Letter to the Editor Open Access
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Exp Med. Jan 31, 2023; 13(1): 1-3
Published online Jan 31, 2023. doi: 10.5493/wjem.v13.i1.1
Fertility outcomes following bariatric surgery
Wassan Nori, Department of Obstetrics and Gynecology, Mustansiriyah University, Baghdad 10052, Saydyia, Iraq
Wisam Akram, Department of Obstetrics and Gynecology, Mustansiriyah, Baghdad 10052, Al Yarmouk, Iraq
Eham Amer Ali, Department of Chemistry and Biochemistry, Mustansiriyah, Baghdad 10052, Iraq
ORCID number: Wassan Nori (0000-0002-8749-2444); Wisam Akram (0000-0002-1968-7004); Eham Amer Ali (0000-0003-0559-9406).
Author contributions: Nori W and Akram W designed the research and analyzed the data; Nori W wrote the letter; Akram W and Ali EA revised the letter; all authors have read and agreed on the final version of the manuscript.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wassan Nori, PhD, Academic Editor, Academic Research, Senior Researcher, Department of Obstetrics and Gynecology, Mustansiriyah University, Al -amin, Baghdad 10052, Saydyia, Iraq. dr.wassan76@uomustansiriyah.edu.iq
Received: November 2, 2022
Peer-review started: November 2, 2022
First decision: December 19, 2022
Revised: December 19, 2022
Accepted: January 10, 2023
Article in press: January 10, 2023
Published online: January 31, 2023


Obesity impacts human health in more than one way. The influence of obesity on human reproduction and fertility has been extensively examined. Bariatric surgery (BS) has been used as an effective tool to achieve long-term weight loss in both sexes. BS improves hormonal profiling, increasing the odds of spontaneous pregnancy and success rates following assisted reproductive techniques in infertile females. For obese males, BS does improve sexual function and hormonal profile; however, conflicting reports discuss reduced sperm parameters following BS. Although the benefits of BS in the fertility field are acknowledged, many areas call for further research, like choosing the safest surgical techniques, determining the optimal timing to get pregnant, and resolving the uncertainty of sperm parameters.

Key Words: Bariatric surgery, Male fertility, Female fertility, Assisted reproduction technique, Seminal fluid

Core Tip: One of the main strengths of bariatric surgery (BS) is achieving long-term weight reduction; many of the medical and dietary interventions have transient and sometimes ineffective results. Infertility is linked with obesity in many ways, including reducing the quality of produced gametes, disturbing the hormonal profile, and increasing oxidative stress, which in turn inversely affects many steps of human reproduction. BS can improve the fertility odds for both genders with assisted reproductive technique; additionally, it improves the odds of natural pregnancy.


With interest, we read Kheirvari's study published in World J Exp Med 2022 about how obesity implicates organ transplants and the predictors of negative outcomes after bariatric surgery (BS)[1]. BS is an underused tool, serving about 1% to 2% of the populace. A misunderstanding about BS sometimes overshadows efforts to educate the general public on its advantages[1,2].

While the obesity epidemic endangers lives by escalating cardiovascular, metabolic, and malignant diseases, one of obesity's important associations is infertility[3].

Obesity is linked to gonadal dysfunction, resulting in female and male infertility at rates of 36% and 64%, respectively. Hyperandrogenism manifests in women as polycystic ovarian syndrome (PCOS). In contrast, hypoandrogenemia promotes male obesity-related secondary hypogonadism[4-6].

The capacity of BS to accomplish significant and long-lasting weight loss and the development of safer techniques are important factors that contribute to the fast growth of BS in fertility, which was not addressed in the study by Kheirvari et al[1].

A growing body of evidence confirms that reducing weight through BS may correct menstrual irregularity and ovulatory dysfunction, and increase spontaneous conception, especially among females with PCOS. Infertile obese women could conceive in 69% of the cases within two and a half years of follow-up[7-9]. The body mass index and the weight lost are independent predictors of pregnancy odds. Additionally, bariatric surgery increases live birth rates through assisted reproductive techniques[10].

