1
|
Andreu A, Flores L, Méndez M, Ibarzabal A, Casals G, Mercadé I, Borrás A, Barral Y, Agustí I, Manau D, Vidal J, Casals G. Impact of bariatric surgery on ovarian reserve markers and its correlation with nutritional parameters and adipokines. Front Endocrinol (Lausanne) 2024; 15:1284576. [PMID: 38559698 PMCID: PMC10978777 DOI: 10.3389/fendo.2024.1284576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction A reduction in anti-müllerian hormone (AMH) levels at short-term after bariatric surgery (BS) has been previously described. However, an assessment of ovarian reserve at longer-follow up, and a comprehensive evaluation of the potentially implicated factors has not been reported. Design Prospective cohort study. Materials and methods Twenty women aged 18-40 years with BMI 43.95 kg/m2 undergoing BS were studied at baseline (BS0), and at 1 month (BS1), 4 months (BS2), 12 months (BS3), and 24-36 months (BS4) after the surgery. Anthropometrics, reproductive hormones (AMH, FSH, LH, estradiol, testosterone, SHBG, androstenedione), metabolic parameters (adiponectin, leptin, ghrelin, insulin), and nutritional blood parameters (markers of nutritional status, vitamins, and minerals) were obtained at each study time point. Antral follicular count (AFC) was assessed by ultrasonography at BS0, BS3, and BS4. Mixed models were used for analysis of longitudinal data. Results The mean AMH level was 3.88 ng/mL at BS0, decreased at BS3 (mean= 2.59 ng/mL; p=0.009), and remained stable between BS3 and BS4 (mean= 2.96 ng/mL; p=0.409). We also observed a non-significant decrease in AFC at BS3 (mean=26.14 at BS0, mean 16.81 at BS3; p=0.088) that remained stable at BS4 (mean= 17.86; p=0.731). Mixed models analysis showed: (a) a decrease in 10 kg of body weight was associated with an average decrease of 0.357 ng/mL in AMH (p=0.014); (b) a decrease in 1 BMI point was associated with an average decrease of 0.109 ng/mL in AMH (p=0.005); (c) an increase in 1 µg/mL of adiponectin was associated with an average decrease of 0.091 ng/ml in AMH (p=0.041) Significant positive correlations were found between the AMH levels after BS and plasma concentrations of testosterone, free androgen index, insulin and HOMA index. No significant correlations were detected between AMH levels and nutritional parameters. Conclusions Our results were in line with previous observations, showing that AMH levels decreased significantly at 12 months after bariatric surgery, in parallel with a non-significant reduction in AFC. Both ovarian reserve markers showed a later stabilization up to the end of the study. Of note, postoperative AMH levels were positively correlated with key androgen and insulin resistance-related parameters.
Collapse
Affiliation(s)
- Alba Andreu
- Obesity Group, Endocrinology and Nutrition Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Lilliam Flores
- Obesity Group, Endocrinology and Nutrition Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomédiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain
| | - Marta Méndez
- Human Assisted Reproduction Section, Hospital Clíınic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Ainize Ibarzabal
- Gastrointestinal Surgery Department, Hospital Clınic de Barcelona, Barcelona, Spain
| | - Gregori Casals
- Biomedical Diagnosis Center, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Imma Mercadé
- Biomedical Diagnosis Center, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Aina Borrás
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomédiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- Human Assisted Reproduction Section, Hospital Clíınic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Yasmina Barral
- Human Assisted Reproduction Section, Hospital Clíınic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Inés Agustí
- Human Assisted Reproduction Section, Hospital Clíınic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Dolors Manau
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomédiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- Human Assisted Reproduction Section, Hospital Clíınic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Josep Vidal
- Obesity Group, Endocrinology and Nutrition Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomédiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain
| | - Gemma Casals
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomédiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- Human Assisted Reproduction Section, Hospital Clíınic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
2
|
Meneghini C, Bianco C, Galanti F, Tamburelli V, Dal Lago A, Licata E, Gallo M, Fabiani C, Corno R, Miriello D, Rago R. The Impact of Nutritional Therapy in the Management of Overweight/Obese PCOS Patient Candidates for IVF. Nutrients 2023; 15:4444. [PMID: 37892519 PMCID: PMC10609803 DOI: 10.3390/nu15204444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common female endocrine disorder, and it has two main pathological aspects: reproductive and metabolic. Overweight/obesity is a risk factor in terms of adverse effects during hormone stimulation, a reduced response to ovulation induction regimens, reduced success of IVF, and an increased risk of obstetric complications. To resolve this vicious cycle of pathological events, weight loss and lifestyle modifications are promising strategies. Among these possible approaches, the consumption of a very-low-calorie ketogenic diet (VLCKD) or Mediterranean diet (MD) represents a valid option. In our study, 84 obese/overweight PCOS patients were recruited to evaluate the effects induced by the VLCKD and MD on weight, hormonal, and metabolic parameters. BMI decreased significantly among the VLKCD patients compared to the MD patients (both presenting p values < 0.0001 at 90 and 120 days), and a significant reduction in body circumference was observed. At the same time, HOMA index values statistically decreased for the VLCKD patients compared to those on the MD (p value < 0.001 at 90 days and p value < 0.05 at 120 days), and this phenomenon was also observed for AFC at 90 and 120 days (both p values < 0.001) and AMH at 90 days (p value < 0.05). Interestingly, the ovarian hyperstimulation syndrome (OHSS) incidence was statistically lower in the VLKCD patients compared to the MD patients (p < 0.001). We state that these dietary regimes may improve anthropometric parameters (such as BMI) and women's reproductive health, restore menstrual regularity, and reduce the risk of OHSS. Regarding the different nutritional therapies, the results suggest that the VLCKD is an optimal choice for entry into IVF, especially in terms of the time range in which these results are achieved.
