Women with PCOS have high pregnancy, live birth rates after bariatric surgery
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Women with polycystic ovary syndrome and obesity who underwent bariatric surgery had a pregnancy rate during follow-up similar to that of women without hyperandrogenism, particularly among those seeking fertility, study data show.
“Women with PCOS and severe obesity who are seeking fertility can benefit from metabolic surgery,” José I. Botella-Carretero, MD, PhD, MBA, of the department of endocrinology and nutrition at Ramón y Cajal University Hospital in Madrid, told Healio. “Several months after the operation, menses and ovulation will be restored and pregnancy may occur among a high rate of women seeking fertility with low maternal and fetal complications.”
Botella-Carretero and colleagues analyzed data from 216 premenopausal women (mean baseline age, 32 years), identified through electronic surgical records, who were screened for PCOS before bariatric surgery. All participants underwent bariatric surgery between 2005 and 2015. About a quarter of the women (n = 53) had PCOS with the presence of the classic phenotype, defined as oligoovulation and biochemical and/or clinical hyperandrogenism. Women were followed after surgery until mid-2019, regardless of PCOS status. Researchers assessed pregnancy and live birth rates among women with and without PCOS.
“Fertility desire was recorded at the time of the first interview, when planning bariatric surgery,” the researchers wrote. “Patients were advised to avoid pregnancy for the first year after bariatric surgery and fertility desire was reassessed within the first 2 years post-surgery, when maximum weight loss occurred and patients were revaluated in our clinic.”
Results of the study, published in The Journal of Clinical Endocrinology & Metabolism, showed 17 women with PCOS (34.7%) and 23 of 145 controls (15.9%) achieved at least one pregnancy during follow-up. Mean time to achieve first pregnancy after surgery was 34 months and 32 months, respectively, among women with PCOS and controls; type of bariatric surgery was not associated with pregnancy rates.
In analyses restricted to 21 women with PCOS and 38 controls seeking fertility, pregnancy rates were 95.2% and 76.9%, respectively.
Overall live birth rates were 34.7% among women with PCOS and 22.5% among controls. In analyses restricted to women seeking fertility, live birth rates were 81% among those with PCOS vs. 69.2% among controls.
Researchers found mean birth weight was lower (P = .04) among newborns of women with PCOS (mean, 2,763 g) compared with newborns of controls (mean, 3,155 g); however, the number of newborns with low birth weight was similar for both groups.
Maternal and neonatal complications were rare and similar between women with PCOS and controls, according to researchers.
“Metabolic surgery must be considered among the therapeutic options for women with PCOS when discussing fertility treatment,” Botella-Carretero said.
For more information:
José I. Botella-Carretero, MD, PhD, MBA, can be reached at Ramón y Cajal University Hospital, Department of Endocrinology and Nutrition, Carretera de Colmenar Km. 9.1, 28034, Madrid, Spain; email: joseignacio.botella@salud.madrid.org.
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Anna L. Goldman, MD
It is well known that weight loss through bariatric surgery can resolve metabolic derangements and restore ovulatory menstrual cycles in women with PCOS. Whether this leads to increased fertility, resulting in an increase in live births, was previously unknown. This retrospective cohort study showed that women with PCOS who desired fertility had high rates of pregnancy and live births, affirming that bariatric surgery in women with obesity and PCOS can be a useful means for achieving fertility. While there was no difference in maternal or neonatal complications between the two groups, the mean birth weight was lower among newborns in the PCOS group. The implications of this are unclear, but potentially concerning, as physicians counsel patients about pursuing bariatric surgery as a potential fertility treatment.
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