The U.K.’s Royal College of Obstetricians and Gynecologists (RCOG) published a Scientific Impact Paper suggesting that weight loss surgery can improve fertility and reproductive outcomes in obese women.

The paper was a product of a review in which the authors analyzed data from the latest evidence around the safety and effectiveness of bariatric or weight loss surgery, and the potential role of these procedures as an option to improve infertility and other unique reproductive issues that obese women may face.

After review and analysis of the primary literature on the subject, the key findings noted that:

• The only effective ways to induce long-term weight reduction in women with severe obesity are either significant sustained lifestyle changes or bariatric surgery.
• Overall, bariatric surgery has been shown to improve a woman’s fertility and reduce pregnancy complications.
• Maintaining a healthy body weight 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.
• Although bariatric surgery can improve a woman’s health and the health of her future family, it should only be used as a last resort when all other treatment options, including lifestyle changes, have not been successful.

In a RCOG press release, Dr. Adam Balen, MB, BS, MD, DSc, FRCOG, professor of Reproductive Medicine and Surgery, Leeds Teaching Hospitals, U.K., lead author of the paper and spokesperson for the RCOG, stated, “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.”

Dr. Balen continued, “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.”

Dr. Balen’s colleague, Dr. Sadaf Ghaem-Maghami, chair of the RCOG’s Scientific Advisory Committee, agreed and expounded on his statement by adding, “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.”