An International Committee Proposed New BMI Guidelines: What it Means for Egg Freezing and Donation

The medical community is rethinking how we measure and define obesity, which could have major implications for fertility care access. And we are totally on board. 

An international committee composed of 56 experts with expertise in nutrition, endocrinology, internal medicine, and public health has published a report in the journal Lancet Diabetes & Endocrinology. They propose moving beyond the longstanding reliance on Body Mass Index (BMI) alone when defining obesity, recommending new, more comprehensive metrics like waist circumference and body fat distribution. For those interested in egg freezing or donation, these developments could finally mean meaningful changes in how fertility clinics evaluate candidates.

Fertility clinics have historically used BMI as a key screening tool for determining eligibility for procedures like egg freezing and donation. The new guidelines acknowledge what many of us in healthcare have long recognized: that BMI alone doesn't tell the full story of someone's health or their suitability for medical procedures.

In this article, we'll explore what these new obesity measurement guidelines mean, how they might affect access to fertility care, and why this matters for anyone considering egg freezing or donation. We'll also look at how these changes align with Cofertility's mission to make fertility preservation more accessible while maintaining high safety standards.

Understanding the new obesity guidelines

The Lancet Diabetes & Endocrinology Commission has proposed significant changes to how obesity is defined and diagnosed. Instead of relying solely on BMI, they recommend incorporating additional measurements such as:

• Waist circumference measurements, which can better indicate the distribution of body fat
• Waist-to-hip ratio calculations to assess body composition
• Organ function and daily activity limitations
• Direct body fat measurements through methods like DEXA scans when available

The commission also introduces two new categories: "clinical obesity" for those with existing obesity-related health conditions and "pre-clinical obesity" for those at elevated risk of developing such conditions.

How fertility clinics use  BMI requirements 

Currently, most fertility clinics require BMI measurements within specific ranges for egg freezing and donation procedures. These requirements stem from several concerns:

• Anesthesia risks during egg retrieval procedures
• Potential complications during hormone stimulation
• Visibility challenges during ultrasound monitoring
• Possible impacts on egg quality and retrieval outcomes

However, these one-size-fits-all BMI-based policies may unnecessarily restrict access to fertility care for many healthy individuals. Dr. Robert Kushner, an endocrinologist at Northwestern University and commission member, notes that BMI can both overestimate and underestimate body fat, potentially misclassifying up to 40% of adults.

For example, someone like rugby player Ilona Maher would not qualify to be an egg donor at some fertility clinics. Despite being an Olympian with a clean bill of health—she would be immediately disqualified due to her BMI (she is 5′ 10″ and weighs 198 lbs).

Implications for egg freezing and donation

We hope the new guidelines lead to more nuanced screening processes for fertility procedures. Rather than using BMI as a sole disqualifying factor, clinics will hopefully begin considering multiple metrics to assess a person's overall health status and procedural risks.

This shift could particularly benefit:

• Athletes and individuals with high muscle mass, who may have elevated BMIs despite healthy body composition
• People with different ethnic backgrounds, as BMI standards were primarily developed based on white body types
• Individuals who carry weight differently but maintain good metabolic health

Safety considerations remain a priority

While these developments are promising for expanding access to fertility care, patient safety must always come first. The new guidelines don't eliminate the need to assess health risks—they simply provide better tools for doing so.

Some key safety factors that will continue to require careful evaluation:

• Anesthesia risks during egg retrieval
• Response to fertility medications
• Overall metabolic health
• Cardiovascular fitness

What this means for Cofertility members

We support evidence-based changes that could make fertility care more accessible without compromising safety.

While these new recommendations have not yet been widely implemented in fertility clinics in the US, we're watching these developments closely as they align with our belief that fertility care access should be accessible to all. 

For those currently considering egg freezing or donation:

• The implementation of new guidelines may take time as clinics decide whether to update their protocols
• We recommend discussing your individual health profile with your healthcare provider and working with them to understand your individual risk factors. 
• Remember that overall health involves multiple factors beyond any single measurement
• Stay informed about evolving medical guidelines that might affect your options

Looking ahead

The medical community's shift toward more nuanced health assessment methods represents an opportunity to improve access to fertility care while maintaining high safety standards. As these new guidelines begin to influence clinical practice, we hope to see positive changes in how fertility clinics evaluate candidates for egg freezing and donation. Cofertility remains committed to supporting members through evidence-based, accessible fertility care options. We'll continue to monitor these developments and update our community as clinical practices evolve.