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Effects of gastric bypass surgery on female reproductive function.

Legro RS; Dodson WC; Gnatuk CL; Estes SJ; Kunselman AR; Meadows JW; Kesner JS; Krieg EF Jr.; Rogers AM; Haluck RS; Cooney RN

J Clin Endocrinol Metab 2012 Dec; 97(12):4540-4548

https://doi.org/10.1210/jc.2012-2205

20041637

Context: Reproductive functionmayimprove after bariatric surgery, although the mechanisms and time-related changes are unclear. Objective: The objective of the studywasto determine whether ovulation frequency/quality as well as associated reproductive parameters improve after Roux en Y gastric bypass surgery. Design: This was a prospective cohort study that enrolled female subjects from 2005 to 2008 with study visits at baseline and then 1, 3, 6, 12, and up to 24 months after surgery. Setting: The study was conducted at an academic health center. Patients: Twenty-nine obese, reproductive-aged women not using confounding medications participated in the study. Main Outcome Measures: The primary outcome was integrated levels of urinary progestin (pregnanediol 3-glururonide) from daily urinary collections at 12 months postoperatively. Secondary outcomes were changes in vaginal bleeding, other biometric, hormonal, ultrasound, dual-energy x-ray absorptiometry measures, and Female Sexual Function Index. Results: Ninety percent of patients with morbid obesity had ovulatory cycles at baseline, and the ovulatory frequency and luteal phase quality (based on integrated pregnanediol 3-glururonide levels) were not modified by bariatric surgery. The follicular phase was shorter postoperatively [6.5 d shorter at 3 months and 7.9-8.9 d shorter at 6-24 months (P < 0.01)]. Biochemical hyperandrogenism improved, largely due to an immediate postoperative increase in serum SHBG levels (P < 0.01), with no change in clinical hyperandrogenism (sebum production, acne, hirsutism). Bone density was preserved, contrasting with a significant loss of lean muscle mass and fat (P < 0.001), reflecting preferential abdominal fat loss (P < 0.001). Female sexual function improved 28% (P = 0.02) by 12 months. Conclusions: Ovulation persists despite morbid obesity and the changes from bypass surgery. Reproductive function after surgery is characterized by a shortened follicular phase and improved female sexual function.

Reproductive-system; Reproductive-effects; Women; Weight-factors; Gastrointestinal-system; Surgery; Urinalysis; X-ray-absorption; Hormone-activity

Richard S. Legro, M.D., Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, 500 University Drive, H103, Hershey, PA 17033

JCEMAZ

20121201

Journal Article

2013

B10242012

12

0021-972X

DART

Manufacturing

Journal of Clinical Endocrinology and Metabolism

PA; OH; NY