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Study claims RYGB can resolve infertility

Patients with PCOS symptoms improved significantly following bariatric surgery

Researchers claim that patients with polycystic ovary syndrome (PCOS) symptoms improved significantly following bariatric surgery and previously infertile women successfully conceived. 

The current understanding of the aetiology of PCOS remains unclear, however, the condition frequently occurs in association with morbid obesity. Furthermore, most patients have a variety of metabolic disturbances, including infertility, insulin resistance, type 2 diabetes, and hypertension.

“Not many patients come to a bariatric surgeon to treat infertility problems,” said Mohammad Jamal, Clinical Assistant Professor of Surgery at the University of Iowa Hospitals and Clinics in Iowa City. “But this study suggests that women with morbid obesity, who are infertile secondary to PCOS, may have a new surgical option. Many other studies have shown bariatric surgery can improve or resolve a multitude of diseases and conditions. It appears that infertility now joins that list.”

He added that the long-term impact of bariatric surgery on PCOS has not been studied carefully. As a result, Jamal and colleagues retrospectively reviewed medical records of 566 women who underwent Roux-en-Y gastric bypass (RYGB) from 2000 to 2009. The analysis revealed 31 (5.5%) patients who had PCOS prior to bariatric surgery.

Eleven patients were excluded due to inadequate follow-up or postmenopausal status. The remaining 20 patients were contacted by telephone and interviewed regarding their health status, including PCOS symptoms and fertility.

The 20 women had a mean age of 32, preoperative BMI of 53, obesity duration of 20 years, and PCOS duration of 8.6 years. Additionally, 85% (17/20) had a history of menstrual dysfunction, 70% (14/20) had hirsutism and 60% (12/20) had ultrasound documentation of polycystic ovaries. Comorbidities included type 2 diabetes in nine patients, hypertension in six, depression in eight, gastroesophageal reflux disease (GERD) in 12 and urinary incontinence in six.

Eighteen of the 20 patients expressed a desire for childbearing, eight of whom had conceived prior to bariatric surgery (five spontaneously and three with the aid of hormonal therapy). Of the remaining 10 patients, six had sought treatment for infertility. The 10 infertile women were followed for an average of almost four years. Their excess weight loss averaged 64%, and they had a mean postoperative BMI of 34 (p<0.05 for both versus baseline).

Comorbidity resolution or improvement included eight of nine patients with diabetes, three of six hypertensive patients, seven of eight clinically depressed patients, all ten patients with GERD, and all six patients with urinary incontinence.

In the overall population, bariatric surgery was associated with significant resolution of PCOS-related symptoms, including all six women who had sought treatment for infertility, five of 14 with hirsutism, and 14 of 17 patients with menstrual dysfunction (p<0.05 versus baseline).

Most of the improvement in PCOS symptoms occurred during the first 12 months after bariatric surgery. Additionally, resolution or improvement in symptoms increased over time with excess weight loss. Importantly, the investigators stated that all the infertile patients who wanted to successfully conceived (naturally or by assisted reproduction) within three years of their RYGB procedure.

“Significant weight loss also reduces the risk of pregnancy related complications, which is another important consideration,” concluded Jamal. “Though this is a small study, it has a big result and should be an area for more investigation and should be discussed with morbidly obese women who are having difficulty conceiving.”

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