Calls to change BMI requirements for publicly-funded IVF treatment

There are calls for Body Mass Index restrictions for publicly-funded IVF to be eased, with claims they disproportionately prevent Māori and Pasifika women from accessing fertility treatment.

Current rules require women to have a BMI no greater than 32 to access public treatment, while private and more costly treatment has no restrictions at all.

"It does discriminate against Māori and Pasifika," Dr Edmond Fehoko, a Senior Lecturer in Human Nutrition at the University of Otago said.

"It is a Western scientific construct that does not allow the diverse communities here in Aotearoa to have an opportunity to explore assisted reproductive technologies."

According to the Body Mass Index scale, 18.5 to 24.9 is within the healthy-weight range, 25 to 30 is overweight and more than 30 is obese.

But Fertility Associates says BMI is an outdated tool that should no longer be so strictly used in IVF treatment, which has been the case for 20 years.

"Things have changed massively in the past 20 years," Dr Andrew Murray from Fertility Associates said.

"BMI does not impact success rates in IVF at all. We look at BMIs of up to 35 and we get exactly the same pregnancy rates. We are now used to looking after women who are heavier," he said.

"The group most disadvantaged by this is Māori and Pasifika. We know that 40% of women of Māori and Pasifika descent have a BMI of over 32 and so there immediately is an inequity."

Fertility New Zealand agrees the criteria should be reviewed.

"BMI might not be the biggest factor impacting someone's fertility," FNZ Spokesperson Juanita Copeland said.

"So when someone is told they do not qualify because of their BMI they have to go away and lose weight, but that might not be what is stopping them from getting pregnant."

"If you have gone months and months of trying to conceive a baby and not had success, and finally go to a specialist and the first thing they say to you is you need to lose weight, that a brings a massive amount of shame and guilt and pressure on the woman in particular."

"It is a tool used across the whole health system but we feel it is quite crude and it is quite outdated."

Dr Fehoko and his research partner, Dr Zaramasina Clark from Victoria University, were recently awarded a grant to look into rising infertility in the Pasifika community, compared to other ethnicities.

The research will be complete in 2026.

"There is no data out there in why that gap exists and so one of the big things we want to look at, is whether BMI cut offs might be a barrier to Pacific people accessing assisted reproduction clinically." Dr Clark said.

"Our Māori and Pacific people are going into these spaces with weight challenges, and then to be informed by fertility specialists, bro you are too fat, you are too obese. That is already a stigma on its own," Dr Fehoko says.

"It is our hope that we can explore through this study whether we can change the criteria that will allow all people to have an opportunity. I think this will be ground-breaking for communities across Aotearoa."

Dr Clark said she hopes the research highlights a traditionally under-discussed issue.

"There is a lot of shame and hurt Pacific families feel around infertility and it is the right time to start developing ways to talk about them in a culturally safe way."

Health New Zealand says publicly-funded fertility treatment is available to those who meet Clinical Priority Assessment Criteria (CPAC) for fertility services.

In a statement it said CPAC allocates points based on a person or couple’s chances of becoming pregnant with and without treatment.

This includes factors such as age, body mass index, and the presence of specific health issues that limit their fertility.

It said there are no current plans to change the criteria for publicly-funded fertility treatment.

Dr Murray said while being obese can impact fertility, the criteria is too narrow to properly reflect the diversity of New Zealand women.

"The last thing someone struggling with fertility issues wants to hear is, we think you are fat and lazy, and that is why you cannot have treatment, because that is just simply not the case," he said.

"Some people are just genetically programmed to be heavier."