Skip to main content

Incidence of Successful Pregnancy After Weight Loss Interventions in Infertile Women: a Systematic Review and Meta-Analysis of the Literature


Little is known about the impact of weight loss interventions on pregnancy rate. A systematic review with meta-analysis of literature has been performed to evaluate the incidence of successful pregnancy after bariatric interventions in infertile women. By pooling together data from 589 infertile obese women, we have been able to provide an aggregate estimation of successful pregnancy after weight loss interventions. Our results showed an impressive high incidence (58 %) of infertile women who become spontaneously pregnant after surgery. Based on our results, bariatric interventions could be included in the treatment of obesity-related infertility. However, the results must be interpreted with caution owning to the quality of the data provided by included studies. Further ad hoc studies are needed to validate the effectiveness of bariatric interventions on reproductive function.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Buchwald H. Consensus Conference Statement Bariatric surgery fo morbid obesity: health implications for patients, health professionals, and third-party payers. J Am Coll Surg. 2005;200:593–604.

    PubMed  Article  Google Scholar 

  2. 2.

    Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294(15):1909–17.

    PubMed  CAS  Article  Google Scholar 

  3. 3.

    World Health Organization. Obesity and overweight. Accessed 06 May 2015.

  4. 4.

    Obesity Update. OECD. Accessed 06 May 2015.

  5. 5.

    Clark AM, Ledger W, Galletly C, et al. Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. Hum Reprod. 1995;10:2705–12.

    PubMed  CAS  Article  Google Scholar 

  6. 6.

    Clark AM, Thornley B, Tomlinson L, et al. Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum Reprod. 1998;13:1502–5.

    PubMed  CAS  Article  Google Scholar 

  7. 7.

    Hollmann M, Runnebaum B, Gerhard I. Effects of weight loss on the hormonal profile in obese, infertile women. Hum Reprod. 1996;11:1884–91.

    PubMed  CAS  Article  Google Scholar 

  8. 8.

    Crosignani PG, Colombo M, Vegetti W, et al. Overweight and obese anovulatory patients with polycystic ovaries: parallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet. Hum Reprod. 2003;18:1928–32.

    PubMed  Article  Google Scholar 

  9. 9.

    Tang T, Glanville J, Hayden CJ, et al. Combined lifestyle modification and metformin in obese patients with polycystic ovary syndrome. A randomized, placebo-controlled, double- blind multicentre study. Hum Reprod. 2006;21:80–9.

    PubMed  Article  Google Scholar 

  10. 10.

    Practice Committee of American Society for Reproductive Medicine. Obesity and reproduction: an educational bulletin. Fertil Steril. 2008;90:S21–29.

    Google Scholar 

  11. 11.

    American College of Obstetricians and Gynecolo- gists. ACOG Committee Opinion number 315, September 2005. Obesity in pregnancy. Obstet Gynecol. 2005;106:671–5.

    Article  Google Scholar 

  12. 12.

    Patel JA, Colella JJ, Esaka E, et al. Improvement in infertility and pregnancy outcomes after weight loss surgery. Med Clin North Am. 2007;91:515–28. xiii.

    PubMed  Article  Google Scholar 

  13. 13.

    Maggard MA, Yermilov I, Li Z, et al. Pregnancy and fertility following bariatric surgery: a systematic review. JAMA. 2008;300(19):2286–96.

    PubMed  CAS  Article  Google Scholar 

  14. 14.

    Bilenka B, Ben-Shlomo I, Cozacov C, et al. Fertility, miscarriage and pregnancy after vertical banded gastroplasty operation for morbid obesity. Acta Obstet Gynecol Scand. 1995;74(1):42–4.

    PubMed  CAS  Article  Google Scholar 

  15. 15.

    Martin LF, Finigan KM, Nolan TE. Pregnancy after adjustable gastric banding. Obstet Gynecol. 2000;95(6 Pt 1):927–30.

    PubMed  CAS  Article  Google Scholar 

  16. 16.

    Marceau P, Kaufman D, Biron S, et al. Outcome of pregnancies after biliopancreatic diversion. Obes Surg. 2004;14(3):318–24.

    PubMed  Article  Google Scholar 

  17. 17.

    Jungheim ES, Travieso JL, Carson KR, et al. Obesity and reproductive function. Obstet Gynecol Clin North Am. 2012;39(4):479–93.

