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Surgical Interventions and Reproductive Function in Obese Women

  • Julie S. Rhee
  • Jason Y. Rhee

Abstract

Surgical treatment options for obesity offer effective means for weight loss with meaningful reductions in obesity-related complications. For women who are morbidly obese with a body mass index ≥40 kg/m2, surgical weight loss intervention is the most reliable method for achievable and sustainable weight loss (Ann Intern Med. 142:532–46, 2005; Ann Intern Med. 142:547–59, 2005). As more and more women of childbearing age elect to undergo surgical intervention for obesity, information regarding the potential impact of bariatric surgery on fertility and pregnancy outcomes is important. Particularly since despite the benefits of bariatric surgery, it does have associated surgical and nutritional complications that may impact pregnancy. Furthermore, observations of fertility in women who have undergone bariatric procedures provide insight as to how obesity and weight loss impact reproductive physiology. This chapter seeks to elucidate and summarize the existing body of literature on the effect of surgical weight loss intervention on fertility and overall reproductive function in obese women.

Keywords

Bariatric surgery Surgical intervention Obesity Pregnancy outcome 

References

  1. 1.
  2. 2.
    Li Z, Maglione M, Tu W, et al. Meta-analysis: pharmacologic treatment of obesity. Ann Intern Med. 2005;142:532–46.CrossRefPubMedGoogle Scholar
  3. 3.
    Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59.CrossRefPubMedGoogle Scholar
  4. 4.
    Chang SH, Stoll CR, Song J, Varela JE, Eagon CJ, Colditz GA. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149:275–87.CrossRefPubMedCentralPubMedGoogle Scholar
  5. 5.
    Vest AR, Heneghan HM, Agarwal S, Schauer PR, Young JB. Bariatric surgery and cardiovascular outcomes: a systematic review. Heart. 2012;98:1763–77.CrossRefPubMedGoogle Scholar
  6. 6.
    Maggard MA, Yermilov I, Li Z, et al. Pregnancy and fertility following bariatric surgery: a systematic review. JAMA. 2008;300:2286–96.CrossRefPubMedGoogle Scholar
  7. 7.
    Gosman GG, King WC, Schrope B, et al. Reproductive health of women electing bariatric surgery. Fertil Steril. 2010;94:1426–31.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    O’Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med. 2006;144:625–33.CrossRefPubMedGoogle Scholar
  9. 9.
    Friedman D, Cuneo S, Valenzano M, et al. Pregnancies in an 18-year follow-up after biliopancreatic diversion. Obes Surg. 1995;5:308–13.CrossRefPubMedGoogle Scholar
  10. 10.
    Marceau P, Kaufman D, Biron S, et al. Outcome of pregnancies after biliopancreatic diversion. Obes Surg. 2004;14:318–24.CrossRefPubMedGoogle Scholar
  11. 11.
    Livingston EH. Obesity and its surgical management. Am J Surg. 2002;184:103–13.CrossRefPubMedGoogle Scholar
  12. 12.
    Santoro N, Lasley B, McConnell D, 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;89:2622–31.CrossRefPubMedGoogle Scholar
  13. 13.
    Jain A, Polotsky AJ, Rochester D, et al. Pulsatile luteinizing hormone amplitude and progesterone metabolite excretion are reduced in obese women. J Clin Endocrinol Metab. 2007;92:2468–73.CrossRefPubMedGoogle Scholar
  14. 14.
    Gosman GG, Katcher HI, Legro RS. Obesity and the role of gut and adipose hormones in female reproduction. Hum Reprod Update. 2006;12:585–601.CrossRefPubMedGoogle Scholar
  15. 15.
    Michalakis KG, Segars JH. The role of adiponectin in reproduction: from polycystic ovary syndrome to assisted reproduction. Fertil Steril. 2010;94:1949–57.CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Brannian JD, Zhao Y, McElroy M. Leptin inhibits gonadotrophin-stimulated granulosa cell progesterone production by antagonizing insulin action. Hum Reprod. 1999;14:1445–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Welt CK, Chan JL, Bullen J, et al. Recombinant human leptin in women with hypothalamic amenorrhea. N Engl J Med. 2004;351:987–97.CrossRefPubMedGoogle Scholar
  18. 18.
    Panidis D, Farmakiotis D, Rousso D, Kourtis A, Katsikis I, Krassas G. Obesity, weight loss, and the polycystic ovary syndrome: effect of treatment with diet and orlistat for 24 weeks on insulin resistance and androgen levels. Fertil Steril. 2008;89:899–906.CrossRefPubMedGoogle Scholar
  19. 19.
