Bariatric Surgery May Help Women with Polycystic Ovarian Syndrome Overcome Infertility

Obese women have a higher incidence of Polycystic Ovarian Syndrome (PCOS), the most common cause of infertility in reproductive-age women. The disease is characterized by enlarged ovaries, higher androgen levels and irregular menstrual cycles, all of which can result in infertility.

Previous studies have shown that weight loss through calorie restriction can help ameliorate PCOS characteristics. Cleveland Clinic researchers wondered if weight reduction through bariatric surgery would have a similar effect.

They recently completed a retrospective investigation, looking at the medical records of women with a PCOS diagnosis who underwent bariatric surgery at Cleveland Clinic between 2009 and 2014.

“What we saw is that these women, post-operatively, had significantly reduced weight and body mass index (BMI),” says Jacob Christ, a medical student at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, who worked on the research with Tommaso Falcone, MD, Chairman of Cleveland Clinic’s Ob/Gyn & Women’s Health Institute.

“We also saw significantly reduced ovarian volumes in postoperative women,” Dr. Christ says, and additionally they found a “significant reduction in patients who reported irregular menstrual cycles postoperatively.” Taken together, these results suggest bariatric surgery is an effective form of weight loss for women with PCOS and may result in reduced severity of some of the key characteristics of this disease.

The research was presented at the American Society for Reproductive Medicine 2016 Scientific Congress & Expo in Salt Lake City, Utah.

Reductions in weight, BMI, ovary size and irregular menstrual cycles

After combing through the medical records of 930 women who underwent bariatric surgery between 2009 and 2015 at Cleveland Clinic, the researchers found 33 had a diagnosis of PCOS.

They then examined those women’s records for their pre- and postoperative statistics: ovarian volume, weight, BMI, hemoglobin, A1C, fasting glucose, total testosterone, free testosterone and dehydroepiandrosterone (DHEAS).

The investigators found a statistically significant reduction in weight and BMI. The women’s weight dropped to 95.7 kg ± 23.2 from 126.3 kg ± 37.6 and their BMI dropped to 37.4 kg/m2 ± 10.3 from 47.5kg/m2 ± 13.9.

They also found a statistically significant reduction in ovarian morphology. The women’s ovaries dropped in volume to an average of 7.7mL ± 4.8 from an average of 14.0 mL ± 9.8, (P = 0.036).

And they found a significant reduction in the number of women reporting irregular menstrual cycles: 84 percent of women in the preoperative group versus 40 percent of women in the postoperative group.

Trend toward lower androgen levels

Finally, though not statistically significant, the researchers also found a consistent trend towards a postoperative decrease in androgen levels:

• Total testosterone (ng/dL): 38.4 ± 1 vs. 56.1 ± 25.6
• Free testosterone (pg/mL) 4.5 ± 4 vs. 10.3 pg/mL ± 5.8
• DHEAS (ug/dL) 132.9 ± 4 vs. 196.3 ± 114.3.

“We found a trend across the board toward a decline in the androgen levels,” Dr. Christ says. “It wasn’t statistically significant, but taken together, we think the trend is real.” He says other studies have found that women with PCOS who lose weight have lower androgen levels.

Because the sample size was small and the study retrospective, Dr. Christ says he’d like to see it repeated with a larger cohort in which investigators follow the women from the time of their PCOS diagnosis through bariatric surgery and finally through their reproductive outcomes.

Overall he says the study points to the idea that bariatric surgery “could potentially be thought of as the next step” if a woman with PCOS is failing ovulation induction therapy and cannot lose weight on her own.