About This Episode
In this short snack, Ruby and Anne chat with Dr. Nichole Barker about if and how weight impacts fertility. They unpack some of the muddiness around BMI, and explore the more nuanced goal: wellness.
Show Notes
Between the medical and cultural layers, weight can be a fraught topic. Does it matter for your fertility?
In this short snack, Ruby and Anne chat with Dr. Nichole Barker about if and how weight impacts fertility. They unpack some of the muddiness around BMI, and explore the more nuanced goal: wellness. Are you curious how your weight might affect your fertility? Are you unsure about how to have those conversations with your provider? Let’s dig in!
Transcript
00:06
RUBY
Welcome to The Whole Pineapple. I’m Ruby Booras,
00:09
ANNE
And I’m Anne Judge. The Whole Pineapple is a podcast about wellness focused around fertility. And on these weekly mini episodes, we bring you bite sized ideas for you to snack on.
00:18
RUBY
Like breathing exercises, book reviews, maybe we’ll review some scientific research, or we’ll share some wellness and fertility stories from our listeners.
00:26
ANNE
So if you’re looking for a tip or a trick related to your fertility and wellbeing, then you’ve come to the right place.
00:37
RUBY
Let’s dig in.
00:42
ANNE
Today for bite size, we’re going to talk about how we talk about weight when it comes to fertility, because this is something that can be intensely personal. And many people have a lot of emotional trauma from years of being in the medical system and feeling judged for weight. And how much of a difference does that really make when it comes to your fertility?
01:00
RUBY
Yeah, and we’re joined again by Dr. Nichole Barker, and she has some wonderful insights at that first appointment when people are concerned about their weight, or maybe they don’t want to bring it up, or they’ve had those kind of more traumatic experiences in the past.
01:23
RUBY
Some people do not want the providers to bring up weight as an issue at their new patient consult. Others are keen on talking about it and its effects. But it’s another one of those things that is, you have to kind of walk this line for how much does it really matter? And how do you address it with your patients?
01:41
NICHOLE
Yeah, it is tough, because I already know that a patient is struggling with weight. They want to talk about it usually, or they don’t want to talk about it, but they know it is something that they’re curious about. So what I found is that a lot of times people will bring it up kind of when at the end of the conversation when I’m like, is there anything else that you are worried about that I haven’t brought up yet? And they’ll lead into that, they’re like, well, I know my weight is not where it should be, what do you think about it? You know, or if they don’t say anything, and I’m, and I do want to make sure that it’s something we address, but try to be as, you know, mindful as possible, because I know that they’ve probably done a lot of overtime to try to lose weight, is I do ask them if it would be okay to talk about weight and how it impacts fertility potentially, and if they have any questions about it. And some people if they say no, I stop there, you know, I respect them. And then most people say sure I’m okay with talking about it. And really, I feel like it’s more about the metabolic profile as opposed to a number. Okay, BMI, it’s something that I don’t love. Because it’s not, I feel like as accurate as it can be to what’s going on metabolically. But at the same time, for years of medicine, we have used BMI and studies and all of this stuff, right? Like it’s always there. So I feel like I try not to focus so much on, you’re at this weight and you need to be at this weight, because that’s not the purpose. It is, let’s figure out if there’s anything else metabolically going on, do you have diabetes, or prediabetes? Do you have high cholesterol? Do you have high blood pressure or pre hypertension? And you know, sometimes patients a lot of times have their own goal in mind. They want to feel good before they get pregnant. And we talk about how we can assist them in that, in their journey of fertility. But at the same time, I also know that some people are very defensive and feel like they are going to be judged as soon as they are having a conversation with me, because they’re thinking, or maybe somebody in the past, and this always breaks my heart, is somebody told them that, well, you’re too big to get pregnant, or you shouldn’t get pregnant, because it’s you know, it’s never going to happen. You’re not, this is the cause. And the reality is that they get frustrated because they know somebody who even weighs maybe more than them and they have five kids, right? It’s not a direct correlation. So I try to focus more on just the metabolic state. And you know, if there’s anything that we need to address that could inhibit them from doing treatments, like having anesthesia in an outpatient facility for IVF. And I try to bring that up right away, so we can tackle that if that’s something that I feel like might be an issue with us. And if we can’t do it, how do we get them to where they need to be for their goal? So really, it’s about how they’re feeling about it. And do we think that from a metabolic standpoint, that they’re healthy enough for pregnancy and what are the risks when they do get pregnant? So again, I try to approach it that way. I know you guys talk a lot with patients. And so you might have some, you know, additional thoughts too. But that’s usually how I address it.
