Honey Tawhai has always known she wanted to become a mum. What she didn't know, was that she would have trouble conceiving.
“My sister has six kids. I’ve got another sister who’s got five kids. Why would I have trouble?” Honey told The Feed.
Honey was 28 when she and her partner started trying for a baby. But after many months of disappointing pregnancy tests, she was referred to a gynaecologist.
“[The gynaecologist] basically said I just need to lose weight. ‘Get to 80 kilos then come back to me and I’ll consider you for fertility treatment’. And that would have been about 60 kilos I had to lose,” she says.
Honey describes herself as a “big girl”.
“I’m Maori and I’ve got Samoan in me as well. We don’t fit in a traditional European BMI (Body Mass Index) weight range.
“This weight isn’t because I’m lazy and I sit around and do nothing all day. Look at the gardens!” she says, pointing to her large manicured backyard in the Hunter Valley.
After seeing the gynaecologist, Honey lost around 10 kilograms - but the target she had been set felt “near impossible”.
Over the years that followed, Honey saw two more fertility specialists who told her the same thing - that she would have to significantly reduce her weight before they would offer her fertility treatment like IVF.
“That’s when I had to try and accept that I was infertile and I would never have children,” she says.
“You just want to cry all the time. It’s torture.”
‘A lot of people in a lot of pain’
Dr Fiona Willer is a lecturer in nutrition and dietetics at the Queensland University of Technology and a founding member of Health at Every Size Australia.
She says it’s not uncommon for women to be turned away by fertility clinics because of their BMI, with a BMI of over 30 considered obese.
“It’s a lot of people in a lot of pain,” Dr Willer told The Feed.
According to the federal government's Health Direct website, the Body Mass Index is a guide to help people estimate their total body fat as a proportion of their total body weight.
BMI is calculated by dividing a person's weight in kilograms by height in metres squared.
Online BMI calculators ask you to input your weight and height to generate a BMI figure.
But Dr Willer says BMI is a “quick and dirty metric" that doesn't always adequately reflect a person's health or body composition.
Dr Fiona Willer says BMI is a “quick and dirty metric".
Dr Willer argues that some private fertility clinics exclude obese women to improve their success rates.
“If [a fertility clinic] can select the kind of patients who are going to have, in their perception, better outcomes that means that their stats look better. And larger-bodied people have been forgotten in that battle,” she says.
But others argue this isn’t the primary reason women are being turned away.
‘That’s not good medicine’
Professor Kelton Tremellen, a gynaecologist attached to Adelaide's Flinders University, points to the guidelines of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).
The RANZCOG guidelines, last updated in 2014 and currently under review, recommend against fertility treatments such as IVF for women with a BMI over 35 except in “exceptional circumstances”.
“I think doctors who are adhering slavishly to these college guidelines are actually not looking at the evidence that’s out there already and they’re being unfair to their patients. That’s not good medicine,” Professor Tremellen says.
Professor Tremellen cites three randomised controlled trials that have looked at the impact of intensive weight loss of seven to nine kilograms before fertility treatment.
“With that weight loss there was no improvement in IVF success. There was no improvement in any of the major outcomes during pregnancy like diabetes or high blood pressure. There was no improvement for the babies’ health,” says Professor Tremellen.
He says obese women should still try to lose weight before attempting fertility treatment.
“But if [weight loss] isn’t successful in those few months it’s just unethical to send them off and say ‘I can’t help you any further’”.
According to Professor Tremellen around a third of women with a BMI over 30 are “metabolically healthy”.
Professor Steve Robson, obstetrician and gynaecologist and former president of RANZCOG, chaired the committee that wrote the guidelines about fertility treatment and BMI.
Speaking on behalf of RANZCOG, he says obesity is the most common condition that affects the health of pregnant women and their babies.
“One of the complications is that babies of women with a very high BMI are more likely to have genetic anomalies such as spina bifida, " he says.
“It also means women are more likely to have a number of complications in pregnancy like hypertension, preeclampsia and diabetes.”
Professor Robson says the guideline was written because of these risks.
“You have an opportunity before pregnancy to try to optimise the health of the woman and importantly to minimise risk to the next generation,” he says.
Professor Tremellan acknowledges the increased risks associated with obesity and says they shouldn’t be “glossed over”.
“But one has to recognise that there are a lot of women who conceive naturally with a BMI above 30 or 35 and we just have to deal with those risks,” he says.
Honey says it should be a woman’s right to choose whether to undergo fertility treatment.
“If I have the whole information in front of me and I still want to take that risk that should be my risk to take. It’s my life, it’s not the doctor’s life,” she says.
Honey Tawhai describes her daughter as a 'miracle baby'.
“[My daughter] is a miracle. I have been told heaps of times ‘you’re infertile, you can’t have kids, you never will until you lose this weight,” she says.
But Honey remains angry at what she calls “the BMI rule for fertility treatment”.
“It’s total discrimination,” she says.