Collapse
Affiliation(s)
- Caterina Meneghini
- Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Via dei Monti Tiburtini 385/389, 00157 Rome, Italy; (F.G.); (A.D.L.); (E.L.); (M.G.); (C.F.); (R.C.); (D.M.); (R.R.)
| | - Claudia Bianco
- Department of Science, University “Roma Tre”, 00146 Rome, Italy;
| | - Francesco Galanti
- Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Via dei Monti Tiburtini 385/389, 00157 Rome, Italy; (F.G.); (A.D.L.); (E.L.); (M.G.); (C.F.); (R.C.); (D.M.); (R.R.)
| | | | - Alessandro Dal Lago
- Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Via dei Monti Tiburtini 385/389, 00157 Rome, Italy; (F.G.); (A.D.L.); (E.L.); (M.G.); (C.F.); (R.C.); (D.M.); (R.R.)
| | - Emanuele Licata
- Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Via dei Monti Tiburtini 385/389, 00157 Rome, Italy; (F.G.); (A.D.L.); (E.L.); (M.G.); (C.F.); (R.C.); (D.M.); (R.R.)
| | - Mariagrazia Gallo
- Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Via dei Monti Tiburtini 385/389, 00157 Rome, Italy; (F.G.); (A.D.L.); (E.L.); (M.G.); (C.F.); (R.C.); (D.M.); (R.R.)
| | - Cristina Fabiani
- Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Via dei Monti Tiburtini 385/389, 00157 Rome, Italy; (F.G.); (A.D.L.); (E.L.); (M.G.); (C.F.); (R.C.); (D.M.); (R.R.)
| | - Roberta Corno
- Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Via dei Monti Tiburtini 385/389, 00157 Rome, Italy; (F.G.); (A.D.L.); (E.L.); (M.G.); (C.F.); (R.C.); (D.M.); (R.R.)
| | - Donatella Miriello
- Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Via dei Monti Tiburtini 385/389, 00157 Rome, Italy; (F.G.); (A.D.L.); (E.L.); (M.G.); (C.F.); (R.C.); (D.M.); (R.R.)
| | - Rocco Rago
- Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Via dei Monti Tiburtini 385/389, 00157 Rome, Italy; (F.G.); (A.D.L.); (E.L.); (M.G.); (C.F.); (R.C.); (D.M.); (R.R.)
| |
Collapse
|
3
|
Deshmukh H, Papageorgiou M, Wells L, Akbar S, Strudwick T, Deshmukh K, Vitale SG, Rigby A, Vince RV, Reid M, Sathyapalan T. The Effect of a Very-Low-Calorie Diet (VLCD) vs. a Moderate Energy Deficit Diet in Obese Women with Polycystic Ovary Syndrome (PCOS)-A Randomised Controlled Trial. Nutrients 2023; 15:3872. [PMID: 37764656 PMCID: PMC10536436 DOI: 10.3390/nu15183872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
We performed an open-label, randomised controlled trial to compare the effects of a very-low-calorie diet (VLCD) vs. moderate energy deficit approach on body weight, body composition, free androgen index (FAI), and metabolic markers in obese women with polycystic ovary syndrome (PCOS). Forty eligible patients were randomly assigned to a VLCD (n = 21) or a conventional energy deficit approach (n = 19) over the same period. After eight weeks, both groups experienced significant weight loss; however, this was greater in the VLCD arm (-10.9% vs. -3.9%, p < 0.0001). There was also a trend towards a reduction in FAI in the VLCD group compared to the energy deficit group (-32.3% vs. -7.7%, p = 0.07). In the VLCD arm, two women (18%) had a biochemical remission of PCOS (FAI < 4); this was not the case for any of the participants in the energy deficit arm. There was a significant within-group increase in the sex-hormone-binding globulin (p = 0.002) and reductions in fasting blood glucose (p = 0.010) and waist to hip ratio (p = 0.04) in the VLCD arm, but not in the energy deficit arm. The VLCD resulted in significantly greater weight reduction and was accompanied by more pronounced improvements in hyperandrogenaemia, body composition, and several metabolic parameters in obese women with PCOS as compared to the energy deficit approach.
