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, weight loss surgery may be an option.

By helping the body lose excess weight quickly and safely, surgical weight-loss procedures may be able to address the problems of hormonal imbalance that are causing infertility. This can allow patients who have struggled to get pregnant to conceive and go on to have healthy pregnancies. Many patients from our practice have gone one to become healthy parents to healthy babies.

The decision to undergo bariatric surgery as a potential solution for infertility, 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.

Conception at a healthier BMI 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.

At a healthy BMI the obstetric 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.

  1. Women planning motherhood 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.

Weight loss surgery 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 apnoea.

If you’re thinking about weight-loss surgery, it is advisable to have an in-depth conversation with your obstetrician or family physician. Together, patients can consider the benefits and risks and decide if bariatric surgery is the right option for addressing their infertility.

  1. Don’t try to conceive soon after surgery.

While weight loss procedures can encourage rapid weight loss, patients shouldn’t start trying to conceive immediately after surgery. It is my recommendation that they wait 18 to 24 months after bariatric surgery before trying to get pregnant.

Waiting for 18 months gives your body time to lose as much weight as possible and stabilise before conceiving, since it’s best to put weight loss on hold once you’re pregnant. Delaying conception also allows your body’s vitamin levels to stabilize, which reduces the risk for foetal malnutrition as well as complications like premature birth and low birth weight.

  1. 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 aren’t absorbed as well. Instead, those patients should use non-oral birth control methods like Mirena or an IUD.

  1. Be in touch with your team of care providers.

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

Weight-loss surgery can increase the risk of deficiencies for nutrients like folate, iron, vitamin B12, calcium, and vitamin D — all of which are critical for foetal 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 in preparation for pregnancy. 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. Also if a C-section is needed, the procedure may need to be altered for some patients.

At Body Genesis Institute – Centre for Weight Loss we have a team of health care providers who can provide further in-depth information and assist you in planning your weight-loss procedure.

You can make a FREE patient advisor appointment to discuss your questions here: https://centreforweightloss.com.au/patient-advisor-appointment/