The Impact of Bariatric Surgery on Obesity-Related Infertility and In Vitro Fertilization Outcomes

Abstract

Obesity-related infertility is one of the most common problems of reproductive-age obese women who desire childbearing. The various types of bariatric surgeries have proved effective in controlling excessive weight gain, improving fertility, and preventing certain maternal and fetal complications in these women. This article summarizes the current evidence regarding the impact of bariatric surgery on obesity-related infertility and in vitro fertilization (IVF) outcomes. We have also attempted to draw conclusions about maternal and fetal risks and the benefits of bariatric surgery. Laparoscopic adjustable gastric banding and Roux-en-Y procedures are the two most commonly performed bariatric surgeries. Bariatric surgery was believed to improve menstrual irregularity and increase ovulation rate in anovulatory obese women, which lead to increased pregnancy rates. Although there are data in the literature suggesting the improvement of both the ovulatory function and the spontaneous pregnancy rates in obese women who lost weight after bariatric surgery, most of these are case-control studies with a small number of patients. The data are insufficient to determine an ideal time interval for pregnancy after bariatric surgery; however, the general consensus is that pregnancy should be delayed 12 to 18 months after bariatric surgery to avoid nutritional deficiencies. Few data exist regarding IVF success rates in women who have undergone bariatric surgery. One pairwise study discussed five patients who underwent bariatric surgery followed by IVF that resulted in three term pregnancies in three patients after the first IVF cycle. Many studies reported reductions in obesity-related pregnancy complications such as gestational diabetes and hypertensive disorders after bariatric surgery. Although data are inconsistent, some studies reported increased rate of preterm delivery and small for gestational age infants after bariatric surgery. Pregnancies after bariatric surgery may be considered high risk due to the concerns for vitamin deficiencies and gastrointestinal symptoms related to the surgery. Therefore the follow-up of these pregnancies might require a team approach including a maternal fetal medicine specialist, bariatric surgeon, and nutritionist.

Obesity and reproduction: a committee opinion

“…Bariatric surgery in women can restore menstrual regularity (155,156), correct ovulation (157,158), shorten folliculogenesis with ovulation, reduce serum T levels, diminish percent body fat, and improve both sexual function (159) and chance of pregnancy (160,161), with weight loss predicting conception (161). In eumenorrheic women with a BMI R35 kg/m 2 , however, surgically induced weight loss only partially improves deficient luteal progesterone production with a rise in LH secretion, suggesting persistent corpus luteum dysfunction (162).…”

“…Therefore, preconceptional assessment of a patient's nutritional status and micronutrient supplementation after bariatric surgery are imperative (150,157,158,173). Delaying pregnancy until 1-2 years after bariatric surgery has been recommended to avoid fetal exposure to nutritional deficiencies from rapid maternal weight loss (173,180,181), although limited data suggest that pregnancy within the first year after bariatric surgery may not necessarily increase the risk for adverse maternal or perinatal outcomes (177,182,183).…”

Rodent vertical sleeve gastrectomy alters maternal immune health and fetoplacental development

“…The major advantage to bariatric surgery during the child-bearing years is the potential for improving reproductive capacity as well as achieving a healthier pregnancy. Improvements after bariatric surgery include return of normal menstrual cycles (16, 55), improved levels of reproductive hormones (44), recovery of luteal function (41), increased spontaneous (unassisted) pregnancies (36, 54), improvements in assisted pregnancies (36), lower risk of gestational diabetes and preeclampsia (19, 27), and reduced risk of large-for-gestational age (LGA) babies (27, 47, 48, 59). Thus, bariatric surgery holds great promise to improve reproductive outcomes for obese women interested in child-bearing.…”

Adverse effects of obesity and/or high-fat diet on oocyte quality and metabolism are not reversible with resumption of regular diet in mice

“…In anovulatory women, a reduction in body mass index can lead to an increase in ovulation and therefore improved fertility [6]. In women who have undergone gastric bypass surgery, the data are currently unclear as to whether or not rapid weight loss leads to overall improved fertility and decreased rates of pregnancy loss [7-11]. Furthermore, this patient population does not represent patients who have lost weight through non-surgical methods.…”