A retrospective cohort study examining the outcomes of patients who present for fertility care and exceed a set body mass index threshold for treatment

Objective: To evaluate the characteristics of patients who exceeded the body mass index (BMI) threshold for fertility treatment at their initial visit and identify those for whom treatment would be constrained.

Design: Retrospective cohort study.

Setting: Academic medical center.

Patients: All new patients who presented for infertility treatment at an academic center between January 2020 and December 2022 and had BMI measured and recorded.

Main outcome measures: Likelihood of weight loss and treatment initiation for patients who exceed a set BMI threshold of 40 kg/m².

Results: Of the 1,268 patients who had their BMI recorded at initial visit, 48% identified as non-Hispanic White, 15% as non-Hispanic Black, 13% as Asian, 11% as Hispanic, 0.2% as Native American, 4% as other; 9% were of unknown race/ethnicity. Overall, 6% of women exceeded the 40 kg/m² cutoff. Among Latino women, 7.5% exceeded the cutoff; among non-Hispanic Black women, 12% exceeded the cutoff. These percentages were greater than the percentage of non-Hispanic White women who exceeded the BMI cutoff (4.8%).

Conclusions: Body mass index thresholds disproportionately affect the ability of ethnic minorities to use fertility treatment and could potentially be worsening barriers to care these population of patients already face.