Weight loss surgery, also called bariatric surgery, is a highly effective weight loss method for people who are seriously overweight. But the surgery and resulting weight loss can have a major impact on your fertility and can also affect how some birth control works.
There are also risks in getting pregnant too soon after weight loss surgery. That’s why women of childbearing age should discuss birth control options with their doctor before undergoing the procedure. Keep reading to learn more about how bariatric surgery affects fertility and what you need to know about contraception after surgery.
How Does Obesity Impact Fertility?
Obesity causes many hormonal changes triggered by excess body fat. This means that reproductive hormones are often out of balance when someone is obese. In women, this can mean irregular periods with less frequent ovulation, which decreases fertility.
Compared to women with a normal body mass index (BMI), obese women are up to three times more likely to experience infertility. But when you lose even a small amount of weight, your fertility can improve.
If you have infertility problems due to your weight, you may have a boost in fertility after weight loss surgery. That might be good news if you want to get pregnant. But unless you use effective birth control, you may also be more likely to get pregnant, even if you’re not trying.
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Pregnancy and Nutrient Deficiencies After Bariatric Surgery
Bariatric surgery promotes significant weight loss because it changes how your digestive tract works. It reduces the size of your stomach, so you eat much less. As a result, you might have a hard time eating enough calories and you also might not absorb enough nutrients from your food. There’s a risk of becoming malnourished or low in certain nutrients, which can affect your health.
This risk increases if you get pregnant. Being pregnant puts more demands on your body because you need extra nutrients to support your baby’s growth and development. If you have compromised nutrition from the surgery, you’ll have a hard time feeding your unborn baby.
After weight loss surgery, you might have low levels of these nutrients in particular:
- Vitamin B12
- Folic acid
- Vitamin D
Your doctor will monitor you and prescribe special vitamins and supplements to avoid medical problems. You’ll need to take vitamins and minerals for the rest of your life to prevent a deficiency.
If you plan to become pregnant, talk to your doctor. They can advise you about any changes you should make to your diet and supplements prior to — and during — pregnancy.
Is Pregnancy After Weight Loss Surgery Safe?
Most people can have a successful pregnancy and a healthy baby after bariatric surgery. After your weight loss stabilizes, you’ll have a lower risk of complications like gestational diabetes and blood pressure problems during pregnancy.
But it’s vital to delay pregnancy immediately after surgery because your body needs time to recover fully. Pregnancy too soon after surgery is dangerous for you and your baby.
If you want to get pregnant, ask your doctor how long you should wait. Generally, doctors advise waiting at least 12 to 18 months after bariatric surgery before trying to become pregnant. It’s vital to use an effective method of birth control during that time.
Risks for the mother
Getting pregnant too soon after bariatric surgery can impact your health because it may worsen nutrient deficiencies. In particular, you’ll run a significant risk of developing iron deficiency anemia. Not only does that make you extra tired, but it can also affect how your heart and lungs work.
Pregnancy soon after bariatric surgery also puts you at greater risk of protein, vitamin, and mineral deficiencies.
Risks for the baby
Your diet before and during pregnancy affects your baby’s growth and development. So having nutrient deficiencies not only has consequences for your health, but it also puts your baby at risk.
- They may have a neural tube defect. This can happen if you don’t get enough folic acid before and in the early weeks of your pregnancy.
- They may develop other birth defects if your diet lacks certain nutrients.
- They may have poor growth and low birth weight. This is more likely if you’re not eating enough calories and gaining enough weight during pregnancy.
- Babies conceived shortly after bariatric surgery have a higher chance of being premature.
- Your newborn might develop health problems requiring neonatal intensive care.
Also, getting pregnant too soon increases the risk of having a stillborn baby or your baby dying shortly after birth.
Contraception After Weight Loss Surgery
An increase in fertility can occur very quickly after bariatric surgery, even before you experience significant weight loss. As you lose weight, your hormones are in flux, and your periods will probably be irregular.
It’s hard to predict when you’re ovulating, and you may get pregnant when you least expect it. So it’s essential to have a birth control method in place before your procedure.
The changes in your digestive tract that affect your nutrition also affect how you absorb certain oral medications, including birth control pills. As a result, the pill is less effective after bariatric procedures. If you’ve been taking a birth control pill, ask your doctor if it’s still a good choice after your surgery.
Also, you might need to avoid certain hormones in the weeks before your operation. So you might need to discuss an alternative form of birth control even before your surgery.
Hormonal birth control that doesn’t go through your digestive system is still effective after bariatric surgery. Ask your doctor about these birth control methods:
- An IUD — A t-shaped device that a doctor places in your uterus.
- A vaginal ring — A small, soft plastic ring you insert in your vagina.
- A birth control patch — A small patch you wear on your skin that releases hormones into your blood.
- Birth control shots — Hormone injections that suppress ovulation.
- Birth control implants — A small flexible rod a doctor places under the skin of your upper arm.
Non-hormonal birth control
If you don’t want hormonal birth control, ask about non-hormonal options. Your health care provider might recommend one or a combination of these forms of birth control:
- A copper IUD. This type of IUD doesn’t release hormones.
- Barrier methods such as condoms, a diaphragm, or a cervical cap plus a spermicide. These block sperm from entering the uterus and fertilizing an egg.
If you’ve been using a barrier method, like a diaphragm, ask your doctor if you’ll need a different size after losing weight.
When to talk to your doctor about birth control
It’s best to have a thorough discussion about birth control before you have weight loss surgery. That way you’re prepared with an updated birth control plan before you get home from surgery. This is important regardless of whether you want to eventually become pregnant.
Choosing contraception is a personal decision based on your preferences, lifestyle, and values. The most important thing is to not overlook birth control if you’re contemplating weight loss surgery.
To learn more about weight loss surgery, visit the UPMC Bariatric Services. And learn about contraceptive options from the Gynecology, Family Planning, and Women’s Health Services Department at UPMC Magee-Womens Hospital.
Editor's Note: This article was originally published on , and was last reviewed on .
About UPMC Bariatric Services
UPMC Bariatric Services is here to help if you’re struggling with obesity and want to lose weight. We offer both surgical and nonsurgical weight loss plans and can help you find the right path for a weight-loss journey. We will work with you to discuss your needs and develop and individualized treatment plan. We meet the highest level of national accreditation for bariatric surgery centers, and our team provides complete care. We offer our services at UPMC locations throughout Pennsylvania and New York. Visit our website to find a provider near you.