Understanding experiences of BMI-Based Exclusion from Fertility Treatment: An Ethnographic Study

According to NICE guidance treatments for health-related fertility issues should be available on the NHS. However, guidelines are not mandatory and decisions about access are frequently set according to local priorities and finances, creating a "postcode lottery" for IVF.

All integrated care systems now restrict NHS-funded IVF to women with a BMI under 30. While intended to minimize clinical risks, these policies are controversial and disproportionately impact women from socioeconomically deprived and minority ethnic backgrounds, who experience higher rates of obesity. Up to 40% of those seeking IVF treatment live with obesity, meaning a significant minority may be excluded from treatment.

Global fertility declines make assisted reproduction a key public health issue, but it is unknown if decisions about funding criteria are accompanied by discussion or interventions designed to encourage change in behaviours, if this would be affective or how received by those planning parenthood.

This ethnographic PhD study will investigate the experiences of women denied fertility treatment due to BMI eligibility criteria. It aims to examine how these rules are enacted, interpreted, and navigated in clinical and social contexts, as well as their impact on stigma, care perception, and reproductive autonomy.

Data collection will take place across NHS and private fertility clinics, weight management services, and community settings using participant observation, semi-structured interviews with affected women and healthcare staff, and policy document analysis.

The research focuses on how women manage exclusion—such as engaging with weight loss interventions
or private pathways—while paying close attention to socioeconomic and ethnic inequalities. Supported by collaboration with an NIHR patient advisory group, the project will provide rich insights to help commissioners, clinicians, and policymakers design more equitable, inclusive, and evidence-based fertility care policies.