Fertility and Sterility
Volume 92, Issue 5 , Pages 1501-1508 , November 2009

Impact of bariatric surgery on female reproduction

  • Zaher O. Merhi, M.D.

      Affiliations

    • Corresponding Author InformationReprint requests: Zaher O. Merhi, M.D., Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461 (FAX: 718-430-8586).

Received 9 November 2008 ,Revised 18 June 2009 ,Accepted 23 June 2009.

References 

  1. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA. 2004;291:2847–2850
  2. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA. 2002;288:1723–1727
  3. McTigue K, Larson JC, Valoski A, Burke G, Kotchen J, Lewis CE, et al. Mortality and cardiac and vascular outcomes in extremely obese women. JAMA. 2006;296:79–86
  4. Meigs JB, Wilson PW, Fox CS, Vasan RS, Nathan DM, Sullivan LM, et al. Body mass index, metabolic syndrome, and risk of type 2 diabetes or cardiovascular disease. J Clin Endocrinol Metab. 2006;91:2906–2912
  5. Cabrera MA, Gebara OC, Diament J, Nussbacher A, Rosano G, Wajngarten M. Metabolic syndrome, abdominal obesity, and cardiovascular risk in elderly women. Int J Cardiol. 2007;114:224–229
  6. O'Brien LM, Sitha S, Baur LA, Waters KA. Obesity increases the risk for persisting obstructive sleep apnea after treatment in children. Int J Pediatr Otorhinolaryngol. 2006;70:1555–1560
  7. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348:1625–1638
  8. Pasquali R, Pelusi C, Genghini S, Cacciari M, Gambineri A. Obesity and reproductive disorders in women. Hum Reprod Update. 2003;9:359–372
  9. Bellver J, Rossal LP, Bosch E, Zuniga A, Corona JT, Melendez F, et al. Obesity and the risk of spontaneous abortion after oocyte donation. Fertil Steril. 2003;79:1136–1140
  10. Nelson SM, Fleming R. Obesity and reproduction: impact and interventions. Curr Opin Obstet Gynecol. 2007;19:384–389
  11. Finkelstein EA, Fiebelkorn IC, Wang G. State-level estimates of annual medical expenditures attributable to obesity. Obes Res. 2004;12:18–24
  12. Wax JR, Pinette MG, Cartin A, Blackstone J. Female reproductive issues following bariatric surgery. Obstet Gynecol Surv. 2007;62:595–604
  13. Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294:1909–1917
  14. NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115:956–961
  15. Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg. 2004;14:1157–1164
  16. Trus TL, Pope GD, Finlayson SR. National trends in utilization and outcomes of bariatric surgery. Surg Endosc. 2005;19:616–620
  17. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–1737
  18. Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–2693
  19. Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–761
  20. Sjostrom L, Narbro K, Sjostrom CD, Karason K, Larsson B, Wedel H, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–752
  21. Saber AA, Elgamal MH, McLeod MK. Bariatric surgery: the past, present, and future. Obes Surg. 2008;18:121–128
  22. Steinbrook R. Surgery for severe obesity. N Engl J Med. 2004;350:1075–1079
  23. Rosenthal RJ, Szomstein S, Kennedy CI, Soto FC, Zundel N. Laparoscopic surgery for morbid obesity: 1,001 consecutive bariatric operations performed at The Bariatric Institute, Cleveland Clinic Florida. Obes Surg. 2006;16:119–124
  24. Maggard MA, Shugarman LR, Suttorp M, Maglione M, Sugerman HJ, Livingston EH, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–559
  25. Buchwald H. Consensus conference statement bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. Surg Obes Relat Dis. 2005;1:371–381
  26. Velhote MC, Damiani D, Santoro S. Bariatric surgery in pediatrics—is it time?. J Pediatr Endocrinol Metab. 2007;20:751–761
  27. Miller RJ, Xanthakos SA, Hillard PJ, Inge TH. Bariatric surgery and adolescent gynecology. Curr Opin Obstet Gynecol. 2007;19:427–433
  28. Benotti PN, Wood GC, Rodriguez H, Carnevale N, Liriano E. Perioperative outcomes and risk factors in gastric surgery for morbid obesity: a 9-year experience. Surgery. 2006;139:340–346
  29. Abell TL, Minocha A. Gastrointestinal complications of bariatric surgery: diagnosis and therapy. Am J Med Sci. 2006;331:214–218
