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.