Obesity in women is linked to a number of adverse reproductive outcomes including anovulation, delayed time to conception, increased rate of miscarriage, and complications during pregnancy and birth. Bariatric surgery (BS) is an effective treatment for the management of obesity and its complications such as type 2 diabetes. It provides sustained and significant weight loss with potential to ameliorate risk. The population undergoing BS is growing with 76% of operations in England now in women - the majority of whom are of child- bearing age. Women may specifically choose to have surgery as a means of improving their fertility as they can conceive quickly after BS. However, pregnancy soon after BS has the potential for surgical complications, nutritional deficiencies and poor fetal outcomes. There are no national guidelines regarding the management of this high-risk group (post-surgery, pre-conception). Current practice advice, such as the recommendation to wait at least 18 months after surgery before conceiving, lacks a robust evidence base and, in not reflecting the needs and lifestyles of the women, is failing to influence their behaviour. A European partnership is currently undertaking systematic review and expert consensus to formulate clinical guidelines. In addition, longitudinal cohort studies are underway to establish effects of surgery on fertility, maternal and fetal outcomes and optimal management for preconception health, nutrition and pregnancy following surgery.