  30. Lee CW, Kelly JJ, Wassef WY. Complications of bariatric surgery. Curr Opin Gastroenterol. 2007;23:636–643
  31. Zingmond DS, McGory ML, Ko CY. Hospitalization before and after gastric bypass surgery. JAMA. 2005;294:1918–1924
  32. Virji A, Murr MM. Caring for patients after bariatric surgery. Am Fam Physician. 2006;73:1403–1408
  33. Malone M. Recommended nutritional supplements for bariatric surgery patients. Ann Pharmacother. 2008;42:1851–1858
  34. Santoro N, Lasley B, McConnell D, Allsworth J, Crawford S, Gold EB, et al. Body size and ethnicity are associated with menstrual cycle alterations in women in the early menopausal transition: the Study of Women's Health across the Nation (SWAN) Daily Hormone Study. J Clin Endocrinol Metab. 2004;89:2622–2631
  35. Jain A, Polotsky AJ, Rochester D, Berga SL, Loucks T, Zeitlian G, et al. Pulsatile luteinizing hormone amplitude and progesterone metabolite excretion are reduced in obese women. J Clin Endocrinol Metab. 2007;92:2468–2473
  36. Bray GA. Obesity and reproduction. Hum Reprod. 1997;12(Suppl. 1):26–32
  37. Pasquali R. Obesity and androgens: facts and perspectives. Fertil Steril. 2006;85:1319–1340
  38. Bastounis EA, Karayiannakis AJ, Syrigos K, Zbar A, Makri GG, Alexiou D. Sex hormone changes in morbidly obese patients after vertical banded gastroplasty. Eur Surg Res. 1998;30:43–47
  39. Gerrits EG, Ceulemans R, van Hee R, Hendrickx L, Totte E. Contraceptive treatment after biliopancreatic diversion needs consensus. Obes Surg. 2003;13:378–382
  40. Victor A, Odlind V, Kral JG. Oral contraceptive absorption and sex hormone binding globulins in obese women: effects of jejunoileal bypass. Gastroenterol Clin North Am. 1987;16:483–491
  41. Rochester D, Jain A, Polotsky AJ, Polotsky H, Gibbs K, Isaac B, et al. Partial recovery of luteal function after bariatric surgery in obese women. Fertil Steril. 2009;92:1410–1415
  42. Yamamoto M, Sobue G, Yamamoto K, Terao S, Mitsuma T. Expression of mRNAs for neurotrophic factors (NGF, BDNF, NT-3, and GDNF) and their receptors (p75NGFR, trkA, trkB, and trkC) in the adult human peripheral nervous system and nonneural tissues. Neurochem Res. 1996;21:929–938
  43. Seifer DB, Feng B, Shelden RM. Immunocytochemical evidence for the presence and location of the neurotrophin-Trk receptor family in adult human preovulatory ovarian follicles. Am J Obstet Gynecol. 2006;194:1129–1134discussion 1134–6
  44. Seifer DB, Feng B, Shelden RM, Chen S, Dreyfus CF. Brain-derived neurotrophic factor: a novel human ovarian follicular protein. J Clin Endocrinol Metab. 2002;87:655–659
  45. Seifer DB, Feng B, Shelden RM, Chen S, Dreyfus CF. Neurotrophin-4/5 and neurotrophin-3 are present within the human ovarian follicle but appear to have different paracrine/autocrine functions. J Clin Endocrinol Metab. 2002;87:4569–4571
  46. Seifer DB, Lambert-Messerlian G, Schneyer AL. Ovarian brain-derived neurotrophic factor is present in follicular fluid from normally cycling women. Fertil Steril. 2003;79:451–452
  47. Feng B, Chen S, Shelden RM, Seifer DB. Effect of gonadotropins on brain-derived neurotrophic factor secretion by human follicular cumulus cells. Fertil Steril. 2003;80:658–659
  48. Merhi ZO, Minkoff H, Lambert-Messerlian GM, Macura J, Feldman J, Seifer DB. Plasma brain-derived neurotrophic factor in women after bariatric surgery: a pilot study. Fertil Steril. 2009;91(4 Suppl):1544–1548
  49. Manco M, Fernandez-Real JM, Valera-Mora ME, Dechaud H, Nanni G, Tondolo V, et al. Massive weight loss decreases corticosteroid-binding globulin levels and increases free cortisol in healthy obese patients: an adaptive phenomenon?. Diabetes Care. 2007;30:1494–1500
  50. Breuner CW, Orchinik M. Plasma binding proteins as mediators of corticosteroid action in vertebrates. J Endocrinol. 2002;175:99–112
  51. Chikunguwo S, Brethauer S, Nirujogi V, Pitt T, Udomsawaengsup S, Chand B, et al. Influence of obesity and surgical weight loss on thyroid hormone levels. Surg Obes Relat Dis. 2007;3:631–635discussion 635–6