Poor quality of life (QOL) hinders pregnancy odds and inversely impacts pregnancy outcomes. Furthermore, QOL is essential for evaluating nursing standards among infertile couples[11]. Obese couples have higher anxiety and depression caused by patients' external appearance added to the obesity-related pathology[11,12]. BS can improve patients' perspectives and help to restore the deranged hormonal profile[7-9]. Therefore, as part of their multidisciplinary approach, including the QOL score is recommended for follow-up of BS cases[13,14].

Although the current evidence supports the advantage of BS in female fertility, certain concerns have been raised about its safety. To begin with, the ideal surgical procedure for improving reproductive outcomes at a young age has yet to be established because BS involves numerous techniques. Furthermore, there is no strong consensus on the optimal time to conceive following BS. The problem of the decreased ovarian reservoir in older women continues to be debated[9,15].

Some but not all obese men have fertility issues; there are conflicting reports regarding the unfavorable impact on sperm parameters (SP), while others suffer erectile dysfunction. A state of hypogonadism was reported in obese men due to reduced sex hormone-binding globulin triggered by hyperinsulinemia[16]. BS in obese men may improve sexual activity and restore the hormonal profile, yet the effect on SP is conflicting, which calls for longitudinal study in that area[17]. Some reports declare reduced SP and assisted reproductive technique success rates following BS owing to nutritional deficiency after the surgery. However, others reported no change in SF up to one year following BS[18]. The concerns of worsening SF have resulted in raised sperm cryopreservation needs for selected cases[19].

In conclusion, BS appears to be an effective long-term weight-loss solution that can improve human well-being and QOL. The role of BS in infertility has been established; however, safety concerns, the surgical technique used, and the long-term effect on neonates and childhood are yet to be established. As for males, the inconsistency regarding regression in semen parameters necessitates a longitudinal study type to be resolved.


To our beloved university, Mustansiriyah, for continuous support.


Provenance and peer review: Unsolicited article; Externally peer reviewed.

Peer-review model: Single blind

Specialty type: Medicine, research and experimental

Country/Territory of origin: Iraq

Peer-review report’s scientific quality classification

Grade A (Excellent): A

Grade B (Very good): B

Grade C (Good): 0

Grade D (Fair): 0

Grade E (Poor): 0

P-Reviewer: Shahid MH, Pakistan; Yap RVC, Philippines S-Editor: Liu JH L-Editor: Wang TQ P-Editor: Liu JH

