Written by: Meredith Raine  |  Updated: July 22, 2009

Editor’s Note: Gastric bypass surgery, Roux-en-Y, lap band procedure are among the surgical methods to help reduce weight in morbidly obese patients. Together they comprise the surgical side of what’s called bariatric medicine, the treatment of obesity. Today’s issue of HealthLeader is Part II of a series on the surprising health benefits of profound weight loss through bariatric surgery.

When Abby Erias had gastric bypass surgery, she remembered the physicians telling her that one of the side effects to her rapid weight loss could be increased fertility.

She already had two daughters and wasn’t planning to have any more children, so she went on birth control. She didn’t want to take any chances.

“I couldn’t find the right birth control for me, so my plan was to go off birth control for 30 days and then go a different route with something new,” Erias says. “In less than 30 days, I didn’t think I could get pregnant, but I went a different route all right. I had a baby!”

When bariatric surgeons at The University of Texas Medical School at Houston host informational sessions about gastric bypass and lap-band procedures, they emphasize that as the unwanted pounds come off, pregnancy may become a very real possibility.

This discussion often produces some chuckles and a few “yeah, right” comments from women in the audience.

Brad E. Snyder, MD, assistant professor of surgery and director of clinical research at Minimally Invasive Surgeons of Texas, understands why women might find this news laughable. Some are toward the end of their childbearing years. Others have had such a difficult time in the past becoming pregnant that they think there is no way weight-loss surgery could improve their ability to conceive. Some are amused because a risk of pregnancy would imply sexual activity—something in which they haven’t engaged in quite some time because of their weight.

Whatever the case, because nearly half of patients undergoing bariatric procedures are reproductive-age women, Snyder has a reminder for his patients: “If you don’t want to get pregnant, you need to be diligent about birth control.”

Roslyn Spivey has some advice for those women who think it can’t happen to them. “I tell people you better be careful.”

Spivey recalled the discussion about increased fertility before her lap-band procedure, but she “just glossed over it” because she thought she was too old to have more children. One day she was fatigued and wasn’t feeling well. She went to her physician to talk to him about what she thought were symptoms of menopause. She couldn’t believe it when the doctor told her “the change” she was experiencing was actually a pregnancy.

Snyder, who operates at Memorial Hermann-Texas Medical Center, says obesity often creates high levels of hormones that can hinder fertility. As women begin to lose weight after bariatric surgery, hormone levels begin to stabilize. Plus, patients are often eating healthier and exercising more, all of which create a more conducive environment for ovulation and conception.

Also, according to Pamela Berens, MD, associate professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the UT Medical School at Houston, many obese women experience irregular menstrual cycles and may have infertility related to difficulty with ovulation such as polycystic ovary syndrome. One researcher found that nearly 50 percent of women undergoing bariatric surgery had ovulatory problems before surgery and approximately 70 percent of them resumed normal menstrual cycles after surgery. It also appeared that more weight loss made it more likely for the women to get regular cycles back.

Nutrition and pregnancy after surgery

Pregnancy after bariatric surgery is considered safe, as long as patients adhere to a few important guidelines.

“It’s best that women wait to become pregnant until at least a year after their bariatric surgery and we prefer that they wait two years,” Berens says. “That’s the period of time when their bodies will experience the greatest weight loss and stress.”

During the 12- to 24-month period, Berens recommends birth control pills, a contraceptive vaginal ring or an intrauterine device (IUD). She advises against Depo-Provera, a three-month shot that may promote weight gain. Some physicians are concerned that birth control pills may not absorb as well into their systems if they’ve had certain types of weight-loss surgery whose hallmark side effects are poorer absorption of nutrients and some medications. Adequate research on this, however, is not yet available, Berens says.

Once the patient is a healthy weight, is a year or two out from surgery and decides to become pregnant, Berens recommends she consult with an obstetrician who has experience with weight-loss surgery patients and begin taking folic acid at least three months before trying to conceive.

The key is to make sure the mother is absorbing enough nutrients to sustain herself and the fetus. For gastric bypass patients who may not be absorbing adequate levels of vitamins and minerals, Berens may recommend B12 injections or a nasal spray, which are more easily absorbed than oral vitamins. Other nutrient concerns include iron, calcium and vitamin D.

Carol Wolin-Riklin, a registered dietitian at The University of Texas Bariatric & Metabolic Surgery Center, adds that chewable prenatal vitamins are now available, and these may be easier than regular supplements for gastric bypass patients to swallow.
“There are a lot of nutritional issues that they need to be aware of and they need to manage so that they can have a healthy baby,” Wolin-Riklin says.

The goal for women who become pregnant after weight-loss surgery should be 1,500 to 1,800 calories per day. “They need five to six meals and snacks a day with no skipping,” she says.

If lap-band patients are having trouble getting enough nutrients or develop severe nausea or vomiting related to pregnancy, the band can always be adjusted to allow expectant mothers to eat more. Gastric bypass patients must be monitored closely.

Wolin-Riklin adds that losing excess weight reduces a woman’s risk of developing high blood pressure and gestational diabetes during pregnancy.

In addition to the health and safety of both mother and baby, women who become pregnant after weight-loss surgery are often concerned about the weight they gain with pregnancy. Wolin-Riklin says most bariatric patients will gain 15-20 pounds during their pregnancy, “and we can work with them to help them lose that weight.”

One study found that women who had undergone bypass procedures gained less weight during pregnancy compared to women planning the procedure, Berens adds.
Erias, whose daughter, Destiny, is now a toddler, says she lost the weight she gained during her pregnancy and then some. “I used to be a size 24,” she says. “Now I’m a size 6. I’m healthy, and I have a healthy baby.”