Partial recovery of luteal function after bariatric surgery in obese women.
OBJECTIVE
To determine whether obesity-related reproductive endocrine abnormalities in ovulatory women are reversible with weight loss.


METHODS
Observational cohort study.


METHODS
Healthy volunteers in an academic research environment.


METHODS
Women aged 18-48 years with regular menstrual cycles 21-40 days and a body mass index (BMI) >or=35 kg/m(2) planning to undergo bariatric surgery were recruited.


METHODS
Twenty-five eumenorrheic (non-polycystic ovary syndrome) women with a mean BMI of 47.3 +/- 5.2 kg/m(2) were sampled with daily menstrual cycle urinary hormones before (n = 25) and 6 months after (n = 9) weight loss surgery resulting in >25% reduction of initial body weight. Daily hormones were compared before and after surgery and with 14 normal-weight control subjects.


METHODS
Metabolites of LH, FSH, E(2), and P were measured daily for one menstrual cycle. Group means were compared using t tests among ovulatory cycles.


RESULTS
Luteal pregnanediol glucuronide (Pdg) increased from 32.8 +/- 10.9 to 73.7 +/- 30.5 microg/mg creatinine (Cr) and whole-cycle LH increased from 168.8 +/- 24.2 to 292.1 +/- 79.6 mIU/mg Cr after surgically induced weight loss. Luteal Pdg remained lower than in normal-weight control subjects (151.7 +/- 111.1 microg/mg Cr). Obese women took longer to attain a postovulatory Pdg rise of >2 microg/mg Cr than control subjects (3.91 +/- 1.51 vs. 1.71 +/- 1.59 days); this improved after surgery (2.4 +/- 1.82 days). Whole-cycle estrone conjugates (E(1c)) was similar to control subjects at baseline, but decreased after weight loss (from 1,026.7 +/- 194.2 to 605.4 +/- 167.1 ng/mg Cr). Follicle-stimulating hormone did not relate to body size in this sample.


CONCLUSIONS
Women of very high BMI have deficient luteal LH and Pdg excretion and a delayed ovulatory Pdg rise compared with normal-weight women. Although these parameters improved with weight loss, Pdg did not approach levels seen in normal-weight women. Luteinizing hormone may be less effective in stimulating the corpus luteum in obesity. The large postoperative decrease in E(1c) may reflect the loss of estrone-producing adipose tissue after weight loss.
Rochester
Dana
D
Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
Jain
Akas
A
Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
Polotsky
Alex J
AJ
Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
Polotsky
Hanah
H
Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
Gibbs
Karen
K
Department of Surgery, Montefiore Medical Center, Bronx, New York.
Isaac
Barbara
B
Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
Zeitlian
Gohar
G
Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
Hickmon
Cheryl
C
Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
Feng
Sophia
S
Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
Santoro
Nanette
N
Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York. Electronic address: glicktoro@aol.com.
D000293:Adolescent; D000328:Adult; D050110:Bariatric Surgery / Q000534:rehabilitation*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008184:Luteal Cells / Q000378:metabolism / Q000502:physiology*; D008183:Luteal Phase / Q000378:metabolism / Q000502:physiology*; D007986:Luteinizing Hormone / Q000378:metabolism / Q000652:urine; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery* / Q000652:urine; D010060:Ovulation / Q000378:metabolism / Q000652:urine; D011276:Pregnanediol / Q000031:analogs & derivatives / Q000652:urine; D020127:Recovery of Function / Q000502:physiology*; D015431:Weight Loss / Q000502:physiology; D055815:Young Adult
C022270:pregnanediol-3 alpha-glucuronide; D007986:Luteinizing Hormone; D011276:Pregnanediol