  52. Moulin de Moraes CM, Mancini MC, de Melo ME, Figueiredo DA, Villares SM, Rascovski A, et al. Prevalence of subclinical hypothyroidism in a morbidly obese population and improvement after weight loss induced by Roux-en-Y gastric bypass. Obes Surg. 2005;15:1287–1291
  53. Raftopoulos Y, Gagne DJ, Papasavas P, Hayetian F, Maurer J, Bononi P, et al. Improvement of hypothyroidism after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2004;14:509–513
  54. Merhi ZO. Weight loss by bariatric surgery and subsequent fertility. Fertil Steril. 2007;87:430–432
  55. Esinler I, Bozdag G, Yarali H. Impact of isolated obesity on ICSI outcome. Reprod Biomed Online. 2008;17:583–587
  56. Lintsen AM, Pasker-de Jong PC, de Boer EJ, Burger CW, Jansen CA, Braat DD, et al. Effects of subfertility cause, smoking and body weight on the success rate of IVF. Hum Reprod. 2005;20:1867–1875
  57. Fedorcsak P, Dale PO, Storeng R, Ertzeid G, Bjercke S, Oldereid N, et al. Impact of overweight and underweight on assisted reproduction treatment. Hum Reprod. 2004;19:2523–2528
  58. Styne-Gross A, Elkind-Hirsch K, Scott RT. Obesity does not impact implantation rates or pregnancy outcome in women attempting conception through oocyte donation. Fertil Steril. 2005;83:1629–1634
  59. Crosignani PG, Colombo M, Vegetti W, Somigliana E, Gessati A, Ragni G. Overweight and obese anovulatory patients with polycystic ovaries: parallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet. Hum Reprod. 2003;18:1928–1932
  60. Clark AM, Thornley B, Tomlinson L, Galletley C, Norman RJ. Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum Reprod. 1998;13:1502–1505
  61. Patel JA, Colella JJ, Esaka E, Patel NA, Thomas RL. Improvement in infertility and pregnancy outcomes after weight loss surgery. Med Clin North Am. 2007;91:515–528xiii
  62. Deitel M, Stone E, Kassam HA, Wilk EJ, Sutherland DJ. Gynecologic-obstetric changes after loss of massive excess weight following bariatric surgery. J Am Coll Nutr. 1988;7:147–153
  63. Bilenka B, Ben-Shlomo I, Cozacov C, Gold CH, Zohar S. Fertility, miscarriage and pregnancy after vertical banded gastroplasty operation for morbid obesity. Acta Obstet Gynecol Scand. 1995;74:42–44
  64. Martin LF, Finigan KM, Nolan TE. Pregnancy after adjustable gastric banding. Obstet Gynecol. 2000;95:927–930
  65. Marceau P, Kaufman D, Biron S, Hould FS, Lebel S, Marceau S, et al. Outcome of pregnancies after biliopancreatic diversion. Obes Surg. 2004;14:318–324
  66. Eid GM, Cottam DR, Velcu LM, Mattar SG, Korytkowski MT, Gosman G, et al. Effective treatment of polycystic ovarian syndrome with Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2005;1:77–80
  67. Sheiner E, Menes TS, Silverberg D, Abramowicz JS, Levy I, Katz M, et al. Pregnancy outcome of patients with gestational diabetes mellitus following bariatric surgery. Am J Obstet Gynecol. 2006;194:431–435
  68. Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci. 2006;331:219–225
  69. Su HI, Sammel MD, Freeman EW, Lin H, Deblasis T, Gracia CR. Body size affects measures of ovarian reserve in late reproductive age women. Menopause. 2008;15:857–861
  70. Nakhuda GS. The role of mullerian inhibiting substance in female reproduction. Curr Opin Obstet Gynecol. 2008;20:257–264
  71. Freeman EW, Gracia CR, Sammel MD, Lin H, Lim LC, Strauss JF. Association of anti-mullerian hormone levels with obesity in late reproductive-age women. Fertil Steril. 2007;87:101–106
  72. Hartz AJ, Barboriak PN, Wong A, Katayama KP, Rimm AA. The association of obesity with infertility and related menstural abnormalities in women. Int J Obes. 1979;3:57–73
  73. Merhi ZO, Minkoff H, Feldman J, Macura J, Rodriguez C, Seifer DB. Relationship of bariatric surgery to Mullerian-inhibiting substance levels. Fertil Steril. 2008;90:221–224
  74. Fedorcsak P, Storeng R, Dale PO, Tanbo T, Abyholm T. Obesity is a risk factor for early pregnancy loss after IVF or ICSI. Acta Obstet Gynecol Scand. 2000;79:43–48
  75. ACOG Committee Opinion number 315, September 2005. Obesity in pregnancy. Obstet Gynecol. 2005;106:671–675
  76. Baeten JM, Bukusi EA, Lambe M. Pregnancy complications and outcomes among overweight and obese nulliparous women. Am J Public Health. 2001;91:436–440
