Bariatric surgery could ‘enhance’ spontaneous fertility for women with PCOS, obesity

Key takeaways:

• Bariatric surgery was more effective than medical therapy for spontaneous ovulation for women with PCOS and obesity.
• The surgery group had greater improvements in cardiometabolic risk factors.

Women with polycystic ovary syndrome, obesity and irregular menses were more than twice as likely to experience spontaneous ovulation during the year after undergoing bariatric surgery compared with medical therapy, researchers reported.

Findings from the BAMBINI randomized controlled trial, published in The Lancet, also showed that compared with medical care, vertical sleeve gastrectomy was associated with greater improvements in cardiometabolic risk factors, psychological health and quality of life at 1 year.

“Our findings show that the safety of laparoscopic bariatric surgery is favorable in a cohort of young women with no established major cardiorespiratory comorbidities, which is in keeping with published data,” Shahd Alabdulkader, PhD, of the department of health sciences at Princess Nourah Bint Abdulrahman University College of Health and Rehabilitation Sciences in Riyadh, Saudi Arabia, and colleagues wrote. “The effect size of surgery on the rate of spontaneous ovulation and most secondary endpoints was substantial. The rate of ovulation in women with PCOS is considered to be one of the best predictors of a future pregnancy.”

The researchers analyzed data from 80 women with a diagnosis of PCOS based on the 2018 international evidence-based guidelines and a BMI of 35 kg/m² or higher, recruited from two specialist obesity management centers and via social media. The median age of women was 31 years and 79% were white. Researchers randomly assigned participants to vertical sleeve gastrectomy (n = 40) or behavioral interventions and medical therapy (n = 40). For the medical therapy intervention, participants were offered oral pharmacotherapy including metformin (maximum dose 1 g twice daily), orlistat (maximum dose 120 mg three times a day) or a combination. Gut hormone analogs were not used.

The primary outcome was the number of biochemically confirmed ovulatory events over 52 weeks of follow-up, assessed using weekly serum progesterone measurements.

The median number of ovulations was six in the surgical group and two in the medical group.

Researchers found women in the surgical group were 2.5 times more likely to experience spontaneous ovulations vs. the medical group, for an incidence rate ratio of 2.5 (95% CI, 1.5-4.2; P < .0007).

Women who underwent surgery also lost significantly more weight at 52 weeks vs. medical therapy, with a mean difference between groups of –29.1 kg (95% CI, –37.5 to –20.8). Researchers also observed significant between-group differences favoring surgery for HbA1c, systolic and diastolic blood pressure, fasting glucose, triglycerides and LDL cholesterol, as well as improvements in depression and anxiety scores that favored bariatric surgery.

“Bariatric surgery could enhance the prospects of spontaneous fertility in women with PCOS and obesity,” the researchers wrote. “The healthier cardiometabolic and anthropometric profiles that women in the surgical group achieved than the medical group could translate to less complicated pregnancies and reductions in the incidence of type 2 diabetes and cardiovascular risk or disease.”

The researchers noted that the findings could inform guidelines and medical insurance providers to offer bariatric surgery to increase the prospects of fertility for women with obesity, PCOS, and oligomenorrhoea or amenorrhea.

“In fact, the second International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome now recommends bariatric surgery as a treatment option to improve cardiometabolic risk factors, ovulation and pregnancy rates in women with PCOS and obesity,” the researchers wrote.