Assisted Reproduction Unit, University of Aberdeen, Aberdeen Maternity Hospital, Forresterhill Road, Aberdeen AB25 2ZL, UK.
Hum Reprod. 2010 Apr;25(4):815-20. doi: 10.1093/humrep/deq013. Epub 2010 Feb 3.
Resource allocation towards fertility treatment has been extensively debated in countries where fertility treatment is publicly-funded. Medical, social and ethical aspects have been evaluated prior to allocation of resources. Analysis of cost-effectiveness, risks and benefits and poor success rates have led to calls of restricting fertility treatment to obese women. In this debate article, we critically appraise the evidence underlying this issue and highlight the problems with such a policy. Poor success rate of treatment is unsubstantiated as there is insufficient evidence to link high body mass index (BMI) to reduction in live birth. Obstetric complications have a linear relationship with BMI but are significantly influenced by maternal age. The same is true for miscarriage rates which are influenced by the confounding factors of polycystic ovary syndrome and age. Studies have shown that the direct costs per live birth are no greater for overweight and obese women. With changing demographics over half the reproductive-age population is overweight or obese. Restricting fertility treatment on the grounds of BMI would cause stigmatization and lead to inequity, feelings of injustice and social tension as affluent women manage to bypass these draconian restrictions. Time lost and poor success of conventional weight loss strategies would jeopardize the chances of conception for many women.
在公共资助生育治疗的国家，生育治疗的资源分配一直是广泛争论的话题。在分配资源之前，已经评估了医疗、社会和伦理方面。对成本效益、风险和收益以及低成功率的分析导致呼吁将生育治疗限制在肥胖女性。在这篇辩论文章中，我们批判性地评估了这一问题的证据，并强调了这种政策的问题。治疗成功率低的说法是没有根据的，因为没有足够的证据表明高身体质量指数（BMI）与活产率降低有关。产科并发症与 BMI 呈线性关系，但受产妇年龄的显著影响。流产率也是如此，其受到多囊卵巢综合征和年龄等混杂因素的影响。研究表明，每活产的直接成本对于超重和肥胖的女性来说并没有更高。随着人口统计数据的变化，超过一半的育龄人口超重或肥胖。以 BMI 为理由限制生育治疗会导致污名化，并导致不平等、不公正感和社会紧张，因为富裕的女性能够规避这些严厉的限制。失去时间和传统减肥策略的成功率低会危及许多妇女的受孕机会。
