Introduction

With one in four adults classified as obese in the UK,1 bariatric surgery is becoming an increasingly common weight loss intervention. The number of procedures has increased from fewer than 1000 procedures performed in 2000 to almost 10 000 in 2010.1 Compared to diet, exercise and pharmacotherapy, bariatric surgery offers sustained, long-term weight loss2 and improvement in obesity-related conditions. Following surgery, published data suggest that patients can expect up to a 72% chance of remission of type 2 diabetes,3 46% resolution of hypertension4 and 75% improvement in sleep apnoea.5 Weight loss through bariatric surgery has also been shown to improve menstrual cycle disorders and theoretically to improve fertility.6 ,7

The National Institute for Health and Care Excellence (NICE) guideline on management of adult obesity recommends bariatric surgery when other weight loss interventions have failed.8 National Health Service criteria for surgery are determined by a body mass index (BMI) (in kg/m²), greater than 40, or 35 with significant disease that could be improved with weight loss, such as type 2 diabetes or hypertension. For severely obese patients with a BMI >50, bariatric surgery may be considered as a first-line option.8

The UK National Bariatric Surgery Registry (NBRS) shows that 80% of bariatric procedures were performed in women, with the majority being in the reproductive age group.1 Compared to women with a normal BMI, obese women may be up to three times more likely to experience infertility.7 Generally, women who undergo bariatric surgical procedures experience improved fertility and maternal outcomes compared to obese cohorts.6 ,7 There is a paucity of literature investigating the effects of the different bariatric procedures on contraceptive efficacy, and whether specific methods should be recommended. Current recommendations advise against pregnancy following bariatric surgery for …