Long-Term Impact of Bariatric Surgery versus Intensive Lifestyle Modification on Fertility and Pregnancy Outcomes in Obese Anovulatory Women

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 265–276

DOI: 10.46882/2026/IJOG/000499

Original Research Article

Title: Long-Term Impact of Bariatric Surgery versus Intensive Lifestyle Modification on Fertility and Pregnancy Outcomes in Obese Anovulatory Women

Names of Authors: Bukola R. Omotayo¹, David C. Iwuala¹

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria

Abstract:
Obesity-induced anovulation presents significant therapeutic challenges in reproductive medicine. This prospective comparative cohort study evaluated the long-term impacts of laparoscopic sleeve gastrectomy bariatric surgery versus an intensive lifestyle modification program on ovulation restoration, spontaneous conception rates, and subsequent pregnancy outcomes in severely obese anovulatory women (BMI ≥ 35 kg/m²). One hundred and fifty women were followed over a 4-year period: bariatric group (n = 75) and lifestyle group (n = 75). At 24 months post-intervention, the bariatric group achieved a significantly higher mean percentage of total body weight loss compared to the lifestyle group (28.4% ± 5.2% vs. 7.1% ± 3.1%, p < 0.001). Spontaneous resumption of regular ovulatory cycles occurred in 82.7% of the surgical cohort versus 44.0% of the lifestyle cohort (p < 0.001). Over the follow-up timeline, the spontaneous pregnancy rate was higher in the bariatric group (61.3% vs. 32.0%, p = 0.001), with a shorter median time to conception. Regarding obstetric outcomes, women in the bariatric group had significantly lower rates of gestational diabetes (6.5% vs. 20.8%, p = 0.042) and preeclampsia (4.3% vs. 16.7%, p = 0.038) compared to the lifestyle arm. However, the incidence of small-for-gestational-age neonates was higher in the bariatric cohort (13.0% vs. 2.1%, p = 0.046). Bariatric surgery provides superior weight loss, higher ovulation restoration, and better spontaneous conception rates than intensive lifestyle modification, though it requires precise nutritional surveillance due to elevated fetal growth restriction risks.

Keywords: Obesity; Anovulation; Bariatric Surgery; Sleeve Gastrectomy; Lifestyle Modification; Spontaneous Conception.

Manuscript Timeline: Received: May 22, 2026; Revised: July 12, 2026; Accepted: August 01, 2026; Published: August 24, 2026.

Citation: Omotayo BR, Iwuala DC. Long-Term Impact of Bariatric Surgery versus Intensive Lifestyle Modification on Fertility and Pregnancy Outcomes in Obese Anovulatory Women. International Journal of Obstetrics and Gynecology. 2026; 14(8): 265–276.

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