Bariatric Surgery in

Relation to Fertility
BY MONICA CORZO AND NAKEA HARRISON
Obesity
● Almost 1/3 of women entering pregnancy in the U.S. are obese.
● Obesity is associated with poor outcomes for both the pregnant woman
and the fetus.
● Obesity in women of the reproductive age is important because of the
risks of type 2 diabetes and cardiovascular disease.
● While dietary and lifestyle modification remain first in line in the
management of obesity, a more widespread use of bariatric surgery is
being observed across the world.
● Class 2 obesity (BMI 35-40) and class 3 obesity (BMI >40) are often hard
to treat with diet and exercise alone.
What is Bariatric Surgery?
● An operation that helps an individual
lose weight by making changes to their
digestive system.
● Some types of bariatric surgeries make
the stomach smaller, allowing an
individual to eat and drink less at one
time and making them feel fuller sooner.
● Other bariatric surgeries also change the
small intestine, the part that absorbs
calories and nutrients from foods and
beverages.
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Who is it for?
● Bariatric surgery is an option for individuals who are severely obese, and
have not been able to lose weight or keep from gaining back any weight
loss.
● It is also an option for those who have serious health problems
- I.e. individuals with T2D, sleep apnea and other conditions that are
related to obesity
● For individuals with a BMI > or = to 40, or more than 100 lbs overweight
● For individuals with a BMI > or = to 35 and at least one or more obesity
related chronic diseases such as T2D, hypertension, sleep apnea,
non-alcoholic fatty liver disease, heart disease etc.
 Three Different Types of Bariatric Surgery
The first Type:
Laparoscopic Adjustable Gastric
Band
A ring with an inner inflatable band is
placed around the top of the stomach to
create a small pouch. The band has a
circular balloon inside that is filled with
salt solution. The surgeon can adjust the
size of the opening from the pouch to the
rest of the stomach by injecting or
Wadhawan, R.
removing the solution through a small
device.
Three Different Types of Bariatric Surgery
The second type:
Gastric Sleeve (vertical sleeve
gastrectomy)
Most of the patient’s stomach is
removed, leaving only a banana-shaped
section that is closed with staples. This
surgery reduces the amount of food that
can fit in the stomach. This surgery can
not be reversed b/c some of the
stomach is permanently removed.
Dr. Jorge Maytorena
 Three Different Types of Bariatric Surgery
The third type:
Gastric Bypass (RYGB)
First the stomach is stapled, creating a
small pouch in the upper section. The
staples make the stomach smaller, so
patient eats less. Next, the small
intestine is cut & attached to the
lower part of it directly to the small
stomach pouch. Food then passes the
stomach & the upper part of the small
intestine so that the body absorbs
Kastrati, F. (2019, February 27). Late
fewer calories. Complications Of Gastric Bypass Surgery.
Bariatric Surgery and Infertility
● 52 eligible patients was extracted from database, 28 underwent bariatric
surgery & 24 did not. Both groups were observed for a two year follow up.
During the follow up, body measurements, blood analysis and diseases
were checked and a gynecological consultation was prescribed.
● This is important because women obesity is associated with menstrual
irregularity, reduced fertility, PCOS, gestational diabetes, pregnancy-related
hypertension and increased risk of obesity in the offspring.
● Results: 27 successfully underwent bariatric surgery with a percentage of
excess weight loss >70% at 24 months while 23 accepted the observation
and control for 24 months and an integral part of the bariatric program.
● Summary: Bariatric surgery improves fertility in obese women at two years
after the operation.
Obesity, Male Reproductive Func. &
Bariatric Surgery
● Bariatric surgery is the most effective treatment for reproductive
abnormalities in obese males. Frequently ensuring the complete
normalization of testosterone levels, long-term weight maintenance.
● This is important because men with obesity, lack function of the testes,
erectile dysfunction and reduced fertility represent complications seriously
affecting the patient quality of health and life.
● Following bariatric surgery, confirmed a significant increase in total
testosterone and reduction of estradiol plasma levels after weight loss.
● Bariatric surgery seems to be effective to improve free and total
testosterone plasma levels in obese men.
 Recommendations
● A healthy lifestyle can preserve or restore erectile function in men, in
particularly men with obesity.
● Women should delay conceiving until 12-24 months after surgery. This is the
period when the most rapid weight loss occurs.
● It is wise to monitor fetal growth in women who have undergone gastric
bypass.
● Multidisciplinary approach to care is desirable with close monitoring for
deficiencies at each trimester.
 References
Caughey, Aaron B. "Bariatric Surgery before Pregnancy — Is This a Solution to a Big Problem?" The New England
Journal of Medicine 372.9 (2015): 877-78. Web.

Consalvo, V., Canero, A., & Salsano, V. (2017, December 22). Bariatric Surgery and Infertility: A Prospective
Study. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29316601

Definition & Facts for Bariatric Surgery. (2016, July 1). Retrieved from
https://www.niddk.nih.gov/health-information/weight-management/bariatric-surgery/definition-facts

Di Vincenzo, A., Busetto, L., Vettor, R., & Rossato, M. (2018, December 18). Obesity, Male Reproductive Function
and Bariatric Surgery. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6305362/

Dr. Jorge Maytorena. (n.d.). Retrieved May 4, 2020, from

https://longtermvsg.com/gastric-sleeve-surgery-in-tijuana-mexico/

Kastrati, F. (2019, February 27). Late Complications Of Gastric Bypass Surgery. Retrieved from
https://www.metdaan.com/late-complications-gastric-bypass-surgery/
 References
Levi, Isaac, Efrat Burshtein, Barak Aricha-Tamir, and Eyal Sheiner. "754: Pregnancy Outcome before and after
Bariatric Surgery." American Journal of Obstetrics and Gynecology 204.1(2011): S296. Web

Types of Bariatric Surgery. (2016, July 1). Retrieved from

https://www.niddk.nih.gov/health-information/weight-management/bariatric-surgery/types

Wadhawan, R. (n.d.). LAGB (Laparoscopic adjustable gastric banding) - Weight Loss Surgery in Delhi. Retrieved
from https://www.randeepwadhawan.com/lagb-laparoscopic-adjustable-gastric-banding/