Need Advice: Move forward with RE or Bariatric Surgery?

beesnhoney

Hey everybody, longtime lurker but finally decided to make a profile and get some advice on this possible dilemma 

A little about me: My DH and I have been TTC for almost 1 year. However, for reasons that are unclear I have not been ovulating despite a normal lab workup and normal-ish TVUS. So, we are now moving forward with a RE and likely starting clomid soon. I have also been obese all my life and have always planned to get bariatric surgery when I was at a good place in my career and life. My doctors aren't sure if my weight is the reason I've stopped ovulating (I also have a very stressful job), but from my own research I know it can't be helping. 

I've met with a bariatric surgeon and they could do the surgery in 6 months, he believes it might significantly increase my fertility... but I wouldn't be able to get pregnant for at least 12 months after the surgery. I'm not AMA but I am up there in age. I have no other medical problems other than being obese and my doctors say I should have no issues with carrying a pregnancy (plenty of obese people get pregnant). 

Right now I'm kind of pursuing both at the same time, and if we happen to get pregnant I'll obviously put surgery plans on hold. I'm still pretty early in the infertility workup process. I just wanted to know if anyone else had any experience or any advice on if I should pursue bariatric surgery now or wait until after we are further along with the RE and exhausted more options since I'd have to wait a whole year!

Thanks for any advice!

JuliaGoolia719

Not able to offer advice, but good luck with whichever direction you go with first! I have a friend who did weight loss surgery and I know it's a huge decision to make and not an easy road after. 

JaeJayStark

Hi there, how old are you? That might help in making a decision. 

beesnhoney

I'm 32 yrs old so not super young but definitely not old by any means.

In a perfect world I was hoping to have our first baby, get bariatric surgery in the years between, and then have baby #2... but neither of us were expecting I would just stop ovulating. So I'm afraid waiting the extra 18 months if I have the surgery we might have even more difficulty if the weight wasn't the problem.

cashewchicken

Have you met with a doctor in Maternal and Fetal medicine?  I'm not obese, but I was diagnosed as pre-diabetic, which raises a risk of developing gestational diabetes that could affect the fetus when I become pregnant.  I was recommended to see the doctor to discuss what are the possible risks for me and the baby if I became pregnant.  I haven't seen the doctor yet, so I can't tell you how the appointments went.  But if you have a health condition such as obesity that could potentially impact the fetus, then I think it's good to get a professional opinion.

If I were you, since bariatric surgeries are major surgeries, I would want to get that done first, give myself a plenty of time to recover and lose weight without worrying about caring for the baby.

beesnhoney

MFM doctors are for when you are already pregnant and have a high risk pregnancy, but I have met with my RE. I have normal BP, no pre-diabetes or diabetes, normal cholesterol so not worried about any of that. According to my doctor, being obese does put me at some increased risk for gestational diabetes, pre-E, etc, but not enough so that she feels I have to do it prior to getting pregnant. But I haven't asked the RE yet.

mtpbadger

@beesnhoney I don't have any experience but I wish you the best of luck! That is not an easy decision to make but it sounds like you are gathering as much information as you can in order to make one that works best for your!

MFM aren't just for those that are already pregnant. A close friend had to go see one prior to being cleared for IVF as she has a heart condition that could be worsened by a pregnancy. She was required to see an MFM to ensure they would be willing to treat her once pregnant and that they didn't have any significant concerns with her health at that stage.

radmom27

@beesnhoney I would definitely talk to your RE.  I'm struggling with infertility (I'm also old) and have had a gastric bypass in the past.  I have read a couple of studies that say there may be some link to nutritional deficiencies after gastric bypass and infertility.  I have no regrets from my surgery, but having said that, I consistently struggle with nutritional deficiencies and have regular iron and B12 IV infusions to keep my levels up.  I'm 9 years out of surgery so can eat somewhat normally but portion sizes were very very limited the first couple of years after surgery which also may make a pregnancy difficult.  I would also think that losing a bunch of weight and then getting pregnant and putting it back on would be another potential challenge.  If it were me and you don't have any other health issues, I would probably have my family first (go through all the fertility testing and workup and also figure out if there is a pinpointable issue) and then pursue surgery.  

beesnhoney

@mtpbadger I didn't know that! Thanks for the info. No, no one has mentioned needing to be cleared by MFM but I'll ask about it.

@radmom27 Thanks so much for your post. That's definitely been on my mind.

beesnhoney

Hey just as an update I saw my RE and they said the newest reccs are to actually wait to have the surgery until after pregnancy.

radmom27

@beesnhoney Thanks for the update!  Did your RE say why?  I'm just curious..

Vagarcia16

**TW: child mentioned**

@beesnhoney I was obese when TTC.  I wasn't considering surgery, but was trying to lose the weight with healthier eating habits and being more active.  According to my RE, my weight was likely not the reason we were struggling to get pregnant, I was diagnosed with mild PCOS, but was ovulating every month.  (We later learned our IF was due to MFI)  I was also not diabetic, no high blood pressure, cholesterol was normal, etc.  

Since our issue was MFI, we did a lot of waiting while trying different protocols to increase DH's sperm count/motility, which gave me a little time to focus on my health.  We eventually did get our BFP through IUI, and while healthier then when we started our journey, I was still obese when I got pregnant.  I had a very healthy pregnancy, no gestational diabetes, no high blood pressure, and I carried to term.  

I would recommend focusing on a healthier lifestyle while TTC.  One of the things I regret about my IF journey is not getting help and starting treatment sooner.  If your are generally healthy despite being obese, I wouldn't put it off. Good luck!!

beesnhoney

@radmom27 The RE basically said it's a debate within the medical community and that yes, there are risks to being pregnant and obese but the latest reccs are to do the surgery after having kids so you aren't struggling to gain adequate weight while pregnant after losing a ton of weight. 

@Vagarcia16 thanks! I've struggled with my weight all my life. Since my wedding I have definitely put on a few pounds and I can't really afford that given I'm already overweight, so I'm getting back on the healthy eating wagon. 

I think your point about starting sooner is really important. I've been seeing doctors for 9+ months and struggling to get a diagnosis of why I wasn't getting periods. I kept telling my doctors I think I have PCOS and none of them listened (and I work in the healthcare field!). Not until I had my first appt with the RE did she finally say oh yea you definitely have PCOS and this is not normal, let's do XYZ. I wish I had been more proactive and advocated for myself sooner. But I'm here now, that's what counts.