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15/10/2015

Weight Loss Surgery 'Improves Female Fertility'

A new study by the Royal College of Obstetricians and Gynaecologists (RCOG) has said that weight loss surgery can improve fertility and reduce pregnancy complications in obese women.

However, they added that such surgery should only be considered as a "last resort".

The Scientific Impact Paper (SIP) which has been published by the RCOG, provides the latest evidence surrounding the safety and effectiveness of different types of bariatric or weight loss surgery as an intervention to improve fertility and reproductive outcomes in obese women.

Yet the authors are in agreement that the only effective ways of inducing long-term weight reduction in women with severe obesity are either significant sustained lifestyle changes or bariatric surgery; but that it is not practical to recommend surgery to all obese women of reproductive age.

Obesity is classed as having a body mass index (BMI) of 30 or over, and is said to affect more than a quarter of the female population. Being very overweight or obese can affect natural conception, miscarriage, pregnancy and the long term health of women and their children.

There is an increased risk of congenital anomalies, pregnancy complications and illnesses associated with obesity, including diabetes, high blood pressure and certain cancers.

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Lead author of the paper, and RCOG spokesperson, Professor Adam Balen, explained: "Our review of all the literature on this subject confirms that weight loss surgery can improve fertility and reproductive outcomes in obese women, but we believe it should only be considered as a last resort when other treatments, such as lifestyle changes, haven't worked.

"As with any major operation, bariatric surgery carries a risk of complications but also requires a significant change in lifestyle afterwards. As well as the time needed to recover from the surgery, it can delay conception by up to 12 to 18 months during the initial weight loss phase, because the fetus may be at risk of nutritional deficiencies.

"Additionally, there is very limited access to these types of interventions on the NHS and the demand is currently higher than supply in many areas of the country."

Bariatric surgery is known to result in a 15% to 25% long-term loss of body weight, as well as significantly reducing healthcare costs and illnesses associated with obesity. Currently, NICE guidelines recommend bariatric surgery only in cases where a patient has a BMI of 40 or more – or a BMI of 35 or more and another serious health condition that could be improved with weight loss.

In these instances, surgery is only available on the NHS when other treatments, such as lifestyle changes, have not worked.

Also in the report, experts suggests that women who undergo bariatric surgery should receive specialist care throughout their pregnancy, including dietetic support, weight monitoring, close observation of fetal growth and monitoring for gestational diabetes. During neonatal care, monitoring for small for gestational age (SGA) babies and preterm birth is vital, they added.

Dr Sadaf Ghaem-Maghami, Chair of the RCOG's Scientific Advisory Committee, said: "As with any operation, bariatric surgery is associated with some risks and complications can include infection, protein malnutrition, deep vein thrombosis and hernia. An increased rate of small for gestational age babies and preterm birth has also been documented in some research.

"It is therefore vital that when bariatric surgery is considered an option and is available for women who wish to improve their chance of conceiving naturally or through assisted means, they speak to their obstetrician and surgeon to balance the risks of surgery against the benefits of improved long-term health and wellbeing for themselves and their future children."

(JP)

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"A new study by the Royal College of Obstetricians and Gynaecologists (RCOG) has said that weight loss surgery can improve fertility and reduce pregnancy complications in obese women."