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Infertility

Bypass improves sexual function but not fertility

Researchers did not find a window post-surgery where fertility was improved in female patients.
Biochemical hyperandrogenism improved, largely due to an immediate postoperative increase in serum SHBG levels

Reproductive function following Roux-en-Y gastric bariatric bypass surgery is characterised by a shortened follicular phase and improved female sexual function, claims a study featured in the Journal of Clinical Endocrinology and Metabolism.

"The effects of weight loss on reproductive function are more modest than we hypothesised,” said Richard Legro, professor of obstetrics and gynecology, Penn State College of Medicine. “In terms of ovulation, there doesn't appear to be a window after surgery where fertility is improved. Other factors may be involved with infertility in obese women, such as diminished sexual desire and thus less intercourse.”

The objective of the study was to determine whether ovulation frequency and quality, as well as associated reproductive parameters, improve after Roux-en-Y gastric bypass surgery. The primary outcome was integrated levels of urinary progestin (pregnanediol 3-glururonide) from daily urinary collections 12 months after the operation. Secondary outcomes were changes in vaginal bleeding, other biometric, hormonal, ultrasound, dual-energy x-ray absorptiometry measures, and Female Sexual Function Index.

The prospective cohort study enrolled 29 female subjects from 2005 to 2008 with study visits at baseline and then one, three, six, 12, and up to 24 months after surgery.

The researchers found that ovulation rates remained high (more than 905 at all time points before surgery and at one, three, six, 12 and 24 months after surgery). The quality of the ovulation also remained unchanged, and there was little effect on the ovarian cycle.

The exception was a notable shortening of eight to nine days of the follicular phase. Three months after surgery, the phase was 6.5 days shorter, and then up to nine days shorter by 24 months post-surgery.

They also found that biochemical hyperandrogenism improved, largely due to an immediate postoperative increase in serum SHBG levels(p<0.01), with no change in clinical hyperandrogenism (sebum production, acne, hirsutism). Bone density was preserved, contrasting with a significant loss of lean muscle mass and fat (p<0.001), reflecting preferential abdominal fat loss (p<0.001). Female sexual function improved 28% (p=0.02) by 12 months.

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