RCOG recommends that bariatric surgery should only be considered as a “last resort”
Weight loss surgery can improve fertility and reproductive outcomes in obese women according to a Scientific Impact Paper (SIP) published today by the Royal College of Obstetricians and Gynaecologists (RCOG).
Obesity, classed as having a body mass index (BMI) of 30 or over, affects over a quarter of the female population. Being very overweight or obese impacts on natural conception, miscarriage, pregnancy and the long term health of women and their children, due to an increased risk of congenital anomalies, pregnancy complications and illnesses associated with obesity, such as diabetes, high blood pressure and certain cancers.
This opinion paper reviews the latest evidence around the safety and effectiveness of different types of bariatric or weight loss surgery as an intervention to improve fertility and reproductive outcomes in obese women. The authors agree that the only effective ways of inducing long-term weight reduction in women with severe obesity, and thereby improving reproductive health, are either significant sustained lifestyle changes or bariatric surgery. However, they stress that it would be impractical to recommend surgery to all obese women of reproductive age.
Professor Adam Balen, lead author of the paper and spokesperson for the RCOG said:
“Our review of all the literature on this subject confirms that weight loss surgery can improve fertility and reproductive outcomes in obese women, but we believe it should only be considered as a last resort when other treatments, such as lifestyle changes, haven't worked.
“As with any major operation, bariatric surgery carries a risk of complications but also requires a significant change in lifestyle afterwards. As well as the time needed to recover from the surgery, it can delay conception by up to 12 to 18 months during the initial weight loss phase, because the fetus may be at risk of nutritional deficiencies. Additionally, there is very limited access to these types of interventions on the NHS and the demand is currently higher than supply in many areas of the country.
“Being a healthy bodyweight increases the chances of conceiving naturally and reduces the risk of the problems associated with being overweight or obese in pregnancy. Before considering weight loss surgery, women planning a family who are overweight or obese should lose weight through a healthy, calorie-controlled diet and increased amounts of exercise. The free NHS weight-loss plan and a referral to a weight loss support group are proven effective ways of achieving weight loss goals”.
Bariatric surgery results in a 15 to 25 per cent long-term loss of body weight, as well as significant reductions in healthcare costs and illnesses associated with obesity, such as diabetes, high blood pressure and certain cancers.
Additionally, this review looked at evidence, which shows that bariatric surgery improves signs and symptoms associated with polycystic ovary syndrome (PCOS) which influences fertility, including anovulation (the ovary failing to release eggs), hormonal changes and libido. Bariatric surgery is also associated with higher success rates of assisted conception, including IVF. In pregnancy, most research has shown improved maternal and infant outcomes in women who have had bariatric surgery compared with similarly obese women or previous pregnancies in the same women. This includes a reduced risk of miscarriage, gestational diabetes, hypertension, macrosomia (large baby) and congenital abnormalities. There is however an associated increased risk of preterm birth and small for gestational age (SGA) babies.
Current NICE guidelines recommend bariatric surgery only in cases where a patient has a BMI of 40 or above or a BMI of 35 or above and another serious health condition that could be improved with weight loss. In both cases, surgery is only available on the NHS when other treatments, such as lifestyle changes, have not worked.
The authors advise that pregnant women who undergo bariatric surgery receive specialist care throughout their pregnancy, including dietetic support, weight monitoring, close observation of fetal growth and monitoring for gestational diabetes. During neonatal care, careful monitoring for SGA and preterm birth is essential.
Dr Sadaf Ghaem-Maghami, Chair of the RCOG’s Scientific Advisory Committee, added:
“As with any operation, bariatric surgery is associated with some risks and complications can include infection, protein malnutrition, deep vein thrombosis and hernia. An increased rate of small for gestational age babies and preterm birth has also been documented in some research.
“It is therefore vital that when bariatric surgery is considered an option and is available for women who wish to improve their chance of conceiving naturally or through assisted means, they speak to their obstetrician and surgeon to balance the risks of surgery against the benefits of improved long-term health and wellbeing for themselves and their future children.”
For further information, please contact the RCOG Media and PR team on +44 20 7772 6300 or email firstname.lastname@example.org.
About RCOG Scientific Impact Papers
RCOG Scientific Impact Papers (formerly SAC Opinion papers) are produced by the Scientific Advisory Committee. They are up-to-date reviews of emerging or controversial scientific issues of relevance to obstetrics and gynaecology, together with the implications for future practice. These documents have been rebranded to raise awareness of the issues in obstetrics and gynaecology discussed in the documents and to more accurately reflect their content and remit of the Committee.
RCOG report High Quality Women’s Health Care (2011)
RCOG Patient Information on why your weight matters during pregnancy and birth
RCOG Patient Information on small for gestational age babies
RCOG Patient Information on PCOS
British Fertility Society website
NHS Choices information on weight loss surgery