WLS: Fertility & Pregnancy

Carrying excess weight can have significant effects on fertility and, therefore, the chances of falling pregnant. Fortunately, losing weight can reverse these difficulties and help with conception.

How Weight Loss Surgery Affects Fertility

• Changes in Hormonal Balance: Excess body fat, especially around the abdomen, can disrupt hormone production and regulation. After weight loss surgery, the reduction in fat tissue can lead to more balanced hormone levels, which is particularly beneficial for reproductive hormones such as oestrogen and progesterone.
• Improved Insulin Sensitivity: Obesity often leads to insulin resistance, which can affect ovulation in women and sperm quality in men. Weight loss surgery can improve insulin sensitivity, making it easier for cells to respond to insulin. This improvement can positively affect fertility by promoting regular ovulation and enhancing overall reproductive health.

Role of Obesity in Fertility Issues

Obesity is a known risk factor for infertility and can contribute to a range of reproductive problems:

• Irregular Menstrual Cycles: Obesity can lead to irregular menstrual cycles and anovulation (lack of ovulation) in women, making it difficult to conceive.
• Hormonal Imbalances: Excess body fat can lead to increased oestrogen production, disrupting hormonal balance and affecting the normal menstrual cycle.
• Polycystic Ovary Syndrome (PCOS): Obesity is closely linked to PCOS, a common cause of infertility in women. PCOS is characterised by irregular periods, cysts on the ovaries, and hormonal imbalances.
• Reduced Sperm Quality: In men, obesity has been associated with reduced sperm quality and fertility issues. Elevated levels of oestrogen in obese men can negatively impact sperm production and function.

Benefits of Weight Loss on Fertility

• Increased Chances of Conception: Weight loss surgery can significantly increase the chances of conception for couples struggling with obesity-related infertility. As individuals lose excess weight, hormonal balance improves, making it easier for women to ovulate regularly and increasing the likelihood of successful conception.
• Enhanced Menstrual Regularity: Weight loss after bariatric surgery often improves menstrual regularity in women who previously had irregular periods. This regularity is a positive sign of restored fertility and makes it easier for couples to time their attempts at conception.

Pregnancy after Weight Loss Surgery

Becoming pregnant is often easier as you lose weight. In addition, if you become pregnant, the pregnancy and delivery are associated with less risk when your BMI is below 30.

Many women consider themselves infertile and may have been unsuccessful in attempting to get pregnant in the past. For many of these women, underlying obesity is a major contributing factor to infertility. Women with severe obesity have about three times higher rates of menstrual disturbance.  Obesity is associated with lower rates of natural fertility and higher rates of miscarriage.

Obesity is associated with increased risks during pregnancy (high blood pressure, gestational diabetes, urinary infection, Caesarean section) and more complications during and after delivery.

With increased weight, fatty tissue holds onto normal hormones longer, and the body also produces an oestrogen-like hormone that can inhibit ovulation. It is common for the obese female to have scant, irregular or no menstrual cycle at all. With as little as a 7-10 kilogram weight loss, the odds of pregnancy are improved, and the miscarriage rate may be reduced.

Your menstrual cycle may become more regular, and reduced fertility due to Polycystic Ovary Syndrome improves. Pregnancy is also usually a lot easier after weight loss, and the risk of developing gestational diabetes and pre-eclampsia is reduced.

After surgery, you may resume sexual activity when you feel physically and emotionally able, but sexually active women of childbearing age need to use birth control—preferably a non-oral contraceptive.

We recommend you wait at least 12-18 months after weight loss surgery and until your weight loss has plateaued before planning a pregnancy.

Nutritional Considerations During Pregnancy

Some patients will fall pregnant following weight loss surgery. At Hunter Weight Loss, we are here to help you should you need it. Some considerations if you fall pregnant within 12-18 months following weight loss surgery include:

• Nutrient Absorption: Weight loss surgery can alter nutrient absorption in the body. Pregnant individuals should work closely with their obstetrician, GP and dietitian to monitor and supplement essential nutrients, including folate, iron, calcium, vitamin D, and protein, to support a healthy pregnancy.
• Balanced Diet: Maintaining a balanced diet is crucial during pregnancy. After weight loss surgery, individuals should focus on consuming nutrient-dense foods to meet their nutritional needs and those of their developing baby.

Postpartum Considerations

• Breastfeeding: Individuals who have undergone weight loss surgery can breastfeed normally.
• Weight Management: After pregnancy, individuals may need to work with healthcare professionals to manage their weight effectively and maintain a healthy lifestyle. This includes following a balanced diet, regular physical activity, and addressing potential nutritional deficiencies.

Nutritional Guidelines for Pregnant Women After WLS

Maintaining a healthy weight and ensuring proper nutrition during pregnancy after weight loss surgery is essential for the well-being of both the mother and the baby.

Balancing calorie intake, exercising regularly, and following nutritional guidelines with the guidance of a dietitian are key components of a successful and healthy pregnancy.