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Bariatric Surgery and Fertility: What’s the connection?

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The healthier you are, the better your chances of conceiving and having a healthy pregnancy. An important factor for infertility in many women of reproductive age is obesity, this also applies to men, as men who are overweight and obese are more likely to have lower sperm counts with lower motility (normal sperm movement). Some people are able to lose weight enough to improve health. But if you’re struggling with obesity and looking to get pregnant, a simple diet and exercise formula may not be enough. At My New Body Obesity Center we have seen many infertility cases where bariatric surgery has provided the solution.

My New Body Obesity Center works with patients to achieve not only their weight loss goals, but their overall health goals as well. With the highest safety standards in the field and over 10,000 bariatric procedures, our unparalleled results consistently show not only successful weight loss, but also the prevention of a variety of health problems, including high blood pressure, diabetes, and even polycystic ovary syndrome. PCOS) and infertility. Bariatric surgery has proven to be an effective tool for weight loss and fertility, we will try to explain where is the connection between Bariatric Surgery and Fertility

Its very common for gynecologists to recommend women trying to get pregnant to loose weight. Several studies have shown that obesity significant improves the risk of infertility in women.

One of the main reasons are hormones. The menstrual cycle is a series of hormonal changes in horomone production and the structures of the uterus and ovaries of the female reproductive system that make pregnancy possible. Many of these hormones are stored in the adipose tissue (fat). And an excess of fat can cause a hormonal imbalance which can cause infertility. On top of that, obesity increases the risk of developing Polycystic ovary syndrome (PCOS).

What is Polycystic Ovary Syndrome?

PCOS is a hormonal imbalance that causes women irregular menstrual periods, heavy periods, excess hair, acne, pelvic pain, difficulty getting pregnant, and patches of thick, darker, velvety skin.

Several studies of bariatric patient outcomes have shown that bariatric surgery can be effective in achieving significant weight loss, restoration of the hypothalamic pituitary axis, reduction of cardiovascular risk and even in improving pregnancy outcomes. Ultimately, bariatric surgery also significantly improves PCOS women.

Reproductive considerations for bariatric surgery

 Does surgery optimize both fertility and pregnancy? The relationship between PCOS, obesity and infertility has been documented for many years. Known effects include anovulation, miscarriage, impairment in folliculogenesis and altered endometrial receptivity. Modest weight loss often increases the odds of spontaneous ovulation.  However, pregnancy risks in woman with Obesity are high. These women face difficulty in managing diabetes, pre-eclampsia, growth disorders, higher rates of cesarean delivery, higher maternal mortality and increase their children’s risks for metabolic disease in the future.

Women already take pregnancy into consideration when choosing Weight Loss surgery. A quick analysis of My New Body Obesity Center patients  of 1538 women who underwent bariatric surgery in the last year showed that 40% of these women reported a history of infertility and that 55% of these women who reported obesity by the age of 18 had infertility. More importantly, 30% of women under the age of 45 cited future pregnancy as a major concern for them. This is especially important given that 54% had hypertension, 33% had diabetes mellitus and 46% had sleep apnea. Clearly, these data show that women undergoing surgery at My New Body Obesity Center are aware of their own reproductive risks and many r of these women are thinking ahead.

Bariatric surgery in reproductive age women has been shown to decrease menstrual irregularities. PCOS women have less hyperandrogenism post operatively and sex hormone binding globulin increases after bariatric surgery. LH and FSH levels have been reported to increase after surgery. On a more functional level, ovulatory function measured by luteal LH and progesterone secretion improved postoperatively, although levels were still below normal expected values. Additionally, leptin levels decrease after bariatric surgery, reflecting improved reproductive metabolic status. Many of these women (10%-25%) have subclinical hypothyroidism which was significantly reduced following bariatric surgery. These changes certainly would suggest improved reproductive function and more studies are certainly needed to gain a better understanding.

The impact of Weight Loss Surgery on fertility treatment is limited but there are enough reported pregnancies to gain important insights. An older study after vertical banded gastroplasty showed a higher conception rate and lower miscarriage rate following surgery[1]. In one of the largest data sets, a retrospective study found that in 110 obese patients with infertility prior to bariatric surgery, 69 became pregnant following bariatric surgery. A BMI drop greater than 5 kg/m2 was a significant predictor of fertility within 2.5 years of follow up after surgery. The type of bariatric procedure did not impact fertility[2]. Another group also showed unexpected spontaneous pregnancies soon after surgery in women with previous primary infertility[3]

With this day we can conclude that pregnancy is safe or even safer after bariatric surgery, less is known about timing or how much to wait after bariatric surgery to get pregnant. It is typicallly recommended  that women should wait at least 12 mo after bariatric surgery before becoming pregnant in order to allow the rapid weight loss and metabolic changes to subside[4]. The most rapid weight gain occurs within 18 mo post-operatively[5]. Concerns exist due to nutritional and vitamin deficiencies in these women during that time frame of rapid weight loss[6].

We can all agree that  Obesity adversely impacts fertility, and weight loss is associated with significant improvement in many parameters of reproductive function. Further research is required  as the optimal timing of pregnancy after bariatric surgery. But if you are looking to get pregnant and struggling with obesity, one way to safely and effectively improve your chances is through Weight Loss Surgery. Contact us for a consultation and find out if and which bariatric surgery is right for you

 

References:

Dağ, Z. Ö., & Dilbaz, B. (2015). Impact of obesity on infertility in women. Journal of the Turkish German Gynecological Association, 16(2), 111–117. https://doi.org/10.5152/jtgga.2015.15232
Musella M, Milone M, Bellini M, Sosa Fernandez LM, Leongito M, Milone F. Effect of bariatric surgery on obesity-related infertility. Surg Obes Relat Dis. 2011
Martin LF, Finigan KM, Nolan TE. Pregnancy after adjustable gastric banding. Obstet Gynecol. 2000;95:927–930.
American College of Obstetricians and Gynecologists. ACOG Committee Opinion number 315, September 2005. Obesity in pregnancy. Obstet Gynecol. 2005;106:671–675.
Wax JR, Cartin A, Wolff R, Lepich S, Pinette MG, Blackstone J. Pregnancy following gastric bypass for morbid obesity: effect of surgery-to-conception interval on maternal and neonatal outcomes. Obes Surg. 2008;18:1517–1521.
Poitou Bernert C, Ciangura C, Coupaye M, Czernichow S, Bouillot JL, Basdevant A. Nutritional deficiency after gastric bypass: diagnosis, prevention and treatment. Diabetes Metab. 2007;33:13–24.
Costello, M. F., Misso, M. L., Balen, A., Boyle, J., Devoto, L., Garad, R. M., Hart, R., Johnson, L., Jordan, C., Legro, R. S., Norman, R. J., Mocanu, E., Qiao, J., Rodgers, R. J., Rombauts, L., Tassone, E. C., Thangaratinam, S., Vanky, E., Teede, H. J., & International PCOS Network (2019). Evidence summaries and recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome: assessment and treatment of infertility. Human reproduction open, 2019(1), hoy021. https://doi.org/10.1093/hropen/hoy021
Cornejo-Pareja, I., Clemente-Postigo, M., & Tinahones, F. J. (2019). Metabolic and Endocrine Consequences of Bariatric Surgery. Frontiers in endocrinology, 10, 626. https://doi.org/10.3389/fendo.2019.00626
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