Patients who fail conventional weight loss measures often seek bariatric surgery. To date, there are no prospective randomized trials assessing the impact of bariatric surgery on PCOS and fertility rates.

Escobar-Morreale and colleagues [3] performed a prospective review of 36 premenopausal patients who presented for bariatric surgery at their institution for a 3½-year period. All patients were diagnosed with PCOS as defined by the National Institute of Child Health and Human Development Conference criteria. All patients underwent biliopancreatic diversion or laparoscopic gastric bypass at the discretion of the surgeon. Seventeen of these 36 patients were diagnosed with PCOS. Another five patients had increased levels of total and or free testosterone levels. However, they had regular menstrual cycles precluding the diagnosis of PCOS. Of the 17 women diagnosed with PCOS, 12 were available for reevaluation at a mean of 12 months after their surgical procedure. The mean weight loss was 41 kg. In addition to this weight loss, there was marked improvement in hyperandrogenism in 11 of these 12 patients. Regular menstrual cycles were restored in all 12 patients following weight loss. Ten of these 12 had luteal phase serum progesterone concentrations available with values of 4 ng/mL, suggesting ovulation was restored in the hyperandrogenic patients in addition to restoration in menstrual regularity. They concluded that their data strongly suggests that the sustained and marked weight loss achieved after bariatric surgery leads to the almost complete resolution of PCOS.

Eid and colleagues [4] performed a retrospective analysis of 24 patients—all of whom were oligomenorrheic. They had a mean age of 34 years and a mean body mass index (BMI) of 50 kg/m². They all underwent Roux-en-Y laparoscopic gastric bypass, and a mean follow-up of 27.5 months had 56.7 % excess weight loss and a mean postoperative BMI of 30 kg/m². In addition to significant resolution of a multitude of other comorbidities, all patients had complete resolution of their menstrual abnormalities and five patients who desired to conceive were able to do so following surgery without the use of clomiphene.

In 2008, Maggard and colleagues [5] published a systematic review of literature looking at pregnancy and fertility following bariatric surgery. They screened 260 articles, of which 75 were included in the review. Specifically with regard to bariatric surgery and fertility, six studies addressed fertility outcomes in patients following a variety of bariatric surgical procedures. Three studies showed improvements in fertility rates and one study noted no change. The other two studies focused on the impact of fertility rates and gestational diabetes. One noted 6.7 % of patients that required fertility treatment following bariatric surgery versus 2.3 % in the general population (P < 0.001). Another showed 21.4 % of patients following bariatric surgery who had gestational diabetes required fertility treatment versus 5.5 % in the general population who had gestational diabetes (P

Stay updated, free articles. Join our Telegram channel

Join