05:09
RUBY
Yeah, that’s super helpful. That, and that approach that wellness over that weight number is usually the approach, at least here that we tend to go with. Anne what has been your experience? I know you did your capstone project. <both laugh>
05:24
ANNE
I did. Yeah, I mean, I pretty much the same thing. I think, being honest from the beginning, because like you said, we know that there’s so many things that contribute. But the reality is that we do have some clinic limits in terms of anesthesia and BMI. And so I think that’s where people can feel really betrayed, is if it wasn’t brought up from the beginning that, you know, if you ever end up needing to do IVF, a BMI of above 40, we can’t do it in our facility. Like that’s something that people need to know early on. Because if they are going to have to work on weight loss, that needs to be real sustainable. The last thing we want is people doing something that’s unhealthy to try and drop weight in a short amount of time just to make an anesthesia barrier that’s made them like less healthy in terms of overall pregnancy, is just going to rebound. So, you know, having a really mindful conversation, but also being honest about the fact that our society is very obesogenic and there are discriminations built into every area of medicine. And that’s not something that we’re going to just be able to undo. And so how can we tell people what their options are, and meet them where they’re at what their goals are, I think is the most important.
06:30
NICHOLE
Absolutely. And, you know, just to kind of touch on this, and this is what I tell patients, is that this is not like, oh, we can’t get to your ovaries, or I can’t get to a follicle, or we couldn’t actually, you can’t do IVF. Like that’s not what we’re talking about, really, it’s more of an airway management and safety issue. So a lot of fertility clinics have outpatient centers where they do these procedures, and it is safest in my opinion, to be asleep for it. Because if you are putting a needle in the back of the vagina, <all laugh>, and that’s gonna hurt no matter if you put local anesthesia in there or not. Okay, and moving around when there’s other things other than an ovary, you got bowel, bladder, blood vessels around, to me is not safe. So I feel like general anesthesia is for me the safest for my patients, and how can I have my patients do this procedure that they deserve to have a chance to do safely? And so it’s more of the airway management and making sure that they are the safest during the procedure. It’s not that you can’t have it, right? So we talk about that. And I talked about, well, if I can’t offer it to you, how can we maybe get you to the goal to do it here. Or maybe there’s another option to send you to a hospital-based setting, which we talk about too. So again, I always, you know, hate that feeling that patients are like, oh, you’re like the gatekeeper of my fertility. And that’s not what I’m here to do. I’m here to keep you safe, I want you to have a baby. I want this to work. And I want it to be safe. So we talk about those things. And those are not easy conversations for most people. But I will say that being like very upfront about that from the beginning. Most people get it, they’re like, I do want to be healthy, or I do have a goal. I’ve been trying to work on it. Do you have anything that can help me or assist me in getting to be metabolically healthier? And stuff like that. So, you know, having our wellness program and having a wellness coach where we are, and having nutrition, and having our nurse practitioners do PCOS visits and stuff like that, and supporting, and symposiums and all this stuff, I feel like is important to support our patients to just be the best they can to hopefully have a healthy pregnancy.
08:49
ANNE
And I know sometimes, you know, it seems hard what we have in the US. But you know, from an international perspective, it’s fascinating that so many countries that do have fertility coverage have very strict BMI limits. And they’re much lower than any of our clinic limits. There are many countries where if a BMI is over 30 or over 35, you don’t qualify for coverage. So as challenging as things are in the US, it’s not all that much better other places.
09:11
RUBY
And one thing to know too, is just we’re not here to put a barrier here for you. Whenever you feel like you’re at the end of the road you probably aren’t, and that’s just a discussion with your doc or your nurse practitioner or your fertility provider. It’s like I feel stuck. I feel like I don’t have anywhere to go from here. And usually there is a discussion, there is a way to go.
09:39
ANNE
Thanks for joining us for this week’s episode of The Whole Pineapple podcast. We hope it was helpful.
9:44
RUBY
If you know someone who could benefit from hearing the podcast. We hope you’ll share it with them.
9:48
ANNE
And don’t forget to subscribe, rate and review The Whole Pineapple on your favorite podcast app. Every rating and review makes us easier to find.
9:55
RUBY
This podcast is sponsored by Seattle Reproductive Medicine and produced by Audiotocracy Podcast Production. We’ll see you next time. Have a delicious week.
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