    PubMed  PubMed Central  Article  Google Scholar 

  18. 18.

    Crujeiras AB, Casanueva FF. Obesity and the reproductive system disorders: epigenetics as a potential bridge. Hum Reprod Update Advance Access. 2014;0:1–13. doi:10.1093/humupd/dmu060.

    Google Scholar 

  19. 19.

    Jungheim ES, Schoeller EL, Marquard KL, et al. Diet-induced obesity model: abnormal oocytes and persistent growth abnormalities in the offspring. Endocrinology. 2010;151(8):4039–46.

    PubMed  CAS  PubMed Central  Article  Google Scholar 

  20. 20.

    Pasquali R, Casimirri F, Platè L, et al. Characterization of obese women with reduced sex hormone-binding globulin concentrations. Horm Metab Res. 1990;22(5):303–6.

    PubMed  CAS  Article  Google Scholar 

  21. 21.

    Legro RS, Schlaff WD, Diamond MP, et al. Reproductive Medicine Network. Total testosterone assays in women with polycystic ovary syndrome: precision and correlation with hirsutism. J Clin Endocrinol Metab. 2010;95(12):5305–13.

    PubMed  CAS  PubMed Central  Article  Google Scholar 

  22. 22.

    Rehman KS, Carr BR. Sex differences in adrenal androgens. Semin Reprod Med. 2004;22(4):349–60.

    PubMed  CAS  Article  Google Scholar 

  23. 23.

    Hillman JB, Miller RJ, Inge TH. Menstrual concerns and intrauterine contraception among adolescent bariatric surgery patients. J Womens Health (Larchmt). 2011;20(4):533–8.

    Article  Google Scholar 

  24. 24.

    Jain A, Polotsky AJ, Rochester D, et al. Pulsatile luteinizing hormone amplitude and progesterone metabolite excretion are reduced in obese women. J Clin Endocrinol Metab. 2007;92(7):2468–73.

    PubMed  CAS  Article  Google Scholar 

  25. 25.

    Eng GS, Sheridan RA, Wyman A, et al. AMP kinase activation increases glucose uptake, decreases apoptosis, and improves pregnancy outcome in embryos exposed to high IGF-I concentrations. Diabetes. 2007;56(9):2228–34.

    PubMed  CAS  Article  Google Scholar 

  26. 26.

    Bellver J, Martinez-Conejero JA, Labarta E, et al. Endometrial gene expression in the window of implantation is altered in obese women especially in association with polycystic ovary syndrome. Fertil Steril. 2011;95(7):2335–41. 2341, e2331–e2338.

    PubMed  CAS  Article  Google Scholar 

  27. 27.

    Brewer CJ, Balen AH. The adverse effects of obesity on conception and implantation. Reproduction. 2010;140:347–64.

    PubMed  CAS  Article  Google Scholar 

  28. 28.

    Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

    PubMed  PubMed Central  Article  Google Scholar 

  29. 29.

    Juni P, Witschi A, Bloch R, et al. The hazards of scoring the quality of clinical trials for meta-analysis. JAMA. 1999;282:1054–60.

    PubMed  CAS  Article  Google Scholar 

  30. 30.

    Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.

    PubMed  PubMed Central  Article  Google Scholar 

  31. 31.

    Sterne JA, Egger M, Smith GD. Systematic reviews in health care: investigating and dealing with publication and other biases in meta-analysis. BMJ. 2001;323:101–5.

    PubMed  CAS  PubMed Central  Article  Google Scholar 

  32. 32.

    Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56:455–63.

    PubMed  CAS  Article  Google Scholar 

  33. 33.

    Eid GM, Cottam DR, Velcu LM, et al. Effective treatment of polycystic ovarian syndrome with Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2005;1:77–80.

    PubMed  Article  Google Scholar 

  34. 34.

    Gosman GG, King WC, Schrope B, et al. Reproductive health of women electing bariatric surgery. Fertil Steril. 2010;94(4):1426–31.

    PubMed  PubMed Central  Article  Google Scholar 

  35. 35.

    Musella M, Milone M, Bellini M, et al. The potential role of intragastric balloon in the treatment of obese-related infertility: personal experience. Obes Surg. 2011;21(4):426–30.

