To Get Back on Track: A Qualitative Study on Childless Women’s Expectations on Future Fertility Before Undergoing Bariatric Surgery

Nilsson-Condori, Emma; Järvholm, Stina; Thurin‐Kjellberg, Ann; Sidlovskaja, Ilona; Hedenbro, Jan; Friberg, Britt

doi:10.1177/1179558119874777

Cited by 6 publications

(5 citation statements)

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“…Bariatric surgery (BS) with its beneficial metabolic consequences ( Herzog et al , 2020 ) is the most effective treatment for obesity ( Maciejewski et al , 2016 ), with large numbers of reproductive age women seeking treatment ( Scandinavian Obesity Surgery Registry, SOReg, 2020 ). Women seem to have high expectations on regained fertility ( Nilsson-Condori et al , 2019 ), and several studies are pointing towards increased fertility among women having gone through BS ( Milone et al , 2016 ), in particular in women with PCOS ( Benito et al , 2020 ). However, obesity-related infertility is not considered an indication for BS ( ACOG, 2009 ; ASRM, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

Outcomes of in-vitro fertilization after bariatric surgery: a national register-based case–control study

et al. 2022

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STUDY QUESTION Does previous bariatric surgery (BS) in women affect cumulative live birth rate in IVF? SUMMARY ANSWER Women having had BS seem to have the same cumulative live birth rate as non-operated women of the same BMI at IVF treatment. WHAT IS KNOWN ALREADY Because of the perinatal risks of obesity to mother and infant as well as impaired outcomes of IVF, obese women are advised to reduce their weight, but it is not clear whether previous BS could affect IVF results. STUDY DESIGN, SIZE, DURATION This national register-based case–control study included all cases of BS (n = 30 436) undergoing IVF (n = 153) from 2007 until 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS Swedish women between 18 and 45 years operated with BS, with at least one first started cycle of IVF after surgery, were included. For each woman having IVF after BS (n = 153), up to five non-operated control women (n = 744) starting their first IVF cycle during the study period were matched for age, parity and BMI at treatment. The primary outcome in this study was the cumulative live birth rate (CLBR) after the first IVF cycle, defined as all live births after the first cycle including fresh and frozen embryo transfers. MAIN RESULTS AND THE ROLE OF CHANCE There was no significant difference in CLBR between the BS group and the matched controls (29.4% compared to 33.1%), even though the number of retrieved oocytes (7.6 vs 8.9, P = 0.005) and frozen embryos (1.0 vs 1.5, P = 0.041) were significantly fewer in the BS group. There was no association between cumulative live birth and BS, adjusted odds ratio 1.04, 95% CI (0.73, 1.51). However, the birth weight was significantly lower in the children born to mothers with previous BS, mean (SD) 3190 (690) vs 3478 (729) g, P = 0.037. LIMITATIONS, REASONS FOR CAUTION Confounders such as age, BMI and previous childbirth were accounted for by the matching design of the study, but there were no data on indication for IVF, anti-Müllerian hormone, smoking or previous comorbidities. The study was exploratory and did not reach sufficient power to detect potential smaller differences in live birth rates. WIDER IMPLICATIONS OF THE FINDINGS The findings concur with those in previously published smaller studies and provide somewhat reassuring results considering IVF outcomes after BS with a CLBR comparable to that of controls, despite a lower mean birth weight. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by grants from the Southern Health Care Region of Sweden. The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER N/A.

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Section: Introductionmentioning

confidence: 99%

Outcomes of in-vitro fertilization after bariatric surgery: a national register-based case–control study

et al. 2022

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“… 19 , 20 In a previous qualitative study, young childless women had high expectations on getting back to a normal life including better sexual health and improved fertility. 21 …”

Section: Introductionmentioning

confidence: 99%

“…19,20 In a previous qualitative study, young childless women had high expectations on getting back to a normal life including better sexual health and improved fertility. 21 There is not much literature about young women, their identity, self-image, and sexual health after bariatric surgery. The aim of this qualitative study was to explore how women perceive the effects of bariatric surgery on quality of life, focusing on sexual health and fertility.…”

