Conception rates and contraceptive use after bariatric surgery among women with infertility: Evidence from a prospective multicenter cohort study

Menke, Marie; King, Wendy C.; White, George L.; Gosman, Gabriella G.; Courcoulas, Anita P.; Dakin, Gregory; Flum, David R.; Orcutt, Molly; Pomp, Alfons; Pories, Walter J.; Purnell, Jonathan Q.; Steffen, Kristine J.; Wolfe, Bruce M.; Yanovski, Susan Z.

doi:10.1016/j.soard.2018.12.026

Cited by 13 publications

(8 citation statements)

References 33 publications

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“…In a large survey of 650 women, Menke et al found an approximately 2.5-fold higher postoperative conception rate in nulliparous women with a preoperative history of infertility compared to those without. This increase includes the early postoperative timeframe (less than 18 months) when conception is contraindicated [40]. This research indicates that preoperative infertility may be improved as a result of bariatric surgery [42].…”

Section: Fertilitymentioning

confidence: 79%

“…Women with a history of infertility especially have an increased probability of unprotected intercourse after bariatric surgery. The authors suggest that these women continue to have perceived infertility and that better counseling is needed [40]. The results of these surveys underscore the relevance of detailed consultation with treating physicians.…”

Section: Contraceptionmentioning

confidence: 93%

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Review: Sex-Specific Aspects in the Bariatric Treatment of Severely Obese Women

Jäger

Wolicki

Spohnholz

et al. 2020

IJERPH

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This systematic literature review aims to point out sex-specific special features that are important in the bariatric treatment of women suffering from severe obesity. A systematic literature search was carried out according to Cochrane and Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guidelines. After the literature selection, the following categories were determined: sexuality and sexual function; contraception; fertility; sex hormones and polycystic ovary syndrome; menopause and osteoporosis; pregnancy and breastfeeding; pelvic floor disorders and urinary incontinence; female-specific cancer; and metabolism, outcome, and quality of life. For each category, the current status of research is illuminated and implications for bariatric treatment are determined. A summary that includes key messages is given for each subsection. An overall result of this paper is an understanding that sex-specific risks that follow or result from bariatric surgery should be considered more in aftercare. In order to increase the evidence, further research focusing on sex-specific differences in the outcome of bariatric surgery and promising treatment approaches to female-specific diseases is needed. Nevertheless, bariatric surgery shows good potential in the treatment of sex-specific aspects for severely obese women that goes far beyond mere weight loss and reduction of metabolic risks.

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Section: Fertilitymentioning

confidence: 79%

Section: Contraceptionmentioning

confidence: 93%

Review: Sex-Specific Aspects in the Bariatric Treatment of Severely Obese Women

Jäger

Wolicki

Spohnholz

et al. 2020

IJERPH

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“…Live birth rate per transfer was higher in post-bariatric women than in non-operated obese controls (20.0% vs 9.3%, P = 0.017) ( Grzegorczyk-Martin et al , 2020 ). Menke et al (2019) reported that post-bariatric women with a history of infertility showed a higher conception rate (121.2, 95% CI 102.3–143.5 per 1000 woman-year) than women without previous infertility (47.0, 95% CI 34.2–62.9 per 1000 woman-year), P < 0.001.…”

Section: Resultsmentioning

confidence: 99%

The effects of bariatric surgery on periconception maternal health: a systematic review and meta-analysis

