Bariatric Surgery, Polycystic Ovary Syndrome, and Infertility

Abstract

Background. Polycystic ovary syndrome (PCOS) is the commonest cause of female infertility. Visceral obesity and insulin resistance are key pathophysiological mechanisms behind PCOS. Women suffering from this syndrome and infertility often seek bariatric surgery hoping that they would be able to conceive postoperatively. Objective. At present, there is no consensus on the role of bariatric surgery in the management of PCOS-associated infertility within the medical community, making it difficult to give specific advice to these women, so a review of the literature was necessary. Results. A detailed review of the literature was performed. Only 6 manuscripts were relevant and contained quantitative data. They demonstrated that bariatric surgery results in postoperative conception rates varying from 33% to 100%. Surgery is also associated with amelioration of menstrual irregularities, hormonal abnormalities, and hirsutism that are associated with PCOS. These studies were retrospective and only had a small number of participants with infertility. Conclusions. Bariatric surgery has been shown to conclusively improve life expectancy, quality of life, and comorbidities like type 2 diabetes and obstructive sleep apnea. However, further research is required to identify whether weight loss surgery results in significant improvement in fertility of women with PCOS and to investigate which operation has the best results.

Pharmacological and surgical treatment of nonreproductive outcomes in polycystic ovary syndrome: An overview of systematic reviews

“…We also identified significant gaps in knowledge regarding the lack of data on psychological outcomes in treatment of women with PCOS. We retrieved included psychological outcomes as an outcome of interest only in 2 reviews despite the widely known increased prevalence of depression, anxiety and lower quality of life in women with PCOS which future studies should address …”

“…The study characteristics and PICO framework of the included systematic reviews are summarized in Table 1. The country of origin of the authors included China (n = 11), [29][30][31][32][33][34][35][36][37][38][39] Australia (n = 6), [40][41][42][43][44][45] United Kingdom (n = 5), 43,[45][46][47][48] the United States of America (n = 4), [49][50][51][52] India (n = 3), 44,52,53 Canada (n = 3), 50,54,55 Brazil (n = 2), 41,56 Iran (n = 2), 40,54 Columbia (n = 1), 46 Greece (n = 1), 57 Italy (n = 1), 57 Spain (n = 1), 58 Scotland (n = 1), 59 Luton (n = 1), 48 Netherlands (n = 1) 41 and Saudi Arabia (n = 1). 46 Thirteen reviews explicitly included randomized control trials (RCTs) only [29][30][31][32]34,36,38,…”

“…46 Thirteen reviews explicitly included randomized control trials (RCTs) only [29][30][31][32]34,36,38,42,43,46,53,57,59 ; 5 reviews included RCTs and phase-1 data of cross-over trials 39,41,44,45,52 ; 2 reviews included RCTs and prospective trials 50,56 ; 2 reviews included RCTs and observational studies 49,58 ; 1 review included RCTs, comparative studies and case series with >5 patients 55 ; 2 reviews included all clinical trials 40,54 ; 3 reviews included all study types 35,48,51 ; and 3 reviews did not state an inclusion criteria for the study type. 33,37,47 Fifteen reviews did not set a language restriction in their literature search 30,31,[39][40][41][43][44][45][46]49,50,52,[56][57][58] ; 11 reviews restricted their search to English publications only…”

Maternal and fetal delivery outcomes in pregnancies following bariatric surgery: a meta-analysis of the literature

“…Serious health consequences associated with obesity include type 2 diabetes, osteoarthritis, heart disease, stroke, and certain cancers [4] . More specifically, obesity in women of childbearing age is associated with subfertility/infertility due to increased rates of anovulation [5,6] . Pregnancy associated complication rates are also increased in obese women, including gestational diabetes, preeclampsia, cesarean delivery, and infectious morbidity [5,7] .…”

“…More specifically, obesity in women of childbearing age is associated with subfertility/infertility due to increased rates of anovulation [5,6] . Pregnancy associated complication rates are also increased in obese women, including gestational diabetes, preeclampsia, cesarean delivery, and infectious morbidity [5,7] . The neonate of a mother who is obese is also at increased risk for complications.…”