Chance to Educate on Link Between Weight Loss and Fertility

Many Americans may be unaware that bariatric surgery can effectively enhance fertility, according to a new survey that suggests a significant knowledge gap regarding the connection between weight loss and fertility improvement.

As many as 1 in 5 married women of childbearing age are unable to get pregnant after 1 year of trying, according to the US Centers for Disease Control and Prevention. Overweight and obesity can affect fertility by preventing ovulation and preventing fertility treatments from working.

The online survey, administered December 2024 by Orlando Health Weight Loss and Bariatric Surgery Institute, included 1019 US adults aged 18 years or older and found that 56% of participants were unaware that bariatric surgery may improve some women’s chances of getting pregnant.

Obesity can affect overall health, including increased risks for diabetes, hypertension, sleep apnea, and various cancers. Half of the survey respondents reported they either didn’t know or are neutral about the negative impact of being overweight on fertility.

For women struggling with obesity, the consequences can be particularly severe. Irregular menstrual cycles, hormone imbalances, and polycystic ovarian syndrome (PCOS) are common issues that can contribute to infertility.

“We have many patients with PCOS, a hormonal condition that affects women of reproductive age, many of whom try and fail to get pregnant for many years,” said Alexander Ramirez, MD, director of Orlando Health Weight Loss and Bariatric Surgery Institute, where the survey was administered. “After bariatric surgery, their chances of conception drastically increase quickly as their hormones are regulated and their menstrual cycle normalizes.”

The findings underscore the need for clinicians to better educate patients about the risks for obesity and its impact on fertility, according to Mark Trolice, MD, professor of reproductive medicine at the University of Central Florida and director of The IVF Center in Winter Park, Florida. Trolice was not involved in the study.

“Physicians are challenged by the heightened sensitivity of patients regarding their weight due to feelings of being judged and ‘shamed,’” said Trolice. “The best approach to communicate with patients regarding weight loss is to first determine the patient’s ability to commit,” said Trolice.

“No matter how proven the management, the journey begins with the patient’s buy-in,” he said.

While weight loss medications like glucagon-like peptide 1 (GLP-1) injections have gained popularity, the survey found that 64% of people are unaware or uncertain that stopping these injections can lead to weight regain.

Bariatric surgery may offer a longer-lasting solution, as it permanently alters the digestive system and helps regulate hormones necessary for ovulation, according to Ramirez.

However, Trolice says, bariatric surgery is not always the best weight loss method for patients who might struggle with obesity-related infertility.

“Aside from lifestyle management, both medication and surgery to manage obesity have long-term risks,” said Trolice.

Side effects of GLP-1 injections can include liver disease, pancreatitis, and gastroparesis.

People who undergo bariatric surgery may be at increased risk for nutritional deficiencies, blood clots, bowel leakage, and breathing difficulties. Women of childbearing age are also advised to avoid pregnancy for as long as 2 years after surgery.

Adherence to regular exercise and a Mediterranean diet is the most effective method to ensure maintenance of weight loss during and after weight loss interventions, he said.

“Whether from lifestyle modification, medication, or surgery, weight loss has been shown to improve ovulation function, fertility, and reduce pregnancy complications,” said Trolice.

Ramirez reported no relevant disclosures. Trolice reported no relevant disclosures.

Lara Salahi is a health journalist based in Boston.