Snoek

Steegers‐Theunissen

Hazebroek

et al. 2021

Human Reproduction Update

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BACKGROUND Worldwide, the prevalence of obesity in women of reproductive age is increasing. Bariatric surgery is currently viewed as the most effective, long-term solution for this problem. Preconception bariatric surgery can reduce the prevalence of obesity-related subfertility and adverse maternal, pregnancy and birth outcomes. Maternal health during the periconception period is crucial for optimal gametogenesis and for embryonic and fetal development which also affects health in the later lives of both mother and offspring. Although preconception bariatric surgery improves several pregnancy outcomes, it can also increase the prevalence of pregnancy complications due to excessive and rapid weight loss. This can lead to iatrogenic malnutrition with vitamin deficiencies and derangements in metabolic and endocrine homeostasis. Thus, bariatric surgery can greatly influence periconception maternal health with consequences for reproduction, pregnancy and health in later life. However, its influence on periconception maternal health itself has never been reviewed systematically. OBJECTIVE AND RATIONALE The aim of this review was to investigate associations between bariatric surgery and determinants of periconception maternal health such as endocrine changes, fertility, vitamin status, irregular menstrual cycles, miscarriages and congenital malformations. SEARCH METHODS Medline, Embase, PubMed, Web of Science, Google Scholar and the Cochrane databases were used for the literature search until 1 November 2020. The search strategy terms included, among others, bariatric surgery, hormones, fertility, malformations, miscarriages and vitamin status. We searched for human studies that were written in English. Abstracts, reviews, meta-analyses and conference papers were excluded. The ErasmusAGE score was used to assess the quality of the included studies. OUTCOMES A total of 51 articles were analysed. The mean quality score was 5 (range 2–8). After bariatric surgery, hormonal axes normalized and menstrual cycle regularity was restored, resulting in increased fertility. Overall, there were no short-term risks for reproductive outcomes such as the increased risk of miscarriages or congenital malformations. However, the risk of vitamin deficiencies was generally increased after bariatric surgery. A meta-analysis of 20 studies showed a significant decrease in infertility (risk difference (RD) −0.24, 95% confidence interval (CI) −0.42, −0.05) and menstrual cycle irregularities (RD −0.24, 95% CI −0.34, −0.15) with no difference in rates of miscarriage (RD 0.00, 95% CI −0.09, 0.10) and congenital malformations (RD 0.01, 95% CI −0.02, 0.03). WIDER IMPLICATIONS The current systematic review and meta-analysis show associations between bariatric surgery and periconception maternal health and underlines the need for providing and personalizing preconception care for women after bariatric surgery. We recommend preconception care including the recommendation of postponing pregnancy until weight loss has stabilized, irrespective of the surgery-to-pregnancy interval, and until vitamin status is normalized. Therefore, regular monitoring of vitamin status and vitamin supplementation to restore deficiencies is recommended. Furthermore, this systematic review emphasizes the need for a long-term follow-up research of these women from the periconception period onwards as well as their pregnancies and offspring, to further improve care and outcomes of these mothers and children.

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“…Because of the concern for SGA births, especially during periods of rapid weight loss, general clinical guidance is for women to wait at least 1 to 2 years after bariatric surgery to become pregnant. Yet this guidance does not appear to be based on existing evidence (19,24), and patients do not seem to adhere to these guidelines (35). The timing between bariatric surgery and pregnancy on birth weight outcomes has also produced conflicting findings (19,36‐38).…”

Section: Discussionmentioning

confidence: 99%

Associations of Pregnancy After Bariatric Surgery with Long‐Term Weight Trajectories and Birth Weight: LABS‐2 Study

Harrod

Elman

Vesco

et al. 2020

Obesity

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Objective This study aimed to examine whether pregnancy following bariatric surgery affects long‐term maternal weight change and offspring birth weight. Methods Using data from the Longitudinal Assessment of Bariatric Surgery (LABS)‐2 study, linear regression was used to evaluate percent change in total body weight over a 5‐year follow‐up period among reproductive‐aged women who underwent Roux‐en‐Y gastric bypass or laparoscopic adjustable gastric banding as well as evaluate the association of bariatric procedure type and offspring birth weight. Results Of 727 women with preoperative age of 36.1 (6.3) years (mean [SD]) and BMI of 46.9 (7.0) kg/m2, 80 (11%) reported at least one pregnancy. After adjusting for covariates, percent change in total body weight was not significantly different between women who became pregnant and those who did not during a 5‐year follow‐up period (β = 2.02; 95% CI: −1.03 to 5.07; P = 0.19). Additionally, mean birth weight was not significantly different between mothers who underwent Roux‐en‐Y gastric bypass versus laparoscopic adjustable gastric banding (P = 0.99). Conclusions Postoperative pregnancy did not diminish long‐term weight loss in women in the LABS‐2 study. The finding of comparable weight loss is relevant for providers counseling women of reproductive age on weight‐loss expectations and family planning following bariatric surgery.

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Conception rates and contraceptive use after bariatric surgery among women with infertility: Evidence from a prospective multicenter cohort study

Cited by 13 publications

References 33 publications

Review: Sex-Specific Aspects in the Bariatric Treatment of Severely Obese Women

Review: Sex-Specific Aspects in the Bariatric Treatment of Severely Obese Women

The effects of bariatric surgery on periconception maternal health: a systematic review and meta-analysis

Associations of Pregnancy After Bariatric Surgery with Long‐Term Weight Trajectories and Birth Weight: LABS‐2 Study

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