Bariatric surgery has become a widely accepted solution for sustainable weight loss for the overweight and obese. Bariatric surgery results in greater weight loss rather than conventional diet and exercise. Bariatric surgery includes a variety of weight loss surgeries such as; gastric sleeve or the gastric bypass. Each surgery type has their own set of pros and cons, with a common goal of substantial weight loss.
Not only can bariatric surgery help to provide a lasting solution for weight loss; it can also dramatically benefit overall health conditions and diagnoses.
Health conditions and diagnoses often plague patients who are overweight and obese include type 2 diabetes, cardiovascular disease, hypertension, sleep apnea, reproductive disorders, PCOS and even mortality.
Due to significant weight loss, physical conditions and illnesses can improve or even reverse. Improvement has been seen in heart disease, sleep apnea and others. Does bariatric surgery improve infertility?
How does Obesity Impact Fertility
Overweight or obese woman in their prime reproductive years, may fail to understand effects from obesity in regards to their fertility.
One health concern in particular can cause; “psychological-emotional disorders or consequences including turmoil, frustration, depression, anxiety, hopelessness, guilt, and feelings of worthlessness in life. 1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4009564/#:~:text=While%20the%20infertility%20is%20not,life%20(7%2D12)”
Although infertility is not a diagnosis, it can have lasting negative effects for women and their partners.
The risk for infertility is higher due to being overweight or obese.
“Obesity is also associated with anovulation, menstrual disorders, miscarriage, difficulties in assisted reproduction and adverse pregnancy outcomes. 2https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456969/”
This makes pregnancy and caring to full term healthily more of a challenge when overweight or obese.
Furthermore, obesity can affect hormones significantly. They have the ability to:
- increase the rate of production of estrogen
- increase leptin
- decreasing levels of sex hormone-binding globulin (SHBG), growth hormone (GH) and insulin-like growth factor (IGFBP.)
This ultimately alters ovulatory function and reproductive health.
- “worsened obstetric outcomes including miscarriage, congenital abnormalities, preeclampsia, and gestational diabetes.” 3https://academic.oup.com/jcem/article/97/12/4352/2536374
- “approximately 30% of mothers who had a stillbirth or neonatal death were obese . Obese women have an increased risk of stillbirth or intrauterine fetal death . They are at greater risk of preterm labour, miscarriage and fetal chromosomal anomalies, as well as macrosomia. Obese women are more likely to suffer from thromboembolism, gestational diabetes, pregnancyinduced hypertension, and preeclampsia. They have a greater incidence of dysfunctional labour, caesarian section  and associated perioperative morbidity, as well as postpartum haemorrhage.4https://www.hindawi.com/journals/jobe/2011/501939/”
Weight Loss as the First Line of Treatment
In recent decades climbing obesity rates are making infertility more common. Now, women of reproductive ages are looking for an effective way to help with weight management and sustainable weight loss. This is where bariatric surgery can be effective.
“The first line of therapy for overweight and obesity is through weight management, which is known to improve a range of surrogate and clinical markers of fertility and outcomes of pregnancy.5https://academic.oup.com/jcem/article/97/12/4352/2536374”
Doctors request that women who are trying to become pregnant aim to retain a healthy body weight. Obese women are asked to lose a modest amount of weight before pregnancy.
As a viable solution, weight loss has many potential benefits for both mother and unborn child. Losing weight, even a modest amount has the ability to make conceiving easier as well as decrease the risks associated with overweight pregnancy6https://academic.oup.com/jcem/article/97/12/4352/2536374.
Bariatric Surgery as a Fertility Solution?
Bariatric surgery has been sought out by many people to help with significant long term weight loss. Bariatric surgery is the most reliable way to sustain weight loss in the morbidly obese. Reproductive age women comprise the majority of bariatric patients, and many may be interested in conceiving after surgery.
Please note, it is important to talk with your doctor about questions and concerns regarding infertility, pregnancy and the risks involved.
“Weight reduction has been shown to readdress this hormonal imbalance and increase fecundity in obese and overweight women . It is therefore postulated that bariatric surgery improves menstrual regularity and ovulation in anovulatory obese women, thus restoring fertility.7Hindawi Publishing Corporation Journal of Obesity Volume 2011, Article ID 501939, 5 pages doi:10.1155/2011/501939“
Many women experience their first surge in fertility after weight loss surgery. This is due to being able to have regular menstruation cycles and a balance in many hormones.
Women are asked to wait 18 months post surgery to try and conceive, after weight stabilizes. This is also to make sure mom and baby do not suffer from malnutrition.
While recovering from surgery; the body goes through a lot of metabolic changes that can pose an issue for a growing baby.
Further Evidence of Increased Fertility after Bariatric Surgery
Bariatric surgery can have the ability to reset the body, entirely. Meaning that “hormonal balance and sexual functions can improve, for both men and women.” After bariatric surgery the body is forced to find a new homeostasis, resulting in cellular changes that can have a dramatic positive effect on hormones 8https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253939/.
Pregnancy rates can improve. Multiple studies reported pregnancy rates rose after bariatric surgeries. Women who were once unable to conceive became pregnant after bariatric surgeries. Furthermore, they found that BMI and the amount of weight loss after bariatric surgery were predictors of pregnancy9https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253939/#:~:text=Four%20other%20studies%20reported%20improved,become%20pregnant%20were%20pregnant%20after.
In a study of 585 women who had undergone bariatric procedures found that they had lower rates of preeclampsia, eclampsia, chronic hypertension, and gestational hypertension. Meaning that women who undergo bariatric surgery may have a lower risk of maternal complications.10https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139211/
Not surprisingly, obesity has been shown to adversely impact fertility. Weight loss can be a direct improvement in many aspects of reproductive health and function11https://pubmed.ncbi.nlm.nih.gov/20124898/.
It is important to remember that bariatric surgery is not a cure all, nor is bariatric surgery for everyone. Please discuss your questions and concerns regarding weight loss treatments, and fertility with a trusted General Practitioner and an Obstetrician.
For those who are looking to aid in infertility, and/or decrease risk factors associated with complications due to being obese, bariatric surgery can be a viable treatment.