    Shah DK, Ginsburg ES. Bariatric surgery and fertility. Curr Opin Obstet Gynecol. 2010;22:248–54.CrossRefPubMedGoogle Scholar
  20. 20.
    Tortoriello DV, McMinn J, Chua SC. Dietary-induced obesity and hypothalamic infertility in female DBA/2J mice. Endocrinology. 2004;145:1238–47.CrossRefPubMedGoogle Scholar
  21. 21.
    Tortoriello DV, McMinn JE, Chua SC. Increased expression of hypothalamic leptin receptor and adiponectin accompany resistance to dietary-induced obesity and infertility in female C57BL/6J mice. Int J Obes (Lond). 2007;31:395–402.CrossRefGoogle Scholar
  22. 22.
    Terra X, Auguet T, Guiu-Jurado E, et al. Long-term changes in leptin, chemerin and ghrelin levels following different bariatric surgery procedures: Roux-en-Y gastric bypass and sleeve gastrectomy. Obes Surg. 2013;23:1790–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Uzun H, Zengin K, Taskin M, Aydin S, Simsek G, Dariyerli N. Changes in leptin, plasminogen activator factor and oxidative stress in morbidly obese patients following open and laparoscopic Swedish adjustable gastric banding. Obes Surg. 2004;14:659–65.CrossRefPubMedGoogle Scholar
  24. 24.
    Teitelman M, Grotegut CA, Williams NN, Lewis JD. The impact of bariatric surgery on menstrual patterns. Obes Surg. 2006;16:1457–63.CrossRefPubMedGoogle Scholar
  25. 25.
    Sharpe RM, Franks S. Environment, lifestyle and infertility—an inter-generational issue. Nat Cell Biol. 2002;4(Suppl):s33–40.CrossRefPubMedGoogle Scholar
  26. 26.
    Jamal M, Gunay Y, Capper A, Eid A, Heitshusen D, Samuel I. Roux-en-Y gastric bypass ameliorates polycystic ovary syndrome and dramatically improves conception rates: a 9-year analysis. Surg Obes Relat Dis. 2012;8:440–4.CrossRefPubMedGoogle Scholar
  27. 27.
    Eid GM, Cottam DR, Velcu LM, et al. Effective treatment of polycystic ovarian syndrome with Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2005;1:77–80.CrossRefPubMedGoogle Scholar
  28. 28.
    Legro RS, Dodson WC, Gnatuk CL, et al. Effects of gastric bypass surgery on female reproductive function. J Clin Endocrinol Metab. 2012;97:4540–8.CrossRefPubMedCentralPubMedGoogle Scholar
  29. 29.
    Musella M, Milone M, Bellini M, Sosa Fernandez LM, Leongito M, Milone F. Effect of bariatric surgery on obesity-related infertility. Surg Obes Relat Dis. 2012;8(4):445–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Doblado MA, Lewkowksi BM, Odem RR, Jungheim ES. In vitro fertilization after bariatric surgery. Fertil Steril. 2010;94:2812–4.CrossRefPubMedCentralPubMedGoogle Scholar
  31. 31.
    American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstet Gynecol. 2009;113:1405–13.CrossRefGoogle Scholar
  32. 32.
    Sheiner E, Edri A, Balaban E, Levi I, Aricha-Tamir B. Pregnancy outcome of patients who conceive during or after the first year following bariatric surgery. Am J Obstet Gynecol. 2011;204:50.e1–6.CrossRefGoogle Scholar
  33. 33.
    Dao T, Kuhn J, Ehmer D, Fisher T, McCarty T. Pregnancy outcomes after gastric-bypass surgery. Am J Surg. 2006;192:762–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Roos N, Neovius M, Cnattingius S, et al. Perinatal outcomes after bariatric surgery: nationwide population based matched cohort study. BMJ. 2013;347:f6460.CrossRefPubMedCentralPubMedGoogle Scholar
  35. 35.
    Kjaer MM, Lauenborg J, Breum BM, Nilas L. The risk of adverse pregnancy outcome after bariatric surgery: a nationwide register-based matched cohort study. Am J Obstet Gynecol. 2013;208:464.e1–5.CrossRefGoogle Scholar
  36. 36.
    Aricha-Tamir B, Weintraub AY, Levi I, Sheiner E. Downsizing pregnancy complications: a study of paired pregnancy outcomes before and after bariatric surgery. Surg Obes Relat Dis. 2012;8:434–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Amsalem D, Aricha-Tamir B, Levi I, Shai D, Sheiner E. Obstetric outcomes after restrictive bariatric surgery: what happens after 2 consecutive pregnancies? Surg Obes Relat Dis. 2014;10:445–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Facchiano E, Iannelli A, Santulli P, Mandelbrot L, Msika S. Pregnancy after laparoscopic bariatric surgery: comparative study of adjustable gastric banding and Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2012;8:429–33.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyWashington University School of MedicineSt. LouisUSA
  2. 2.Department of SurgeryWashington University School of MedicineSt. LouisUSA

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