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The New Ethics on Smoking, Obesity and Alcohol Consumption

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by Rachel Lehmann-Haupt, Feb. 1, 2009

The European Society of Human Reproductive and Embryology’s Task Force on Ethics has come out with a bold statement on the impact of obesity, smoking, and alcohol consumption on natural and medically assisted reproduction. Published in January 2010 in the journal Human Reproduction, the group made five recommendations:

    1) Fertility doctors should refuse treatment to women used to more than moderate drinking who are not willing or able to minimize their alcohol consumption due to potential risk for the future child.

    2) Treating women with severe or morbid obesity requires special justification because the available data suggests that weight loss would have a positive reproductive effect (although more data is needed to establish whether assisted reproduction should be made conditional upon prior lifestyle changes for obese and smoking females).

    3) Fertility doctors should insist that a serious effort to lose weight and stop smoking be made before treatment can be considered. Because of the implied time delay, this should, however, not be asked from women approaching the end of their fertile period.

    4) When making assisted reproduction conditional upon lifestyle modifications, fertility doctors should help patients to achieve the necessary results.

    5) More data on obesity, smoking and alcohol consumption as well as other life style factors is necessary to assess reproductive effects. Fertility doctors should continue research in this area.

Clearly this is a complex issue due to the balance between a patient’s autonomy and the moral weight of the interests of society and the future child. The question is whether these recommendations might harm individual rights and fall into the realm of discrimination.

While the paper has not been formally reviewed by the Ethics Committee of the American Society for Reproductive Medicine, Dr. Robert Brzski, the Ethics Committee chair, responded saying, "I think it is safe to say that practitioners and practices should consider their reactions to requests for fertility services from individuals with medical conditions such as diabetes or hypertension, both of which increase the risk to the mother and child when confronted with smokers, drinkers, or obese individuals. Clearly we have an obligation as practitioners to inform and educate patients regarding their risks and provide resources and support to minimize that risk.”

Such an obligation, however, shouldn’t result in discrimination, however. According to Brzski, “the Committee has taken the position that infertile persons should not be discriminated against in meeting their reproductive goals because they require fertility services.” Brzski explains the Committee's reasoning, “If there are no legal or societal constraints against fertile drinkers, smokers or obese individuals to reproduce then neither should there be such constraints directed against the infertile.”

That doesn’t mean decisions about care are easy. “I think personally practitioners have the most problem with assisting problem drinkers,” Brzski explains, “ because the harm can be profound and predictable compared to the other two lifestyle effects."


Rachel Lehmann-Haupt ( is a journalist and the author of In Her Own Sweet Time: Unexpected Adventures in Finding Love, Commitment and Motherhood (Basic Books, 2009).