Bariatric surgery may have positive effect on reproduction in women

ASRM 64th Annual Meeting

Weight loss surgery may improve pregnancy outcomes for morbidly obese women, according to data presented at the American Society for Reproductive Medicine 64th Annual Meeting in San Francisco.

Researchers at Albert Einstein College of Medicine in New York measured markers of ovarian reserve in morbidly obese women. Before bariatric surgery–induced weight loss, follicle-stimulating hormone (3.6 mU/mL) and inhibin B (23.2 pg/mL) were markedly low in obese women compared with normal-weight women (4.9 mU/mL and 80.4 pg/mL). Following surgery and weight loss, FSH levels increased to 6.1 mU/mL and inhibin B to 30.2 pg/mL; however, the rise in inhibin B levels was not statistically significant.

"These data imply that in a morbidly obese woman either the brain is not sensing the ovarian hormone signal (ie, inhibin) or the signal itself is not working properly in this setting," Alex J. Polotsky, MD, assistant professor of obstetrics & gynecology and women's health at Albert Einstein College of Medicine, told Endocrine Today.

In another study, researchers at Washington University in St. Louis analyzed five obese patients who underwent bariatric surgery (80% Roux-en-Y gastric bypass) before in vitro fertilization. Findings demonstrated “successful IVF outcomes for women with a history of morbid obesity treated with bariatric surgery,” the researchers wrote.

All women became pregnant — three with the first IVF cycle and two with additional cycles. To date, three women delivered healthy full-term infants and two are still in healthy pregnancies. – by Katie Kalvaitis

Basically, the brain is so stressed out by the weight that it is not able to respond to ovarian signals. The brain message, gonadotropin-releasing hormone, is secreted in pulses of one every 90 seconds to keep the system up and running. It can be too fast, too slow or just right. It is typically quite slow in women who are very thin, such as anorectics or those with anorexia nervosa. It is not often realized that being overweight is also a form of physical and metabolic stress, and it makes the hypothalamic gonadotropin-releasing hormone pulse generator so sick it cannot do its job. Even after bariatric surgery, it takes a while for everything to get back to normal. The other problem with bariatric surgery is there could be some micronutrient deficiencies that ensue. Like I tell my patients, 'You can't fool the hypothalamus.'

– Sarah L. Berga, MD

Professor and Chairman
Department of Gynecology and Obstetrics
Emory University School of Medicine

For more information:

Lewkowski BM. #P-48.

Polotsky AJ. #P-55. Both presented at: American Society for Reproductive Medicine 64th Annual Meeting; Nov. 8-12, 2008; San Francisco.