Gastric Bypass, Lap Band and REALIZE Band Surgery Increases Fertility in Morbidly Obese Women
By Ajay Goyal, MD, FACS, New Jersey Bariatric Center
One of the first questions many of my female patients in their
twenties and thirties ask me when contemplating gastric bypass 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. The
good news is that in addition to improving ones overall health, both procedures
can have a positive effect on fertility. While they can’t
overcome serious fertility issues, research shows both gastric bypass
and lap band surgery can improve many factors related to infertility for
those who are obese.
Obesity’s Toll on Fertility and Pregnancy
Obesity takes a toll on the body, as many people know it’s often
the cause of diabetes, heart disease, high blood pressure and sleep apnea. What
many don’t realize is the toll carries over to fertility too. Being
seriously overweight causes an increase in the level of two key hormones
related to fertility – estrogen and testosterone. While
an increase in these two hormones result in excess body hair and risk
in breast and uterine cancer, it’s also directly related to infertility,
causing irregular or heavy periods. Weight loss after
gastric bypass or lap band surgery results in normalization of estrogen
and testosterone, and a return to normal menstrual cycle and improved
fertility.
For those who are able to conceive, obesity also takes a toll
on the pregnancy increasing the risk for gestational diabetes, hypertension
and spontaneous abortions. There is also an increased rate of cesarean
sections due to large weight fetus that results from gestational diabetes. Weight
loss surgery prior to pregnancy can help resolve the pregnancy-related
medical conditions obese woman are at risk for, often resulting in a safe
and healthier birth.
Pregnancy after Gastric Bypass or Lap Band Surgery
After patients learn about the benefits to weight loss on fertility,
they quickly ask how gastric bypass or lap band surgery will affect
pregnancy. Is pregnancy safe after surgery? Will I be able
to take in enough nutrients for both me and the baby? 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 surgery as this is the time where
one’s weight loss will be most significant. Contraception is a
must for the first year after both procedures, and for gastric bypass
in particular oral contraceptives (OCP) might not be adequately absorbed
after the procedure so it’s important to use an additional 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.
As with any patients who have had weight loss surgery, nutritional
supplements need to be taken religiously before, during and after pregnancy. This
is because gastric bypass surgery is both a restrictive and mal-absorptive
procedure. It results not only in a decreased intake of food – four
to six ounces of food per meal - but it also decreases the absorption
of calories and nutrients you have consumed.
Lap band and the new Realize band surgery is a restrictive procedure,
resulting in only decreased amount of solid food one can consume
at one setting. The decrease in calories, means a decrease of nutrients
you take in, so it’s important to add 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 (Table1)
or protein bars as one cannot take the recommended daily allowance of
60 grams of proteins per day from foods. I recommend taking at least
half or 30 grams in supplements and the rest from foods rich in proteins.
(Table 2)
For women who have undergone gastric bypass 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
