ready” assumptions, and gives no consideration to the benefits the male partner might receive from becoming a parent. This methodology “masks other influences, such as negative attitudes towards obese people that render them easy targets for cost-cutting commissioners”, Dr Brown said said in the journal Healthcare Analysis.

Nice does not specify that this means heavier people should be denied IVF. However, the BMI limit is imposed by almost all clinical commissioning groups (CCG) and health boards in the UK – a quarter impose cut-offs on the male partner's BMI or age.

Sian Gilbert, 29, and her partner have been trying to conceive for six years.

She has polycystic ovary syndrome (PCOS) which means she does not ovulate naturally and also affects her hormones, making it harder for her to lose weight.

As her partner has fertility issues as well, despite being otherwise healthy, they have been told a more expensive form of IVF known as intracytoplasmic sperm injection (ICSI) is their only chance to conceive.

However, they have never received any form of fertility treatment because of weight BMI restrictions imposed by West Kent CCG.

Sian Gilbert and her partner have been told IVF is their only hope of conceiving but are ineligible for NHS funding (Sian Gilbert)

Ms Gilbert said they have been left “in limbo” since her last meeting with a fertility specialist at Pembury Hospital.

“He literally said ‘Go away and come back when you’ve lost weight’,” she told The Independent “That’s it. No advice, no support on how to do that with somebody who suffers from PCOS, nothing.”

While she was regularly playing football and keeping active, an injury has made it harder for her to run or cycle and after recently changing jobs she has struggled to justify the cost of a gym membership.

“With PCOS you kind of get stuck,” Ms Gilbert said. “You’re doing all this work, eating well doing what you can to lose weight, but it just stops – it’s the most disheartening thing ever.”

Nice told The Independent its guidelines did not specify that NHS organisations should deny IVF to people who are overweight. However, the sustained squeeze on funds means many CCGs use it as a justification to impose ever more restrictive measures.

West Kent CCG has recently run a consultation on lowering the number of IVF cycles it offers from two to one, well below the Nice-recommended three, and although the majority of respondents opposed the cuts it has yet to make a decision.

“When organisations like Nice and the NHS get involved by refusing to provide treatments to people on the basis of their obesity, it reinforces this distinction that these people are unable to be helped by the normal mechanisms,” Dr Brown said.

“If that’s backed up by really good evidence, I don’t think it’s illegitimate to use obesity as a criteria.

“If it’s really dangerous, or completely ineffective, then sure. But that doesn’t seem to be the case, so I speculate that it’s driven by other kinds of things like an assumption that its within people’s control to lose weight and a willingness to treat them less well than we treat other kinds of people.”

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