October 17, 2016

Bariatric Surgery May Help Women with Polycystic Ovarian Syndrome Overcome Infertility

The procedure reduces androgen levels and ovarian size

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.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

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.

Advertisement

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.

16-obg-2201

Trend toward lower androgen levels

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

Advertisement
  • 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.

Related Articles

woman with milk and lettuce
February 14, 2024
Neighborhood Factors Affect Early Pregnancy Metabolic Health

Deprivation is linked to impaired glucose intolerance and racial disparities

23-WHI-4386458 – OGI – CQD – topical treatment for VIN
November 30, 2023
Trial Shows Promise for Topical Treatment for VIN

Artesunate ointment is safe well and tolerated patients with vulvar intraepithelial neoplasia

contraception
June 15, 2023
Update on Current Contraceptive Options

A case-based discussion of efficacy, eligibility and use

OB/GYN Residents Wellness
January 13, 2022
Wellness Efforts Are Needed by OB-GYN Residents, But One Solution Does Not Fit All

Workshop curriculum was valued by some, while others would have preferred time for themselves

Cecile Ferrando MD
June 1, 2021
Pain in Transgender Men Undergoing Hysterectomy

Study finds lower incidence of endometriosis than in cisgender patients

18-OBG-1364-DesaiAccessBlastocyst-650×450
September 23, 2020
Uninterrupted Culture in Time-Lapse Incubator Supports Human Embryonic Development

Large randomized study compares embryo growth kinetics and live birth rates between culture media

20-WHI-1938960 CQD WHI – Outcomes of Vaginoplasty Surgery – Ferrando_CQD Hero_650x450
August 27, 2020
Gender-Affirming Vaginoplasty: Reducing Complications

Surgeon experience is key to reducing adverse events

20-WHI-1878668-CQD-Predicting-Early-Pregnancy-Loss_Detti_CQD_650x450_A
April 23, 2020
Predicting Early Pregnancy Loss: Insights from Early, Serial Ultrasounds in Pregnancy

Introducing Laura Detti, MD, newly appointed Chair of the Department of Subspecialty Care for Women’s Health

Ad