Overweight on NHS IVF

[Marimul]

I'm wondering if anyone else is going starting the same process of fertility through IVF while being overweight.

I have pcos and anxiety(currently on sertraline)
The duo causes me weight gain and has made loosing weight near impossible, I've tried everything I can financially afford. ( Had been referred for weight loss injections but nothing came of it)

I've been referred by the GP for IVF 4 weeks ago.
I have read through NHS IVF and seen the criteria, which I currently don't meet due to my weight.

My question is has anybody had this same experience and how did you manage? Did the specialist decline the IVF or did they help with weight loss? Or was there an exception?

I'm worried I won't be accepted and won't be able to get pregnant.

Any advice or experience stories welcomed.

I'll be honest because I don't think there is any point sugar coating it. The GP referred me, knowing my weight, but didn't really emphasise the importance, and this was a long time ago now.

When my appointment came through they said they would do all the tests, but my BMI had to meet the threshold before I would get treatment.

Getting to the right weight took me an extra 6 months, and my funded cycle failed, so I ended up paying anyway.

dS1 is 15 now, so add a few years on to that, but I wasn't offered any help with weight loss.

I haven't been through it but know several people we where referred and denied due to weight and eventually either gave up trying because they couldn't lose the weight or saved to pay for it privately

Thank you. I new it would be a problem but had no pre warning or any information about it.

I know the NHS criteria is so strict but I'd rather have known before being referred so I'm not disappointed straight away.

Thanks for the honesty.

Are you aware of weight criteria for privately funded IVF?

Privately funded IVF is more lenient, they said under BMI 30 at my clinic.

So is dependant on the specific clinic as NHS I believe is 35 BMI.

It's so difficult to loose the weight for me, I don't know where to start and it hasn't even started yet!😫

Yes, but there is a good reason — I asked my consultant why there was a limit, because lots of overweight women have babies successfully. He said the problem isn’t the pregnancy, but the drugs — they are unable to work properly if your BMI is too high.

The NHS was a bmi of 30 when I had to lose the weight, I was 39 at the time

35 is quite lenient. That's quite into the obese range. Are you far off that?

Okay it makes sense about the medication,

And I'm not too far off but since being on sertraline I have not been able to loose no more than 2 pounds or so, whereas before with my personal trainer I managed to lose 1.5 stone, but have gained and more on the sertraline.

I'm not able to come off the medication as I get anxiety attacks, with the medication I'm good.

The BMI limits are not arbitrary, being outside 19-30 makes you less likely to conceive.

How old are you? If you are not near the age limits I would work on reducing your BMI to below 30 before having IVF

Will you not need to come off Sertraline when pregnant? It does come with risks. Very low I know.

Could you get help with weight loss first, like injections? You might well find that if you lose weight you won’t need IVF. “Ozempic babies” are a thing!

Don’t take this the wrong way…. But can’t you just eat whole lot less than you do? This is coming from someone who lost 14kg last year for IVF. I knew I wanted a baby so the starvation was worth it… not healthy perhaps, but so worth it.

It is fairly strict for a reason, the drugs just won’t work with a higher BMI and although overweight ladies can have babies, the chances of a successful conception/pregnancy do decrease when BMI is higher. Also things like thyroid levels, hormone levels and blood sugar levels are all grossly affected by being overweight - all of which are so important for TTC.

I don’t wholeheartedly agree with BMI being an accurate measure. I have PCOS and also on sertraline, however I swim a lot and to cross fit, so I have large shoulders and legs - always have. I’m a healthy size 12 but my BMI is always high due to my muscle mass. Even the fact I was clearly healthy and fit, this still wasn’t taken into to consideration when needing NHS help for fertility. It really is strict.

The only option I had was a trim down. Healthy eating and portion control is a great start. Exercise definitely helps.

I understand what you’re saying about sertraline and anxiety, however there is no possible way you can’t lose weight with a calorie deficit and regular exercise. It’s really hard to get started, but if wanting a baby isn’t motivation enough to get you to do, I don’t know what is.

Wishing you the best of luck!

OP, I’m not in the UK, but where I live, I have a couple of friends who were in the same boat as you with PCOS and high BMI.
Their ivf clinics refused to start till they had dropped below 35. They tried VLCDs (Very Low Calorie Diets). They’re basically nutritionally balanced (not protein!) shakes in different flavours, savoury and sweet. You have 1 for each meal, and they give you a list of foods and drinks you can have as snacks or if you’re still hungry.
My friends both dropped enough weight in 2 and 3 months respectively, and went on to have lovely babies. It’s not a long-term solution, but something to get kick-started and get to a healthier weight. Perhaps worth discussing with your GP if they’re available in the UK?