Section: Introductionmentioning

confidence: 99%

A New Beginning: Young Women’s Experiences and Sexual Function 18 Months After Bariatric Surgery

et al. 2020

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Introduction Female patients expect improved quality of life, including sexual health and regain of fertility after bariatric surgery. Little has been published on to the extent to which patients’ expectations are met by the weight loss after surgery. Aim To explore how women perceive the effects of bariatric surgery on quality of life, focusing on sexual health and fertility. Methods A qualitative study based on thematic analysis, supported by questionnaire data. Interviews following a semistructured guide were conducted with childless women (n = 11) aged 25–34 years recruited from a university-affiliated Swedish bariatric center. The interviews took place 18 months after surgery in the participants’ homes or at the hospital and were recorded and transcribed verbatim. Data were analyzed with a thematic approach. Questionnaires were filled in at the time of the interviews and compared with preoperative data using a Wilcoxon test for paired data. Main outcome measures Participants described experiences related to female sexual health after bariatric surgery. The Hospital Anxiety and Depression Scale and the Female Sexual Function Index questionnaires were administered preoperatively and postoperatively. Results “A new beginning” was identified as the master theme, with 3 underlying subthemes: “Being worthy of love,” “Exploring sexuality,” and “Considering parenthood.” The participants described a transformation into being more comfortable with themselves that affected all areas of life, including sexual life. These findings were supported by lower scores for depression, 6.5 vs 2, and improved total Female Sexual Function Index scores, median 23.3 preoperatively and 29.1 postoperatively, P = .012. Conclusions Improved body image and enhanced self-esteem play important roles in improved sexual functioning in women after bariatric surgery. Nilsson-Condori E, Järvholm S, Thurin-Kjellberg A, et al. A New Beginning: Young Women’s Experiences and Sexual Function 18 Months After Bariatric Surgery. Sex Med 2020;8:730–739.

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“…The relatively high rate of women undergoing weight loss surgery is not unique to the UK, with data from 51 countries from 2014 to 2018 indicates that 73•7 % of people who had surgery were female (4) . A qualitative study of women in Sweden without children undertaken a few weeks prior to surgery supported the observation that improved fertility may be a motivating factor (51) . Participants (n 12) were aware that obesity can lead to a high-risk pregnancy, with potential risks to both mother and offspring.…”

Section: Weight Loss Surgery and Fertilitymentioning

confidence: 83%

Tackling the dual burden of malnutrition in pregnancy – pregnancy after weight loss surgery

Maslin,

Hart,

Shawe

2024

Proc. Nutr. Soc.

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The dual burden of malnutrition is characterised by the coexistence of undernutrition alongside overweight/obesity and diet-related noncommunicable diseases. It is a paradox which disproportionately affects women and is applicable to those who become pregnant after weight loss surgery. Obesity before and during pregnancy is associated with increased risk of adverse perinatal outcomes in both mother and child. Overall lifestyle interventions targeting weight loss in the preconception period have not proven effective, with people, and women in particular, increasingly seeking weight loss surgery. In women with severe obesity, surgery may normalise hormonal abnormalities and improve fertility. In those who become pregnant after surgery, evidence suggests a better overall obstetric outcome compared to those with severe obesity managed conservatively, however there is heightened risk of maternal nutritional deficiencies and infants born small for gestational age. Specifically, pregnancy soon after surgery, in the catabolic phase when rapid weight loss is occurring, has the potential for poor outcomes. Lifelong micronutrient supplementation is required and there is considerable risk of malnutrition if nutritional aftercare guidelines are not adhered to. It is therefore recommended that pregnancy is delayed until a stable weight is achieved and is supported by individualised advice from a multidisciplinary team. Further research is required to better understand how weight loss surgery affects the chances of having a healthy pregnancy and to ultimately improve nutritional management and patient care. In this review we aim to summarise the evidence and guidance around nutrition during pregnancy after weight loss surgery.

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To Get Back on Track: A Qualitative Study on Childless Women’s Expectations on Future Fertility Before Undergoing Bariatric Surgery

Cited by 6 publications

References 22 publications

Outcomes of in-vitro fertilization after bariatric surgery: a national register-based case–control study

Outcomes of in-vitro fertilization after bariatric surgery: a national register-based case–control study

A New Beginning: Young Women’s Experiences and Sexual Function 18 Months After Bariatric Surgery

Tackling the dual burden of malnutrition in pregnancy – pregnancy after weight loss surgery

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