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5 Things to Know About Bariatric Surgery and Fertility

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Posted by Tatyan M. Clarke, MD, FACS, FASMBS

For a growing number of people of child-bearing age, having excess weight makes becoming pregnant more challenging. Achieving a healthier weight can improve fertility, but sometimes lifestyle changes alone may not be enough to help them reach their weight-loss goals. In those cases, bariatric surgery may be an option.

By helping the body lose excess weight quickly, surgical weight-loss procedures may be able to address the problems that are causing infertility. That can allow patients who have struggled to get pregnant to conceive, and go on to have healthy pregnancies. In fact, I’ve seen this happen many times with patients in my work as a bariatric surgeon at Temple Health.

The decision to undergo bariatric surgery as a solution for infertility, however, calls for education and careful consideration. If you’re thinking about pursuing it as an option to improve your chances of pregnancy, here are some important things you should know.

1. Bariatric surgery can help improve fertility and pregnancy outcomes in several ways.

Excess weight may trigger hormone imbalances that can affect a person’s ovulation cycles and make it harder to get pregnant. It can also increase the chances for conditions that affect fertility, like polycystic ovary syndrome (PCOS).

Moving toward a healthier weight can help address these issues, such as promoting more predictable ovulation cycles and reducing insulin resistance, which causes blood sugar levels to rise and may cause irregular ovulation, or no ovulation at all.  Some individuals may be able to achieve a healthier weight with lifestyle changes like diet and exercise. For others, undergoing bariatric surgery can lead to dramatic fertility improvements because it promotes increased weight loss at a faster rate.

Once a person has conceived a child, being at a healthier weight can also help lead to better outcomes during pregnancy and delivery. For instance, there’s a lower chance for problems like gestational diabetes, preterm birth, macrosomia (a larger than average baby), and stillbirth.

When a pregnant person loses excess weight, their care team is also able to perform prenatal diagnostic procedures like ultrasounds more accurately. They may experience a shorter delivery time and be at less risk for postpartum complications like bleeding and infection, too.

2. Women and other people with uteruses should discuss the pros and cons of bariatric surgery for fertility with their doctors.

Bariatric procedures are major surgeries that come with risks, so they’re not typically considered a first-line treatment for infertility. On the other hand, they may be the best option for helping people with excess weight become pregnant. 

I believe that bariatric surgeries can often be effective for people who have a large amount of weight to lose or who have serious health problems that stem from excess weight, such as high blood pressure, heart disease, diabetes, or sleep apnea.

I encourage those who are thinking about weight-loss surgery to have an in-depth conversation with their OB/GYNs or family physicians. Together, patients can consider the benefits and risks and decide if bariatric surgery is the right option for addressing their infertility.

3. Patients shouldn’t try to conceive right after surgery.

While bariatric procedures can encourage rapid weight loss, patients shouldn’t start trying to conceive immediately after surgery. In our program, we recommend that they wait 18 to 24 months after bariatric surgery before trying to get pregnant. 

As I explain to my patients, waiting gives their body time to lose as much weight as possible before conceiving, since it’s best to put weight loss on hold once they’re pregnant. Delaying conception also allows their body’s vitamin levels to stabilize, which reduces the risk for fetal malnutrition as well as complications like premature birth and low birth weight.

4. Discuss post-surgery birth control options with your doctor.

Because delaying conception is so important, it’s critical for patients to use birth control following bariatric surgery. However, oral contraceptives like birth control pills may not be effective for those who’ve undergone malabsorption procedures like gastric bypass, since the medication isn’t absorbed as well. Instead, those patients should use non-oral birth control methods like Norplant or an IUD.

5. A multidisciplinary team delivers the best care.

Your bariatric surgeon, obstetrician, and dietitian all play key roles in helping you prepare to conceive and have a healthy pregnancy after bariatric surgery.

Bariatric procedures can increase the risk of deficiencies for nutrients like folate, iron, vitamin B12, calcium, and vitamin D — all of which are critical for fetal development. We carefully monitor vitamin levels in our post-surgical patients, and if you like, a dietitian can work with you to develop an eating plan and supplementation regimen that’s tailored to meet your nutritional needs. You’ll continue to work with a dietitian after giving birth, particularly if you’re breastfeeding, since breastfed infants of people who have had gastric bypass are at risk for nutritional deficiencies.

After you conceive, your baby’s growth will be monitored with frequent ultrasounds to manage risks like intrauterine growth restriction — poor growth of a baby while in the womb — and small size relative to gestational age, which can be more common after bariatric surgery. Depending on your health history, you may also need to be screened for gestational diabetes sooner than the standard recommended timeframe of 24 to 28 weeks.

Frequent monitoring by a team of experienced specialists means that people who have undergone bariatric surgery have a good chance for an uncomplicated vaginal delivery. But if a C-section is needed, the procedure may need to be altered for some patients.

Choose the right team for a safe weight-loss journey and pregnancy

At Temple Health, the experts that make up our bariatric surgery team can help you reach your weight loss goals and work toward achieving a healthy pregnancy.

To learn more about our bariatric program, sign up for our free Virtual Bariatric Surgery Seminar, led by a bariatric surgeon, that explores the bariatric surgery journey.

Tatyan M. Clarke, MD, FACS, FASMBS

Dr. Clarke is a bariatric surgeon with clinical interests in metabolic diseases, preventive care for obesity, and minimally invasive surgery. She is also Associate Professor of Clinical Surgery at the Lewis Katz School of Medicine at Temple University, and a member of several organizations including the American Society for Metabolic and Bariatric Surgery, Society of Black Academic Surgeons, and American Medical Women’s Association.

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