Is Gastric Bypass In Your Future?

After four years of trying -- and failing -- to get pregnant, Trish Reeves of Spartanburg, South Carolina, blamed her inability to conceive on polycystic ovarian syndrome, an insulin-resistance disorder that's one of the leading causes of infertility. She also blamed her weight. Just 5'4" and 265 pounds, Trish knew the extra 100 pounds she was packing not only dropped her chances of conceiving, but made it more likely she'd have a high-risk pregnancy if she did.
Melody Warnick

"My health was deteriorating," she says. "I really wanted a child, and I thought, 'I'll do whatever it takes to give my body the best opportunity to get pregnant.'" Ready for a drastic solution, last summer Trish had gastric bypass surgery, also known as weight loss surgery.

Fast results
The effects were immediate: in seven months she dropped nearly 100 pounds, and she started ovulating again for the first time in years. Just eight months out from the surgery, Trish's OB/GYN tried an exploratory round of intrauterine insemination injections to see how her newly slimmed-down body would handle it. She got pregnant on the first try. Now busy outfitting a nursery for a baby boy, Trish says, "after four years it's a big blessing."

Get healthy, then get pregnant
Of course, gastric bypass was designed as a last-chance catalyst for weight loss, not a surefire fertility booster. But more and more women who are at least 100 pounds overweight are opting for weight loss surgery -- and they love that one of its happy side effects is a better shot at a healthy pregnancy, whether they're struggling with infertility or simply anxious to avoid a host of pregnancy ills.

"For a morbidly obese woman, any pregnancy is a high-risk pregnancy, because of complicating factors like preeclampsia," says Joseph Afram, MD, director of the Center for Obesity Surgery at George Washington University Hospital, in Washington, DC. "We want women to get healthier before they get pregnant."

Not that gastric bypass doesn't have its own set of pregnancy risks, like nutritional deficiencies that in extreme cases can require intravenous feeding. But despite misconceptions, babies born to weight loss surgery patients aren't more likely to have birth defects than babies born to already-slim moms, according to Blaine Nease, MD, a laparoscopic bariatric surgeon at Garden Grove Hospital, in Garden Grove, California. "You can have a baby after weight-loss surgery and not have all of these crazy defects you might attribute to terrible nutrition. Getting pregnant after weight-loss surgery is absolutely an option, and there's nothing wrong with it so long as it's done in a planned, thoughtful way."

The waiting game
With gastric bypass surgery, food is routed past the stomach to a small pouch that accommodates only tiny amounts of food. Because patients can only eat so much -- for some, only 500 calories a day -- weight loss is immediate. But the nutritional cutbacks also send the body hurtling into breakdown mode, says Dr Nease. "The person barely takes in enough nutrition to keep their own body functions and nutritional status at a healthy level. When you put a baby on top of that, you're talking about a lot more nutritional requirements. It's potentially very dangerous."

Dr Nease says preventing pregnancy for at least 18 months after surgery gives you time to reach your maximal weight loss, when your body's better equipped to provide nutrition to a growing fetus. But birth control can be tricky, since you may not be able to absorb enough of the Pill to make it effective, and diaphragms need continual readjustment as you lose weight. That's why Dr Nease urges patients to use at least two forms of birth control during the first 18 months after surgery.

Cultivating a support team
Once you're expecting, working with both your bariatric surgeon and your OB/GYN -- and making sure they're communicating with each other -- gives you the best chance of having a problem-free pregnancy. If your obstetrician's not up on weight loss surgery research, be your own advocate.

"I'm my OB/GYN's first gastric bypass patient," says Chrystal Swenson, of Attleborough, Massachusetts, who's expecting her second child. "I gave him information about pregnancy and gastric bypass, and he read all of it and did research on his own. He consulted with my surgeon and really listened to me. He's been wonderful."

Steering clear of pregnancy traps
Having your weight-loss surgeon on your side also helps you avoid problems your OB/GYN might not know about. For instance, taking the standard glucose tolerance test for gestational diabetes, for instance, can bring on a full spate of "dumping" symptoms for gastric bypass patients: nausea, sweating, abdominal cramps, diarrhea, heart palpitations and other symptoms, says Dr Nease. Ask your OB/GYN to check for gestational diabetes by testing your fasting blood sugar. Similarly, your doctor might prescribe a standard prenatal vitamin, but there are also vitamins created for gastric bypass surgery patients that might be more effective.

The nutrition you need
Gastric bypass patients may not be able to up their calorie intake too much -- but they can make their 1,200 daily calories count by eating plenty of proteins, along with healthy amounts of fats and complex carbohydrates. "When I go with my son to the park, I usually have steak or chicken in my purse," says Swenson. "If I don't have protein I get really ill and weak, feeling like I'm going to faint."

As with most pregnant women, eating more often can help. "Now that I'm pregnant I'm hungrier faster, so my snacks are a small meal," Reeves says. "Instead of just a carrot I'll have a salad. It's not so much that I'm eating more, I'm just eating more often."

Dealing with a burgeoning belly in the middle of a South Carolina summer, Reeves is continually asked if the heat's giving her a hard time. She just laughs. "Last year I was 97 pounds heavier. This is a breeze comparatively. I have a lot more energy and a lot more confidence." She also plans on breastfeeding her baby, which Dr Nease says is usually no problem for a healthy gastric bypass patient.

While many patients do enjoy success, weight loss surgery isn't a panacea for infertility or other health problems, Reeves knows.

"If you're going to have surgery and one of your hopes is to get pregnant, just realize that it's not a guarantee," she advises. "You've got to do this surgery for you."


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