Bariatric surgery can improve fertility

A report by the Royal College of Obstetricians and Gynaecologists (RCOG) in the UK has found that bariatric surgery can improve fertility. The report entitled, ‘The Role of Bariatric Surgery in Improving Reproductive Health’, examined the safety and effectiveness of bariatric or weight loss surgery as a way of improving female fertility and reproductive health in obese women, and concluded that bariatric surgery improves a woman’s fertility and reduce pregnancy complications. This new report is the second report from the RCOG on the role of bariatric surgery on female fertility, the first edition was called The Role of Bariatric Surgery in the Management of Female Fertility (2010).

Roger Ackroyd

"We welcome the RCOG report which has valuable insights and we agree entirely that bariatric surgery is indeed often beneficial to overweight women wishing to become pregnant,” said Mr Roger Ackroyd, President of the British Obesity and Metabolic Surgery Society. “Not only does it increase fertility in women who are often less fertile due to their weight and/or polycystic ovaries, but it can decrease problems and complications of pregnancy and in the newborn. NICE Guidelines now recommend surgery down to a BMI30 in patients with Type 2 diabetes which may include many women of child-bearing age."

It is known that obesity has a negative impact on natural conception, miscarriage, pregnancy and the long term health of the mother and child due to an increased rate of birth defects, pregnancy complications and the possibility of disease later in life. Furthermore, obesity is a common problem among women of reproductive age with 26 percent of women in the UK reported to have a BMI>30. In addition, women are three times as likely to be admitted to hospital with a primary diagnosis of obesity as men and female patients outnumber male patients seeking bariatric surgery by a ratio of around 3:12 - approximately 70% of these women are of childbearing age. Indeed, one study found that 25% (29/115) of women presenting for bariatric surgery suffered from infertility.

However, research has suggested that bariatric surgery does improve female fertility, including an improvement in symptoms of polycystic ovary syndrome (PCOS) which influences fertility, the release of eggs, hormonal changes, sexual activity and libido. In addition, surgery can also reduce pregnancy complications when compared to untreated obese women or previous pregnancies in the same women, including a reduced risk of miscarriage, gestational diabetes, hypertension, macrosomia (large baby) and congenital abnormalities.

This latest paper reviews the most recent evidence on the safety and efficacy of bariatric surgery as an intervention to improve female fertility and reproductive outcomes in obese women.

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