A diagnosis of polycystic ovarian syndrome (PCOS) can be a major blow when you’re trying to start a family. But bariatric surgery can be an effective PCOS treatment — and increase the odds you conceive, too.
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“Instead of starting with IVF and spending all that time, effort, emotion and money, obese patients should consider bariatric surgery as a tool for weight loss and fertility,” says bariatric surgeon Jesse Gutnick, MD. “Fertility significantly improves after bariatric procedures.”
Dr. Gutnick explains who’s eligible for these procedures and what to expect.
How PCOS relates to obesity and fertility
PCOS is a hormone disorder — and the leading cause of infertility in women ages 20 to 35. Obesity and PCOS are typically related to one another:
“Obese patients have insulin resistance, which manifests itself differently around the body,” explains Dr. Gutnick. “In the pancreas, it shows up as diabetes. In the liver, people develop fatty liver disease. In the ovaries, they develop PCOS. Patients can also develop PCOS at a young age, resulting in obesity later on.”
But when you lose weight, insulin resistance decreases — improving all of these conditions in one swoop. You can imagine what that does for your fertility. In one study, bariatric surgery reduced:
- Ovarian size (PCOS enlarges the ovaries).
- Irregular menstrual cycles.
- Weight and body mass index (BMI).
Who should use bariatric surgery to get pregnant with PCOS?
Doctors recommend bariatric surgery for women with BMIs of 40 and above. Women with BMIs between 35 and 40 can also benefit if they have associated conditions like diabetes, high blood pressure and sleep apnea.
As for the type of bariatric surgery that’s best, that depends on a comprehensive evaluation of your health and goals. Dr. Gutnick notes that for PCOS, it’s more about successful weight loss — propelled by healthy lifestyle changes — than procedure type.
“When a patient is severely obese, usually it’s hard to lose weight. And if the patient can lose weight, it’s very difficult to keep it off,” says Dr. Gutnick. “While we can help them with the lifestyle changes needed to lose weight and prescribe medications to boost results, sometimes their best efforts just aren’t enough. In these cases, the only way to have substantial, meaningful weight loss is usually with a bariatric procedure.”
Fertility after bariatric surgery: What to expect
If you decide to pursue bariatric surgery as a PCOS treatment, keep these things in mind:
- Cool your conception jets: You’ll need to use a reliable method of birth control for the first 18 months after surgery. “The first 18 months are a time of active weight loss,” relates Dr. Gutnick. “That’s not the best environment to grow a fetus in. There’s also a small risk of preterm labor and having a baby with low birth weight.”
- Plan for a pill parade: After surgery, you’ll need to take certain supplements and vitamins. And if you get pregnant, you may need to take even more. “We do blood work every six months to make sure that your nutritional values are in an acceptable range.”
- Prepare for the pitter-patter of tiny feet: While you should heed his advice to wait to try to get pregnant, the odds will be in your favor when you do.