Hormonal status, fertility, and pregnancy before and after bariatric surgery.

At the present time, the exact etiology and developmental course of obesity in many individuals is still being debated. The majority of healthcare professionals are in agreement, however, that morbidly obese persons are at risk for a wide range of health problems, both before and after bariatric surgery. Obesity is, unfortunately, a condition in which the disease as well as the available treatments have the potential to cause serious alterations in health status. The average candidate for bariatric surgery has experienced decades of varying degrees of obesity as well as multiple failed dietary and medication regimens. As a result of almost continual physiologic instability, these individuals typically are subject to a wide range of hormonal imbalances. Since the majority of persons who are obese, and those seeking bariatric surgery, are women, it is important for healthcare providers to understand how these hormonal fluctuations can have a devastating impact on sexual and reproductive function. Although the research to date has been limited, studies have demonstrated changes in fertility, contraceptive response, and pregnancy outcomes in obese women, as well as obese women who undergo bariatric surgery. As morbid obesity continues to increase in incidence in the female population, greater numbers of women will seek bariatric surgery, and, as a consequence, experience some of the untoward effects shown to date. Addressing the concerns of these patients, both before and after surgery, will continue to be a complex and challenging task.