I'm currently in the process of losing weight to qualify for IVF on the NHS (having all the pre tests done and my other half's test is late September so expecting an appointment soon after). I know from friends that if their BMI was over the top limit their funding request was rejected. I don't like BMI being used as a health measure in general but unfortunately it's a statutory number I need to hit. I have started calories counting and eating in a deficit again (which I've done successfully before) and I've lost nearly 2kg in 2 weeks without starving and still eating all the foods I like just in smaller quantities and not all the time! It is possible on sertraline (speaking from experience) you just need to figure out what your deficit is. You don't need to spend money on fancy diets.

I was referred and knew my BMI was an issue. They did all blood work etc but had advised I had to lose weight before any fertility treatment.

I had 6 monthly appointments planned to see my progress and was referred to the NHS weight loss team which was pretty good.

At my 1st appointment however, I was prescribed metformin to help with my PCOS symptoms / help regulate my cycle (very infrequent periods / ovulation) .. also to help with the weight loss. And I actually conceived whilst taking this (within the first 3 months) and I am currently 31 weeks (after 8yrs ttc) .

This meant by my 2nd app, I was discharged.

Is metformin something you have discussed / asked for for help with the PCOS symptoms? Worth trying in my opinion - doesn't work for everyone however, helps to manage insulin resistance in someone with PCOS. Only thing that's ever worked for me. Also helped with the hair growth / hunger levels etc.

Hello! Fellow PCOS cyster here! I’m also losing weight in anticipation of IVF. I was diagnosed with PCOS in May 2023 and my doctor put me on 2000mg of Metformin per day. It has honestly completely transformed my life. I’ve been able to lose weight for what feels like the first time in my life. I’m 1 stone 8 pounds down and got another stone to lose to get to the 30 BMI threshold.

I also go to the gym 3 x a week for 90 mins per session (30 mins cardio, 60 mins weights) and do 4-5 mile walks twice a week.
I also swapped all white carbs for brown carbs and I take MyoInositol supplements.

With PCOS and a thyroid issue (hashimotos) the only way I was able to lose weight was to cut out most carbs. I just stopped eating all bread pasta cake biscuits rice etc. nothing else worked

Just my two cents but in my current experience BMI needs to be under 35 for my private clinic and under 30 for NHS (I’m undergoing testing right now and am in the North West).

Sadly it’s not arbitrary. I say this as someone with a 32 BMI. Hoping to drop a stone in a month 😬

I have PCOS and went through fertility checks. I ended up conceiving whilst taking metformin which can also assist weight loss with the right diet. Have they explored using metformin for you? Try a low carb, high protein diet which often work well for weight loss with PCOS.

I have Pcos

I lost half a stone due to metformin and myo inostol .

Its hard with pcos
Re insulin resistance

Have you taken daily myo inostol ?

Are you drinking lotsa water ?

Have you reduced carbs ?

Have half a plate of veg with each meal

Dont eat late
Snack less

Dont eat after dinner - NHS dietician told me that

NHS requirements are under 30. Private clinics will often take up to 35. There may be clinics that go higher. The limits also relate to the riskier egg collection sedation/ general anaesthetic.

Work out a couple of really healthy meals you love, so they're never a chore to eat and try to walk as much as possible and/ or get some home weights to do with a youtube tutorial so you can do even 20 minutes here and there.

Good luck!

As a medical negligence solicitor, I've seen numerous cases where the mother's high BMI affected the clinicians' ability to provide care.

Obese mothers are less likely to feel fetal movements so often need additional antenatal appointments to reassure them that baby is OK.

It's much harder to detect fetal heart rate on a CTG through a significant layer of fat. It also affects the clarity of imaging.

Sorry to be so negative but there's good reason for a doctor to recommend weight loss when TTC.

Hi op, we had IVF 5 years ago and I was told all the way through that my BMI was over the threshold and I had to try and get it down else I would be refused and my top of the waiting list appointment would be moved back down to the bottom. I honestly can't remember how overweight I was, I think possibly 12lb or so (I am now three stone over than now!) so for the month leading up to the appointment I was living on alternate breakfasts of 2 scrambled egg with spinach, or 2 scrambled egg with heck low fat sausages, lunches of an apple and an orange, and dinners of either fish and veg or chicken and salad - no condiments, no sauces, no sugar in any hot drinks, and I was walking the dog twice a day. It did work, but the headaches were crippling, likely due to my blood sugar.

At my appointment she weighed me (I asked if I could strip to my underwear just to make sure!) and as soon as you hit the magic number, that's the last time you are weighed and your treatment is authorised (or at least this was the case back then).

Best of luck op, I know how hard it is