Haley Brown, a 32-year-old mother of one (soon to be two), has always existed in a larger body. While trying for their second child, Haley and her husband were denied insurance coverage due to Haley’s body mass index (BMI) — despite seeking treatment for male-factor infertility. The experience turned Haley into an even greater advocate for bringing more nuance into the conversation around weight and fertility. Below, Haley shares her experience in her own words.
In college, working at a holistic veterinary practice was game-changing for me as far as how I viewed health and the idea of food as medicine. One of my coworkers totally reframed my perspective on reproductive health: She described welcoming her period every month as the best “check engine” light we have. Instead of thinking of my period as a burden, I learned to see it as an indicator of health and think more broadly about ways to understand my body. When my husband and I started thinking about having kids, I began paying even closer attention to my cycle.
I had some preconceived notions that, due to my size, it might take me longer than usual to get pregnant. There wasn’t anything specific in my health history that caused this concern — but a lifetime of fatphobic messaging around health and having my size called into question in healthcare settings contributed to a general sense of worry. That worry was wiped away when I got pregnant really quickly with our first child. Trying to conceive our second child, though, was totally different.
We were in treatment for male-factor infertility… but my BMI was part of the conversation.
I was hoping that lightning would strike twice and we would luck out right away... but that definitely didn’t happen. We ended up experiencing some challenges with male-factor infertility. After trying for about nine months, we decided to start exploring treatment options — which mostly looked like getting him set up with a urologist and a physical exam, and us meeting with a fertility clinic.
The initial meeting with the clinic went really well, but the doctor said I was required to have maternal-fetal medicine and nutritionist consultations because of my BMI — even though we were there for male-factor infertility. I wanted to roll my eyes because we were in treatment specifically for male-factor issues, and because other than my BMI, nothing in my health history would lead me to need those kinds of consults. Even though I was a little miffed about those consults being required, I understood that I was playing the game. I had to just suck it up and jump through the hoops.
About a week after our appointment, the financial coordinator at our fertility clinic called to go over insurance benefits — everything was great until she got to the part about our network not covering treatment for folks with a BMI over 40. My BMI is currently 42, so I was looking at a 20-25 pound weight loss before any kind of fertility treatment was covered. That news was a huge blow to our plans and to my mental health — I felt like I'd been told I was too fat to receive the medical care that we were seeking, without anyone taking into consideration that we were seeking treatment for male-factor infertility.
Existing in a bigger body doesn't necessarily mean you're unhealthy.
Our story ended happily because we conceived within a month of that phone call from the clinic — but the experience leading up to that was really discouraging. I'd conceived a child at the same size three years earlier with no issues: We’d had a textbook pregnancy, a vaginal birth with no complications, and a perfect (100th percentile) baby girl.
For our insurance to have this cutoff for people above a certain BMI threshold just seemed really unfair. There are folks who exist in bigger body sizes and it doesn't necessarily mean that we're unhealthy. I’ve always existed in a larger body — I’m tall and curvy. At the height of an eating disorder in my 20s, I was still a size 12. I'm thankful we didn’t end up needing to go through fertility treatment because I was preparing myself to start dieting and having to lose weight just to hit this number so we could start treatment. But it didn't get to that point for us.
It was wonderful to have the Modern Community at my fingertips through what was such a volatile time in the process of getting pregnant with our second child. It's such a safe and welcoming space. It was so nice to have people who get what you're going through and can empathize, but can also help you with questions that you have. It made the process feel a little less lonely.
Emphasize less on size and more on how you're feeling.
For anyone else who’s experiencing weight stigma in their fertility journey, remember that you're your best advocate — you know your body best. Trust yourself and the things you know to be true about your body. Listen to those gut feelings. If you feel like there's better care out there for you, don't hesitate to find someone else. I know there are a lot of accessibility issues and that everyone’s situation with healthcare is different. But, if you can, find a provider who makes you feel safe and who listens to you — especially if you're trying to conceive. Because once that happens, you're establishing a long-term relationship with that provider. Don't stop until you find the care you deserve.
I'd like to see a future with reproductive healthcare that emphasizes less on size and more on how you're feeling, what you're struggling with, and fueling your body with food through intuitive eating. I want to see representation of larger bodies in doctor's offices, pamphlets, and photos on the walls. There's such a beautiful range of people who carry children and we should celebrate that. I also wish that we weren't weighed unless it was specific to a surgery, procedure, or something within our health history. I've done a lot of healing around dieting and I hadn't been on a scale in years before my first pregnancy, so having to do that for prenatal appointments was difficult for me as someone with a history of disordered eating. This pregnancy, I'm turning away from the scale and not even dealing with it.
We aren't taught how to really take care of ourselves in this country — and the systems in this country are not set up to foster us taking care of ourselves. To see major change in how weight is treated in reproductive healthcare, it's gonna take a lot more work dismantling how we receive medical care and what that medical care looks like.
Fertility could be top of mind or on the back burner for now — but it has the power to impact everything. We're sharing your stories to both celebrate and create space for the many ways we navigate our careers, relationships, and finances in relation to our reproductive health. If you have a story to share, get in touch.