  77. Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol. 2004;103:219–224
  78. Young TK, Woodmansee B. Factors that are associated with cesarean delivery in a large private practice: the importance of prepregnancy body mass index and weight gain. Am J Obstet Gynecol. 2002;187:312–318discussion 318–20
  79. Prentice A, Goldberg G. Maternal obesity increases congenital malformations. Nutr Rev. 1996;54:146–150
  80. Dietl J. Maternal obesity and complications during pregnancy. J Perinat Med. 2005;33:100–105
  81. Burstein E, Levy A, Mazor M, Wiznitzer A, Sheiner E. Pregnancy outcome among obese women: a prospective study. Am J Perinatol. 2008;25:561–566
  82. Lashen H, Fear K, Sturdee DW. Obesity is associated with increased risk of first trimester and recurrent miscarriage: matched case-control study. Hum Reprod. 2004;19:1644–1646
  83. Roth D, Grazi RV, Lobel SM. Extremes of body mass index do not affect first-trimester pregnancy outcome in patients with infertility. Am J Obstet Gynecol. 2003;188:1169–1170
  84. Granstrom L, Backman L. Fetal growth retardation after gastric banding. Acta Obstet Gynecol Scand. 1990;69:533–536
  85. Gaudry P, Maurice A, Montagliani L, Dankoro A, Aubert P, Ponties JE. Pregnancy after adjustable gastric band for morbid obesity: specific features of follow-up.]. J Gynecol Obstet Biol Reprod (Paris). 2004;33:235–240
  86. Haddow JE, Hill LE, Kloza EM, Thanhauser D. Neural tube defects after gastric bypass. Lancet. 1986;1:1330
  87. Karmon A, Sheiner E. Pregnancy after bariatric surgery: a comprehensive review. Arch Gynecol Obstet. 2008;277:381–388
  88. Merhi ZO, Pal L. Effect of weight loss by bariatric surgery on the risk of miscarriage. Gynecol Obstet Invest. 2007;64:224–227
  89. Friedman D, Cuneo S, Valenzano M, Marinari GM, Adami GF, Gianetta E, et al. Pregnancies in an 18-year follow-up after biliopancreatic diversion. Obes Surg. 1995;5:308–313
  90. Baird DT, Glasier AF. Hormonal contraception. N Engl J Med. 1993;328:1543–1549
  91. Brunner Huber LR, Hogue CJ, Stein AD, Drews C, Zieman M. Body mass index and risk for oral contraceptive failure: a case-cohort study in South Carolina. Ann Epidemiol. 2006;16:637–643
  92. Melin I, Falconer C, Rossner S, Altman D. Sexual function in obese women: impact of lower urinary tract dysfunction. Int J Obes (Lond). 2008;32:1312–1318
  93. Esposito K, Giugliano F, Ciotola M, De Sio M, D'Armiento M, Giugliano D. Obesity and sexual dysfunction, male and female. Int J Impot Res. 2008;20:358–365
  94. Trischitta V. Relationship between obesity-related metabolic abnormalities and sexual function. J Endocrinol Invest. 2003;26:62–64
  95. Adolfsson B, Elofsson S, Rossner S, Unden AL. Are sexual dissatisfaction and sexual abuse associated with obesity? A population-based study. Obes Res. 2004;12:1702–1709
  96. Kim KK, Kang HC, Kim SS, Youn BB. Influence of weight reduction by sibutramine on female sexual function. Int J Obes (Lond). 2006;30:758–763
  97. Merhi ZO. Bariatric surgery and subsequent sexual function. Fertil Steril. 2007;87:710–711
  98. Kinzl JF, Trefalt E, Fiala M, Hotter A, Biebl W, Aigner F. Partnership, sexuality, and sexual disorders in morbidly obese women: consequences of weight loss after gastric banding. Obes Surg. 2001;11:455–458
  99. Camps MA, Zervos E, Goode S, Rosemurgy AS. Impact of bariatric surgery on body image perception and sexuality in morbidly obese patients and their partners. Obes Surg. 1996;6:356–360
  100. Hafner RJ, Watts JM, Rogers J. Quality of life after gastric bypass for morbid obesity. Int J Obes. 1991;15:555–560
  101. Assimakopoulos K, Panayiotopoulos S, Iconomou G, Karaivazoglou K, Matzaroglou C, Vagenas K, et al. Assessing sexual function in obese women preparing for bariatric surgery. Obes Surg. 2006;16:1087–1091

 Edward E. Wallach, M.D.Associate Editor

 Z.O.M. has nothing to disclose.

 Supported by two grants (to Z.O.M.) from the Maimonides Research and Development Foundation.

PII: S0015-0282(09)01419-8

doi: 10.1016/j.fertnstert.2009.06.046

Fertility and Sterility
Volume 92, Issue 5 , Pages 1501-1508 , November 2009

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