Should People Who Are Obese and Smoke Be Allowed IVF?


This is a question that delves not only into science and medicine, but ethics as well. While the argument has been made that denying a potentially life-saving or life-improving treatment or medicine to somebody based on their lifestyle habits or weight is unethical, in vitro fertilization (IVF) is not a procedure designed to save lives or improve health. It’s an assisted reproductive technology (ART) that helps otherwise infertile couples or individuals get pregnant by combining sperm and eggs to create embryos, and then transferring those embryos to the uterus for implantation in the uterine lining.

Smoking and obesity may contribute to infertility, making it more difficult to conceive naturally or even with the help of fertility treatment, and smoking is considered harmful to a developing fetus. Some argue that participants in IVF cycles be required to quit smoking for several months prior to treatment, and require that they achieve a healthy body mass index that puts them neither overweight or underweight. Such measures may help improve fertility, which may even help them conceive naturally as opposed to going through a cycle of treatment. Requiring they quit smoking may also protect fetuses from developmental problems associated with mothers who smoke while pregnant. For some, it is an ethical issue of helping a mother who smokes become pregnant.

Some National Health Service primary care trusts (PCT) in the United Kingdom have already instituted policies regarding patients who smoke or who are not in what is considered the healthy BMI range between 19 and 29.9. Patients are required to quit smoking for six months and achieve a healthy BMI prior to undergoing the procedure. Other procedures, such as hip and knee replacements, also require that patients quit smoking and achieve a healthy BMI. This has garnered criticism from some who see such policies as discriminatory. Critics of the requirements argue that such decisions involving patient health and fertility should be made by the patients themselves as well as their doctors who will help determine what is safe.

This is an issue that has sparked intense debate in some scientific, medical, and policy-making circles, with arguments made for the rights of the patients, rights of other patients, and rights of the resulting fetus. The public has even weighed in, adopting arguments from experts on both sides and presenting some of their own. The debate is not likely to go away as more and more couples turn to IVF and other procedures to help overcome infertility.