    PubMed  Article  Google Scholar 

  36. 36.

    Musella M, Milone M, Bellini M, et al. Effect of bariatric surgery on obesity-related infertility. Surg Obes Relat Dis. 2012;8(4):445–9.

    PubMed  Article  Google Scholar 

  37. 37.

    Neto RML, Herbella FAM, Tauil RM, et al. Comorbidities Remission After Roux-en-Y Gastric Bypass for Morbid Obesity is Sustained in a Long-Term Follow-up and Correlates with Weight Regain. Obes Surg. 2012;22:1580–5.

    Article  Google Scholar 

  38. 38.

    World Obesity Federation. Obesity Data Portal. Accessed 06 May 2015.

  39. 39.

    Deitel M, Stone E, Kassam HA, et al. Gynecologic-obstetric changes after loss of massive excess weight following bariatric surgery. J Am Coll Nutr. 1988;7(2):147–53.

    PubMed  CAS  Article  Google Scholar 

  40. 40.

    World Obesity Federation. Obesity Data Portal. Accessed 06 May 2015.

  41. 41.

    Lloyd GER, editor. Hippocratic writings. London: Penguin; 1978.

    Google Scholar 

  42. 42.

    NIH Conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Int Med. 1991;115(12):956–61.

    Article  Google Scholar 

  43. 43.

    Merhi ZO. Weight loss by bariatric surgery and subsequent fertility. Fertil Steril. 2007;87(2):430–2.

    PubMed  Article  Google Scholar 

  44. 44.

    Guelinckx I, Devlieger R, Vansant G. Reproductive outcome after bariatric surgery: a critical review. Hum Reprod Update. 2009;15(2):189–201.

    PubMed  Article  Google Scholar 

  45. 45.

    Magdaleno Jr R, Pereira BG, Chaim EA, et al. Pregnancy after bariatric surgery: a current view of maternal, obstetrical and perinatal challenges. Arch Gynecol Obstet. 2012;285(3):559–66.

    PubMed  Article  Google Scholar 

  46. 46.

    Sheiner E, Levy A, Silverberg D, et al. Pregnancy after bariatric surgery is not associated with adverse perinatal outcome. Am J Obstet Gynecol. 2004;190(5):1335–40.

    PubMed  Article  Google Scholar 

  47. 47.

    Gerrits EG, Ceulemans R, van Hee R, et al. Contraceptive treatment after biliopancreatic diversion needs consensus. Obes Surg. 2003;13(3):378–82.

    PubMed  Article  Google Scholar 

  48. 48.

    Teitelman M, Grotegut CA, Williams NN, et al. The impact of bariatric surgery on menstrual patterns. Obes Surg. 2006;16(11):1457–63.

    PubMed  Article  Google Scholar 

  49. 49.

    Escobar-Morreale HF, Botella-Carretero JI, Alvarez-Blasco F, et al. The polycystic ovary syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery. J Clin Endocrinol Metab. 2005;90(12):6364–9.

    PubMed  CAS  Article  Google Scholar 

  50. 50.

    Bastounis EA, Karayiannakis AJ, Syrigos K, et al. Sex hormone changes in morbidly obese patients after vertical banded gastroplasty. Eur Surg Res. 1998;30(1):43–7.

    PubMed  CAS  Article  Google Scholar 

  51. 51.

    Doblado MA, Lewkowsksi BM, Odem RR, et al. In vitro fertilization after bariatric surgery. Fertil Steril. 2010;94(7):2812–4.

    PubMed  PubMed Central  Article  Google Scholar 

  52. 52.

    Mascarenhas MN, Flaxman SR, Boerma T, et al. National, Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys. PLoS Med. 2012;9(12):e1001356.

    PubMed  PubMed Central  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Marco Milone.

Ethics declarations

Conflict of Interest

All the authors have nothing to declare.

Financial Support



Appendix 1

Fig. 4

Prisma flow-diagram

Appendix 2

Fig. 5

Publication bias

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Milone, M., De Placido, G., Musella, M. et al. Incidence of Successful Pregnancy After Weight Loss Interventions in Infertile Women: a Systematic Review and Meta-Analysis of the Literature. OBES SURG 26, 443–451 (2016).

Download citation


  • Obesity
  • BMI
  • Bariatric
  • Infertility
  • Fertility