Bariatric surgery Singapore: Can I still conceive after rapid weight loss?

Bariatric surgery and fertility: Can I still conceive after rapid weight loss? More than half of bariatric surgery patients are females, and of that group, about 60% are married. Many of my patients have expressed their desire to get pregnant in future and asked ifit’s safe to conceive after weight loss surgery. The short answer is yes, of course.

Pregnancy after bariatric surgery can be safe and healthy if managed well by you and your healthcare provider. There are some factors you have to keep in mind — here are some tips I’ve gathered based on my experience working with women who conceive after weight loss surgery.

How does obesity affect fertility?

Overweight and obese women have higher levels of leptin, a hormone produced by your body’s fat cells. High levels of leptin have been shown to deregulate the hypothalamic pituitary gonadal system, leading to reproductive dysfunction, including reduced fertility. Women with a body mass index (BMI) over 27 are three times more likely to have difficulty conceiving. Simply put, the more excess weight you have, the lower your chances of fertility.

By the way, the same goes for males — a review of studies on paternal obesity found that obesity reduces sperm quality, and for every 10kg of extra weight carried, fertility reduces by 10%.

Now, we know the implications obesity can have during pregnancy too. According to the American College of Obstetricians and Gynaecologists, obesity during pregnancy puts you at risk of several health problems, including:

Gestational hypertension
Preeclampsia
Gestational diabetes
Obstructive sleep apnea
Birth defects
Preterm birth
Macrosomia, in which the foetus is larger than usual, increasing the risk of caesarean birth
Stillbirth

The best way to decrease the risk of obesity-related problems during pregnancy is to lose weight before pregnancy — hence why some individuals opt for bariatric surgery.

With all that’s said, please note that bariatric surgery should NOT be considered a treatment for infertility.

Dr Ganesh performing Bariatric surgery in Singapore

How soon can I get pregnant after bariatric surgery in Singapore?

A 2005 report in the Journal of Obstetric, Gynecologic, and Neonatal Nursing found that women with female infertility linked to obesity ovulated regularly for the first time in years after their weight loss surgery. Further, if you suffer from polycystic ovarian syndrome (PCOS), your fertility should also get a boost after surgery. So yes, this rapid weight loss can indeed produce a sudden positive change in your ability to conceive.

While this all sounds like good news, there is a caveat — if you are not on birth control, you want to avoid getting pregnant by accident 18 months post-surgery.

The Cleveland Clinic Bariatric and Metabolic Institute recommends waiting 18 months before conceiving. This is to protect you and your baby from potential malnutrition as rapid weight loss is expected after surgery. After gastric bypass bariatric surgery, nutritional deficiencies for the following nutrient groups are common:

Protein
Iron
Calcium
Folate
Vitamins B12 and D

Even past the post-surgery period, many women face nutritional problems that can pose problems during pregnancy.

I highly advise you to work closely with a bariatric surgeon and nutritionist to ensure your nutritional status is on track. In the event you get pregnant during the window period, close monitoring is for sure a non-negotiable.

Will I experience any side effects afterbariatric surgery in Singapore?

Apart from the risk of malabsorption and nutritional deficiencies, there are so far no known serious side effects. However, please take note that gastrointestinal problems common in pregnancy such as nausea and vomiting may sometimes be due to the risk of delayed postoperative complications; it is not uncommon for bariatric patients to experience abdominal discomfort a few months post surgery. Hence, please consult a bariatric surgeon early to determine if the symptoms are related to the surgery.

I also hear from patients that they cannot tolerate the procedure administered to screen for gestational diabetes, in which they are required to drink a solution high in glucose. If this is you, consider alternative screening methods like home glucose monitoring instead.

Will bariatric surgery affect labour and delivery?

Bariatric surgery should not affect labour and delivery, but women who’ve had weight loss surgery are more likely to have a C-section, according to the American Journal of Obstetrics and Gynaecology. It is not clear why, but some things to consider:

Does your healthcare provider consider you at a high risk for a C-section? If so, why?

What is your provider’s experience with C-sections?

In what event will your provider call for a C-section during a vaginal delivery?

Regardless, if you’ve had weight loss surgery and intend to get pregnant, please communicate with your healthcare providers early so they can arrange the best care for you. As always, I’m open if you have any questions.

Good luck!