Patients found unaware of fertility improvements from bariatric surgery

Patients found unaware of fertility improvements from bariatric surgery | Image Credit: © Vadim - © Vadim - stock.adobe.com.

There is a lack of knowledge about the link between bariatric surgery and improved fertility, according to a recent survey from Orlando Health.¹

Only 50% of survey respondents indicated they had knowledge of the benefits bariatric surgery has on fertility, with the other 50% either being unsure or disagreeing with this statement. This indicated a lack of knowledge about these benefits in the general US population.¹

“When female patients are struggling with obesity and pregnancy, there is typically a correlation between their weight and infertility,” said Alexander Ramirez, MD, FASMBS, director of Orlando Health Weight Loss & Bariatric Institute – Bayfront.¹

According to the World Health Organization, 1 in 6 individuals are impacted by infertility (WHO).² Infertility is determined by a failure to achieve pregnancy after at least 1 year of unprotected sexual intercourse. It has been linked to significant distress, stigma, and financial hardship.

WHO has reported underfunding for fertility treatments such as assisted reproductive technology. High costs, social stigma, and limited availability prevent patients from receiving these treatment options.²

The report from WHO also highlighted a lack of infertility data in many countries. Authors called for increased availability of national infertility data to highlight patient populations in need of fertility care.²

Multiple adverse health conditions have been linked to obesity, such as hypertension, diabetes, sleep apnea, and increased cancer risk.¹ Women with obesity may also experience hormone imbalances, irregular menstrual cycles, and polycystic ovarian syndrome (PCOS). These conditions all may contribute to infertility.

“We have many patients with PCOS, a hormonal condition that affects women of reproductive age, many of whom try and fail to get pregnant for many years,” said Ramirez. “After bariatric surgery, their chances of conception drastically increase very quickly as their hormones are regulated and their menstrual cycle normalizes.”¹

The positive impact of bariatric surgery on pregnancy weight gain was reported in a JAMA Network Open study.³ Patients had a mean early-pregnancy body mass index (BMI) of 29.4 groups, and those with a history of bariatric surgery had decreased pregnancy weight gain vs those with no prior surgery regardless of early-pregnancy BMI category.

Investigators from Orlando Health also noted a lack of knowledge about other weight loss options.¹ GLP-1 medications may be used to lose weight, but 64% of respondents were unaware weight gain may occur when stopping GLP-1 injections.

Bariatric surgery leads to a permanent change in the digestive system, with hormone production increased and ovulation improved. For these reasons, Ramirez considers bariatric surgery as the more effective and longer-lasting weight loss option compared to GLP-1 medications.¹

Ramirez also recommended waiting 18 to 24 months after bariatric surgery before attempting to conceive to give the body time to adjust to changes from the surgery. According to Ramirez, this adjustment period helps reduce the odds of complications such as hypertension, preeclampsia, and gestational diabetes during pregnancy.¹

“My advice for anyone with obesity, and especially for those who want to have a child, is to ask about bariatric surgery because it's the most powerful tool we have to lose weight in a healthy way and keep obesity in remission,” said Ramirez. “And that is going to increase their chances of having a successful and healthy pregnancy.”¹

References

1. New survey finds over half of Americans are unaware that bariatric surgery can improve fertility. Orlando Health. January 14, 2025. Accessed January 16, 2025. https://www.eurekalert.org/news-releases/1069724
2. 1 in 6 people globally affected by infertility: WHO. World Health Organization. Accessed January 16, 2025. https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility
3. Krewson C. Bariatric surgery reduces pregnancy weight gain, study reveals. December 7, 2023. Accessed January 16, 2024. https://www.contemporaryobgyn.net/view/bariatric-surgery-reduces-pregnancy-weight-gain-study-reveals