Published September 29, 2023
Some patients struggling to get pregnant may benefit from a conversation with their doctor about weight loss. Excess weight is linked to issues such as increased inflammation in the body, changes in estrogen levels and irregular periods, which can interfere with someone’s ability to conceive. Sometimes patients seeking care from a fertility specialist are told to lose weight first before they can start fertility treatments.
Any patient interested in weight loss will benefit from making lifestyle modifications such as changes to diet and exercise. For patients who need help losing a significant amount of weight, there are a lot of treatment options available including obesity medications and bariatric surgery.
“People are more fertile after surgery and there are a lot of success stories,” said Neil Floch, MD, director of Bariatric Surgery for Greenwich Hospital.
Patients typically qualify for bariatric surgery if they have a BMI of 40 or higher or have a BMI of 35-39 with other health issues such as diabetes, cardiac disease or sleep apnea. New guidelines developed by the American Society of Metabolic and Bariatric Surgeons, or ASMBS, now qualify patients with diabetes at a BMI of 30 or higher but insurance companies have yet to follow them.
Common procedures include sleeve gastrectomy and gastric bypass, both of which alter gut hormone levels much like weight loss medications and make the stomach smaller, limiting the volume of food patients eat. While Dr. Floch says some patients see medication as an easier path to weight loss and thus pregnancy, bariatric surgery may be a better fit for some.
“The question is, do you want to just get pregnant and have the child? Or do you want to keep the weight off long term? If you are going to go through this whole process, you might as well have the surgery which has the best track record of keeping weight off and improving overall health,” said Dr. Floch.
After bariatric surgery, patients need to wait at least 18 months before trying to get pregnant. Dramatic weight loss can lead to vitamin deficiencies and low levels of folic acid can impact a developing fetus. In addition, the patient’s care team needs to ensure there are no potential complications from the surgery that could impact the baby.
“We know there’s increased fertility with any weight loss, but more specifically with surgery when you lose a lot of weight, suddenly there may be patients who are thinking they can’t get pregnant and we have to warn them specifically to have a plan to prevent conceiving,” said Dr. Floch.
For patients yearning to become a parent, 18 months feels like a long time. But Dr. Floch says making that investment in their health is worth the wait. In addition to impacting fertility, weight loss can have a positive outcome on a patient’s pregnancy, delivery and the health of their child by reducing the risk of complications.
Once the baby comes, it will be important for patients to continue to take their health seriously. It can be difficult for anyone to lose weight after having a baby, but bariatric surgery patients are at an increased risk of struggling with weight loss during the postpartum period. Dr. Floch recommends patients create a plan of action for their postpartum weight loss, keep all regular appointments with their care team and reach out for help if they are starting to struggle with weight gain once again.
