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Gastric Bypass, Gastric Sleeve, LAP-BAND® and REALIZE® Band Surgeries Increase Fertility in Morbidly Obese Women

By Dr. Ajay Goyal | October 13, 2014

One of the first questions many of my female patients ask me when contemplating gastric bypass, gastric sleeve or LAP-BAND® surgery is how the procedures will affect their ability to get pregnant. Many have tried to conceive in the past and have been unsuccessful. While weight loss surgery won’t be able to overcome all fertility issues, the good news is that weight loss procedures can have a positive effect on both fertility and pregnancy.

Obesity’s Toll on Fertility and Pregnancy

Obesity takes a toll on the body. It often causes diabetes, heart disease, high blood pressure and sleep apnea. What many people don’t realize is obesity impacts fertility too. Being seriously overweight causes an increase in the level of two key hormones related to fertility – estrogen and testosterone. An increase in these hormones results in excess body hair and higher risk of breast and uterine cancer and is also directly related to infertility, causing irregular or heavy periods. Weight loss after gastric bypass, gastric sleeve or LAP-BAND® surgery results in normalization of estrogen and testosterone and a return to normal menstrual cycle and improved fertility.

Obesity also negatively affects pregnancy, increasing the risk for gestational diabetes, hypertension and miscarriage. There is also an increased rate of cesarean sections in obese women because of the high-weight fetus that occur when gestational diabetes is present. Weight loss prior to pregnancy lessens the risk of obesity related medical conditions during pregnancy, often resulting in safer, healthier pregnancy and birth.

Pregnancy after Gastric Bypass, Gastric Sleeve or LAP-BAND® Surgery

Another top concern for patients who are thinking about becoming pregnant after weight loss surgery, is directly related to the amount of food they can eat and their weight loss. “Will I be able to take in enough food for both me and the baby?” they ask. Multiple studies show that pregnancy is safe after bariatric surgery provided you follow a couple of key guidelines.

To start, for your safety and the safety of the baby, it’s very important to avoid becoming pregnant for one year after gastric bypass and gastric sleeve surgery because during this time period, weight loss is the most rapid and significant. Contraception is a must for the first year after weight loss surgery procedures. For gastric bypass in particular, oral contraceptives might not be adequately absorbed into the body so it’s important to use an additional non-oral form of contraception.

With LAP-BAND® surgery, one can safely conceive six months after the procedure but might not have lost enough weight yet to avoid pregnancy-related health conditions.

Nutritional supplements, which were important before your surgery, become even more important now that you are pregnant to ensure both you and your baby are getting enough nutrients.
Women who’ve had Gastric Sleeve or LAP-BAND® procedures cannot consume very much food in one sitting. For women who’ve had gastric bypass surgery, which is restrictive and malabsorptive procedure, you’ll be taking in less food and also absorbing fewer calories and nutrients than you did before surgery. You won’t be physically able to “eat for two” so it’s important to add the correct amount of nutritional supplements to your diet.

Key supplements to increase include iron to form new red blood cells, calcium for mineralization of fetal skeleton, folic acid to prevent birth defects, vitamin B1 (thiamine), vitamin B12 and vitamin A. Women should also take protein supplements in the form of protein shakes or protein bars as you will not be able to eat enough food to get the recommended daily allowance of 60 grams of proteins per day. I recommend taking at least half or 30 grams of protein in supplement form and the rest from foods rich in proteins. (See tables below for good choices)

For women who have undergone the gastric bypass, gastric sleeve or LAP-BAND® procedure, pregnancy can be safe for them and even healthier for the baby with regular follow-up visits to your bariatric surgeon and obstetrician. Below are ten guidelines to help you along the way.

Ten Guidelines to follow for a safe pregnancy:

  • Avoid pregnancy for one year after weight loss surgery
  • Take multivitamins (Vitamin A, B1, B12, Iron, Folic Acid)
  • Make regular appointments with your bariatric surgeon and obstetrician
  • Obtain regular blood test to check for vitamin deficiency
  • Eat multiple small meals a day (at least four meals per day) and spend 30 minutes to eat each meal
  • Eat high-protein, low-carbohydrates and a low fat diet
  • Take 30 grams of proteins in supplements
  • Drink plenty of water (40 – 60 ounces per day)
  • Continue regular low impact exercise for both body and mind
  • For LAP-BAND® or REALIZE® band patients, one can remove the restriction by an adjustment if patients develop pregnancy related nausea.

Table 1: High-protein and low-carbohydrates shakes

Protein supplement shakes are best mixed with skim milk or lactaid milk as lactose intolerances can occur after surgery.  Another option is to mix in the blender the protein powder with sugar-free yogurt or sugar-free beverages. You may split your protein shake into 2 or 3 servings, as long as you take 30 -40 grams of protein in 100-150 calories. Suggested supplements include:

  • Designer Protein (90kcal/17.5g pro per scoop)
  • Isopure (210kcal/50g pro per 2 scoops)
  • Pro-stat 64 (15g proteins and 1g Carbohydrate per2 tablespoon)
  • ISS Whey Protein (96kcal/17g pro per scoop)
  • Twinlabs Triple Whey Fuel (100kcal/21g pro per scoop)

Table 2: Foods Rich in Protein

Our bodies need the amino acids and other nutrients found in protein-rich foods. Protein builds and repairs muscle, and is the fuel that gives our body energy. Patients should attempt to get at least 60 grams of protein a day. Good sources of protein include:

  • Turkey, chicken, or beef - purchase 97% lean meat
  • Baked, broiled, or BBQ skinless chicken, white turkey meat, or fish
  • Ground or chopped chicken or turkey (white meat) for salads (use nonfat, non-dairy based dressing)
  • Water packed tuna (1/4 cup = 1 oz meat)
  • Egg whites or egg substitute. (Yolk has all the cholesterol and fat, whites are pure protein)
  • Nonfat yogurt
  • Cereals: oatmeal or cream of wheat with nonfat milk
  • Kidney beans, navy beans, lima beans, pinto beans
  • Baked potato
  • Nonfat cottage cheese (great on a baked potato)
  • Cereals (read labels for those high in protein and fat free or low fat)
  • Fish baked or broiled
Ajay Goyal, MD, FACS, is founder and director of the New Jersey Bariatric Center, a medical & surgical weight loss center with offices in Springfield, Somerville, Hoboken, East Brunswick, Sparta, and Totowa New Jersey. New Jersey Bariatric Center helps patients achieve long-term weight loss success through the most advanced bariatric surgery procedures, including gastric sleeve and gastric bypass procedures. New Jersey Bariatric Center’s approach to patient care has resulted in zero mortalities and a complication rate that is lower than the national average.
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