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Health Care Analysis
Published in: Health Care Analysis 2/2019

Open Access 01-06-2019 | Fertility | Original Article

Irresponsibly Infertile? Obesity, Efficiency, and Exclusion from Treatment

Author: Rebecca C. H. Brown

Published in: Health Care Analysis | Issue 2/2019

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Abstract

Many countries tightly ration access to publicly funded fertility treatments such as in vitro fertilisation (IVF). One basis for excluding people from access to IVF is their body mass index. In this paper, I consider a number of potential justifications for such a policy, based on claims about effectiveness and cost-efficiency, and reject these as unsupported by available evidence. I consider an alternative justification: that those whose subfertility results from avoidable behaviours for which they are responsible are less deserving of treatment. I ultimately stop short of endorsing or rejecting such a justification, though highlight some reasons for thinking it is unlikely to be practicable.
Footnotes
1
These data have been collected by the group Fertility Fairness which used freedom of information requests to access individual commissioning organisations’ policies regarding BMI and IVF provision. Such policies do not guarantee that no person with a BMI outside this range receives NHS funded IVF since there remains the possibility for individual physicians to circumvent the decisions made by commissioners.
 
2
Even this may not be wholly uncontentious. Evidence suggests people derive value from being provided with ART even when it reduces their chances of conception, as in a paper by Bhattacharya et al. [2] where satisfaction with treatment was higher in the treatment group (who received clomifene citrate) than in those in the expectant management group, even though it turned out that clomifene citrate acted as a mild contraceptive.
 
3
Cochrane reviews synthesise data from separate studies and frequently provide a meta-analysis of the evidence from separate research trials in order to try to better assess the effect of a particular intervention.
 
4
For more on the methods used to calculate QALYs for fertility-affecting treatment, see [15, 49].
 
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Metadata
Title
Irresponsibly Infertile? Obesity, Efficiency, and Exclusion from Treatment
Author
Rebecca C. H. Brown
Publication date
01-06-2019
Publisher
Springer US
Published in
Health Care Analysis / Issue 2/2019
Print ISSN: 1065-3058
Electronic ISSN: 1573-3394
DOI
https://doi.org/10.1007/s10728-019-00366-w

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