1.  Kheirvari M, Goudarzi H, Hemmatizadeh M, Anbara T. Bariatric surgery outcomes following organ transplantation: A review study. World J Exp Med. 2022;12:92-99.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in CrossRef: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 1.0]  [Reference Citation Analysis (0)]
2.  Gagner M. Comment on: Conversion of laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass: patterns predicting persistent symptoms after revision. Surg Obes Relat Dis. 2021;17:1689-1690.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]
3.  Frank JW. Controlling the obesity pandemic: Geoffrey Rose revisited. Can J Public Health. 2022;113:736-742.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 4]  [Article Influence: 4.0]  [Reference Citation Analysis (0)]
4.  Roomi AB, Nori W, Al-Badry SH. The Value of Serum Adiponectin in Osteoporotic Women: Does Weight Have an Effect? J Obes. 2021;2021:5325813.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 8]  [Article Influence: 4.0]  [Reference Citation Analysis (0)]
5.  Charalampakis V, Tahrani AA, Helmy A, Gupta JK, Singhal R. Polycystic ovary syndrome and endometrial hyperplasia: an overview of the role of bariatric surgery in female fertility. Eur J Obstet Gynecol Reprod Biol. 2016;207:220-226.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 43]  [Cited by in F6Publishing: 32]  [Article Influence: 4.6]  [Reference Citation Analysis (0)]
6.  Wood GJA, Tiseo BC, Paluello DV, de Martin H, Santo MA, Nahas W, Srougi M, Cocuzza M. Bariatric Surgery Impact on Reproductive Hormones, Semen Analysis, and Sperm DNA Fragmentation in Men with Severe Obesity: Prospective Study. Obes Surg. 2020;30:4840-4851.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 12]  [Cited by in F6Publishing: 8]  [Article Influence: 2.7]  [Reference Citation Analysis (0)]
7.  Vitek WS, Hoeger KM. Worth the wait? Fertil Steril. 2022;118:447-455.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]
8.  Wilson R, Aminian A, Tahrani AA. Metabolic surgery: A clinical update. Diabetes Obes Metab. 2021;23 Suppl 1:63-83.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 11]  [Cited by in F6Publishing: 9]  [Article Influence: 4.5]  [Reference Citation Analysis (0)]
9.  Soares Júnior JM, Lobel A, Ejzenberg D, Serafıni PC, Baracat EC. Bariatric surgery in infertile women with morbid obesity: defınitive solution? Rev Assoc Med Bras (1992). 2018;64:565-567.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 6]  [Article Influence: 1.2]  [Reference Citation Analysis (0)]
10.  Grzegorczyk-Martin V, Fréour T, De Bantel Finet A, Bonnet E, Merzouk M, Roset J, Roger V, Cédrin-Durnerin I, Wainer R, Avril C, Landais P. IVF outcomes in patients with a history of bariatric surgery: a multicenter retrospective cohort study. Hum Reprod. 2020;35:2755-2762.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 17]  [Cited by in F6Publishing: 18]  [Article Influence: 9.0]  [Reference Citation Analysis (0)]
11.  Cheng CY, Stevenson EL, Yang CT, Liou SR. Stress and Quality of Life for Taiwanese Women Who Underwent Infertility Treatment. J Obstet Gynecol Neonatal Nurs. 2018;47:498-508.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 11]  [Cited by in F6Publishing: 8]  [Article Influence: 1.6]  [Reference Citation Analysis (0)]
12.  Nori W, Shallal F, Zghair MAG. Aspirin effect on Mid luteal Phase Doppler Indices in Patients with Recurrent Pregnancy Loss. Int J Pharm Res. 2020;12:2929-2934.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 5]  [Cited by in F6Publishing: 3]  [Article Influence: 1.0]  [Reference Citation Analysis (0)]
13.  Ni Y, Tong C, Huang L, Zhou W, Zhang A. The analysis of fertility quality of life and the influencing factors of patients with repeated implantation failure. Health Qual Life Outcomes. 2021;19:32.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 8]  [Article Influence: 4.0]  [Reference Citation Analysis (0)]
14.  Boivin J, Takefman J, Braverman A. The Fertility Quality of Life (FertiQoL) tool: development and general psychometric properties. Fertil Steril. 2011;96:409-415.e3.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 100]  [Cited by in F6Publishing: 89]  [Article Influence: 7.4]  [Reference Citation Analysis (0)]
15.  Parent B, Martopullo I, Weiss NS, Khandelwal S, Fay EE, Rowhani-Rahbar A. Bariatric Surgery in Women of Childbearing Age, Timing Between an Operation and Birth, and Associated Perinatal Complications. JAMA Surg. 2017;152:128-135.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 70]  [Cited by in F6Publishing: 73]  [Article Influence: 12.2]  [Reference Citation Analysis (0)]
16.  Practice Committee of the American Society for Reproductive Medicine. Obesity and reproduction: a committee opinion. Fertil Steril. 2015;104:1116-1126.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 125]  [Cited by in F6Publishing: 143]  [Article Influence: 17.9]  [Reference Citation Analysis (0)]
17.  Reis LO, Zani EL, Saad RD, Chaim EA, de Oliveira LC, Fregonesi A. Bariatric surgery does not interfere with sperm quality--a preliminary long-term study. Reprod Sci. 2012;19:1057-1062.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 55]  [Cited by in F6Publishing: 62]  [Article Influence: 5.6]  [Reference Citation Analysis (0)]
18.  Sermondade N, Massin N, Boitrelle F, Pfeffer J, Eustache F, Sifer C, Czernichow S, Lévy R. Sperm parameters and male fertility after bariatric surgery: three case series. Reprod Biomed Online. 2012;24:206-210.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 83]  [Cited by in F6Publishing: 64]  [Article Influence: 5.3]  [Reference Citation Analysis (0)]
19.  Reis LO, Dias FG. Male fertility, obesity, and bariatric surgery. Reprod Sci. 2012;19:778-785.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 40]  [Cited by in F6Publishing: 42]  [Article Influence: 3.8]  [Reference Citation Analysis (0)]