Effects of gastric bypass surgery on female reproductive function.
BACKGROUND
Reproductive function may improve after bariatric surgery, although the mechanisms and time-related changes are unclear.


OBJECTIVE
The objective of the study was to determine whether ovulation frequency/quality as well as associated reproductive parameters improve after Roux en Y gastric bypass surgery.


METHODS
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.


METHODS
The study was conducted at an academic health center.


METHODS
Twenty-nine obese, reproductive-aged women not using confounding medications participated in the study.


METHODS
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.
Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, 500 University Drive, H103, Hershey, Pennsylvania 17033, USA. rsl1@psu.edu
Richard S
RS
Legro
William C
WC
Dodson
Carol L
CL
Gnatuk
Stephanie J
SJ
Estes
Allen R
AR
Kunselman
Juliana W
JW
Meadows
James S
JS
Kesner
Edward F
EF
Krieg
Ann M
AM
Rogers
Randy S
RS
Haluck
Robert N
RN
Cooney
D015502:Absorptiometry, Photon; D000328:Adult; D015992:Body Mass Index; D015519:Bone Density / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D015390:Gastric Bypass / Q000534:rehabilitation; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D008597:Menstrual Cycle / Q000502:physiology; D008599:Menstruation Disturbances / Q000453:epidemiology; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D010298:Parity / Q000502:physiology; D011247:Pregnancy; D012098:Reproduction / Q000502:physiology*; D015431:Weight Loss / Q000502:physiology; D055815:Young Adult