Abstract
Obesity has a negative impact on multiple aspects of female reproductive function. Bariatric surgery is increasingly being used to address obesity and its health sequelae that do not respond to diet and lifestyle modification. Women of reproductive age comprise a large proportion of those undergoing surgery. The impact of bariatric surgery on female reproductive function (i.e. both implied fertility potential and demonstrated fertility through pregnancy rates) has yet to be conclusively established.
This study aims to address this gap in the knowledge base by recruiting women aged between 18-45 years prior to bariatric surgery and following their progress for twenty-four months after surgery to observe any improvements in reproductive function. Multiple methods were used to assess the various aspects of reproductive function; questionnaires captured data on menstrual frequency, clinical hirsutism, contraception use, pregnancy rates and sexual quality of life, biochemical testing measured sex hormone binding globulin, total testosterone (allowing free androgen index to be calculated) and anti-mullerian hormone (a marker of ovarian reserve) and ultrasound was used for ovarian imaging. Any changes in these components of reproductive function were then correlated with the type of surgery and degree of weight loss/normalisation. A separate control group of women living with obesity who continued to have obesity during follow-up was included for anti-mullerian hormone.
All aspects of reproductive function measured within the study showed improvements post-surgery. The burden of polycyclic ovarian syndrome reduced from 35% (n=35) of the surgical cohort at baseline to 7% (n=3) at twenty-four months follow-up. Improvements in androgen profile and menstrual frequency were observed in all women irrespective of diagnosis of polycystic ovarian syndrome. Ovarian volume significantly reduced following surgery in the subgroup of women with polycystic ovarian syndrome. Over the course of follow-up anti-mullerian hormone remained stable in the control and surgical group without polycystic ovarian syndrome, but fell in the surgical group with this diagnosis (likely reflecting the improvement in/resolution of the condition). Sexual quality of life showed a modest sustained improvement in the surgical cohort at twenty-four months. None of the changes observed were related to procedure type.
Although uncertainties persist, this study supports that weight loss secondary to bariatric surgery can provide improvements in a wide range of elements of female reproductive function.