When Kate Pearson found out she was pregnant last season on This Is Us, fans rejoiced. But then she miscarried, and the loss felt personal—even to actress Chrissy Metz. “I would literally go home and not want to talk to anybody,” she told Glamour about filming the storyline. “It was difficult because you’re crying and all these emotions are right there all the time.”
Her journey didn’t end there, though. This season’s premiere showed Kate and her husband, Toby, visiting a fertility specialist to discuss their options. But when the doctor delivers her assessment to the couple, she says this: “At your weight, the chances for a successful pregnancy are very slim—even with IVF.”
The doctor frames the prognosis around Kate’s weight, even though she also knows Kate has PCOS (polycystic ovarian syndrome) and is 38, which is medically considered “advanced maternal age.” (This category actually applies to all pregnancies in women over 35 — just another example of the BS women face at the doctor’s office.) Both of these factors complicate one’s ability to get pregnant, but her doctor chose to focus on one thing: the number on the scale.
It’s a gutting moment for Kate, who has been reduced to her weight many times on the show. And after the episode aired, many women took to social media to voice their opinion on the storyline:
But for others, it hit home. Sarah Meres, 30, told Glamour her story of trying to get pregnant is eerily similar to Kate’s in many ways, including having PCOS and a husband with a low sperm count. (The doctor tells Toby his sperm count is low because he’s on antidepressants.)
“I saw one gynecologist who told me I need to lose another 40 pounds because my weight, along with having PCOS, was causing me to continue to be infertile,” Mares says. “He told me that my weight [plays] a major role in my PCOS, and the faster I lose [it] the better. What he doesn’t understand is how hard it is to lose weight with PCOS.” Mares says she’s lost 75 pounds so far, but still hasn’t been able to conceive.
Another fan of the show, Ivanka Sanchez, 36, who also has PCOS, agrees. “It was relatable, though maybe not realistic,” she says. “I lost a massive amount of weight in 2016 when I got pregnant for the first time. When I asked how it was possible, the doctor’s answer was the weight loss. But I’ve had struggles with infertility for 16 years, at every weight.”
While simply saying “lose weight and you’ll get pregnant” definitely sounds out-of-touch, there is a reason why a doctor might bring it up: It’s one of the only factors a woman has immediate control over when it comes to fertility. (There’s currently no cure for PCOS.) “We want to look at where can we make an intervention, and weight loss is a place where we can achieve a real increase in chances of a successful pregnancy,” says Nathaniel DeNicola, M.D., an assistant professor of obstetrics and gynecology at George Washington University and the environmental health expert for the American Council of Gynecology. “Even losing five percent of body weight helps.”
But why? As Dr. DeNicola explains, obesity leads to excess estrogen in the body, which can mess with ovulation. “It’s sort of the same mechanism as a birth control pill,” he explains. “If you produce more estrogen, that creates feedback that you don’t need to ovulate.” If you reduce fat tissue, you lessen the effect.
Still, Dr. DeNicola says there’s actually no definitive answer to whether or not body weight is a factor with IVF. “There’s no question obesity decreases the chance of getting pregnant, but for IVF, body weight as a factor is unclear,” he says, adding that, in his opinion, it was also not entirely realistic to have a doctor say she won’t be able to take Kate on as a patient because of how her BMI might affect the outcome. (The doctor later changes her mind.) “The standard is informed consent,” he explains. “The patient should have the autonomy to make a choice whether they want to continue treatment.” In other words, a doctor should lay everything out for the patient and let her decide.
Co-showrunner Isaac Aptaker told Glamour in a previous interview that the show did consult doctors on Kate’s storyline. “Once we started to hear that [PCOS] is common, then we brought in doctors and said, ‘What does the reality of this look like? And how do we get it right?'” he said. “We showed this episode to a fertility doctor, and he was like, ‘Thank you. Nobody is doing this, and it’s so common. I see it every day.'”
Ultimately, Kate does decide to move forward with IVF. Whether or not she’s able to conceive, the storyline will hopefully continue to help women who’ve dealt with similar struggles feel seen.
“I felt all the emotions Kate did when they suggested adoption or fostering,” Mares says. “There was a sting, because you want a baby and you are two people so in love who deserve children and it just isn’t happening. And being overweight or obese just makes dealing with fertility even more difficult. I felt her pain.”