# “You don’t treat your skinny patients like this”: a qualitative study of fertility care experiences among women with larger bodies and infertility

## TL;DR

This study explores how women with larger bodies experience stigma and substandard care in fertility treatment, highlighting the need for more compassionate and personalized healthcare.

## Contribution

The study provides novel qualitative insights into the intersection of weight stigma and infertility care, emphasizing the need for patient-centered approaches.

## Key findings

- Participants reported stigmatizing treatment and substandard care from fertility providers.
- Many received abbreviated diagnostic evaluations that missed critical diagnoses.
- Quality care was perceived as achievable when providers offered humanizing and individualized treatment.

## Abstract

Prior studies show that people with larger bodies experience pervasive weight stigma, which is often directly perpetuated by healthcare providers. This pattern has also been observed in women receiving prenatal and postpartum care. Individuals seeking treatment for infertility commonly encounter concrete barriers, such as formalized BMI-based restrictions. These limitations may further compound the isolating and stigmatizing experiences already known to affect women with infertility.

Qualitative study exploring the experiences and perceptions of patients with larger bodies and infertility. Women seeking fertility care within the past 2 years with a BMI ≥ 30 kg/m2 were eligible for participation. Demographic surveys and one-on-one semi-structured interviews were performed. Interviews were deidentified, transcribed, and analyzed inductively using a thematic analysis approach. Major themes and subthemes were identified by two coders with discrepancies being resolved with a third coder.

A total of 33 subjects were included in the analysis. Mean age of participants was 36.9 years. Key themes identified included stigmatizing treatment, perceptions of substandard care, complex body relationships, and quality care as an achievable goal. Many participants reported receiving shaming and judgmental care throughout their healthcare encounters including fertility care, which for several directly influenced their decision to pursue treatment. Participants often reported receiving abbreviated, substandard diagnostic evaluations that in many cases missed critical diagnoses. Participants conveyed significant awareness of the impact of weight on fertility and complex weight cycling histories, and this knowledge paired with these experiences often went unaddressed by providers.

Consistent with the experiences of patients with larger bodies broadly, patients with infertility similarly report receiving stigmatizing treatment and perceived substandard care from their fertility providers. This potential harm to patients is not inevitable; participants report receiving quality care where providers offer humanizing and individualized care. There is a clear need for personalized and patient-centered treatment for this population of patients, that while marginalized, account for an increasing percentage of fertility patients.