Society issues guidance on IVFBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7567.517-c (Published 07 September 2006) Cite this as: BMJ 2006;333:517
All rapid responses
In his report on the guidance issued by the British Fertility
Adrian O'Dowd makes the rather sensational claim that the society
recommended obese women should be denied fertility treatment. In this,
he shows the same bias as much of the rest of the media. The guidance
issued by the BFS actually states that women at both extremes of weight
(BMI<19 or >29) should be referred for dietetic advice, warned of
pregnancy risks and, if appropriate, provided with access to further
interventions including psychological.
The media furore has focused exclusively on the obesity advice,
the advice about underweight women. An array of published studies show
associations between eating disorders, intrauterine growth retardation,
preterm delivery and and poor pregnancy outcome (1,2, ). Subfertility in
eating disordered women is a homeostatic response to inadequate
nutrition, but failure to appreciate this has led to cases of conception
as a result of artificial ovulation induction, with poor outcomes(3). A
survey of obstetricians in Sydney showed that few made any reference to
body weight records during prenatal visits, with fewer than 50% asking
about body weight control and disordered eating (4). A subsequent study
in the UK showed considerable deficits in knowledge of eating
disorders' reproductive pathology among obstetricians (5).
We regret that the selected reporting of the guidelines led to a
opportunity to raise awareness of the profound effects of eating
disorders on reproductive pathology, both on fertility and on the
outcome of pregnancy.
1.Morgan J F. Eating Disorders and Reproduction. Aust NZ J Obstet
Gynaecol 1999; 39: 2:167-173.
2. Morgan JF, Chung, E, Lacey JH. Risk of Postnatal Depression,
Miscarriage, and Preterm Birth in Bulimia Nervosa. Psychosomatic
Medicine , 68, 487-492, 2006.
3. Abraham S, Mira N, Llewellyn-Jones D. Should ovulation be induced
women recovering from an eating disorder or who are compulsive
exercisers? Fertil Steril 1990; 53:566-568.
4. Obstetricians and maternal body weight and eating disorders during
pregnancy. J Psychosom Obstet and Gynecol 22(3):159-163, 2001.
5. Morgan JF. Eating Disorders and gynaecology - knowledge and
among clinicians. Acta Scandanavica Obstetricia et Gynecologica 78(3): 233
Competing interests: No competing interests