Collapse
Affiliation(s)
- Harshal Deshmukh
- Department of Academic Diabetes and Endocrinology, Allam Diabetes Centre, Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, UK; (H.D.); (S.A.)
- Department of Academic Diabetes and Endocrinology, Hull York Medical School, University of Hull, Hull HU6 7 RX, UK
| | | | - Liz Wells
- School of Sport, Exercise and Rehabilitation Sciences, University of Hull, Hull HU6 7 RX, UK; (L.W.); (R.V.V.)
| | - Shahzad Akbar
- Department of Academic Diabetes and Endocrinology, Allam Diabetes Centre, Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, UK; (H.D.); (S.A.)
| | - Thomas Strudwick
- School of Psychology and Social Work, University of Hull, Hull HU6 7 RX, UK; (T.S.); (M.R.)
| | - Ketki Deshmukh
- School of Sport, Exercise and Rehabilitation Sciences, University of Hull, Hull HU6 7 RX, UK; (L.W.); (R.V.V.)
| | - Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09121 Cagliari, Italy;
| | - Alan Rigby
- Institute of Clinical and Applied Health Research, Hull York Medical School, Hull HU6 7 RX, UK;
| | - Rebecca V. Vince
- School of Sport, Exercise and Rehabilitation Sciences, University of Hull, Hull HU6 7 RX, UK; (L.W.); (R.V.V.)
| | - Marie Reid
- School of Psychology and Social Work, University of Hull, Hull HU6 7 RX, UK; (T.S.); (M.R.)
| | - Thozhukat Sathyapalan
- Department of Academic Diabetes and Endocrinology, Allam Diabetes Centre, Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, UK; (H.D.); (S.A.)
- Department of Academic Diabetes and Endocrinology, Hull York Medical School, University of Hull, Hull HU6 7 RX, UK
| |
Collapse
|
4
|
Babarinsa IA, Bashir M, AbdelRahman Ahmed H, Ahmed B, Konje JC. Bariatric surgery and reproduction-implications for gynecology and obstetrics. Best Pract Res Clin Obstet Gynaecol 2023; 90:102382. [PMID: 37506498 DOI: 10.1016/j.bpobgyn.2023.102382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/21/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023]
Abstract
As the rates of obesity continue to rise across the world, there has been an increasing resort to bariatric surgery amongst the options for treatment. Through the reproductive lifespan, between menarche and menopause, women might benefit from this surgical intervention, which may have a bearing on other aspects of their health. The consequences of bariatric surgery have been reported and evaluated from various perspectives in obstetrics and gynecology. Fertility and sexuality are enhanced, but not all gynecological diseases are ameliorated. There are also psychological and behavioral sequelae to be cognizant of. With multi-disciplinary and responsive care, most post-bariatric pregnancies have satisfactory outcomes. The effects of bariatric surgery on the babies conceived thereafter remains a subject of interest, whereas the possible effect on the climacteric is speculative.
Collapse
Affiliation(s)
- Isaac A Babarinsa
- Women's Wellness and Research Centre, Hamad Medical Corporation, Doha.
| | | | | | - Badreldeen Ahmed
- Feto Maternal Centre, Al Markhiya, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar; Qatar University, Qatar
| | - Justin C Konje
- Feto Maternal Centre, Al Markhiya, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar; Department of Health Sciences University of Leicester, UK
| |
Collapse
|
5
|
Kloos J, Coyne K, Weinerman R. The relationship between anti-Müllerian hormone, body mass index and weight loss: A review of the literature. Clin Obes 2022; 12:e12559. [PMID: 36181300 PMCID: PMC9787654 DOI: 10.1111/cob.12559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/10/2022] [Accepted: 09/15/2022] [Indexed: 01/09/2023]
Abstract
Anti-Müllerian hormone (AMH) is commonly used as a proxy for ovarian reserve due to its secretion by antral follicles. It is considered a metric for prediction of ovarian response to certain assisted reproduction therapies. As obesity has a negative impact on fertility, it is important to establish whether obesity-induced hormonal changes influence AMH levels, if and how weight loss affects AMH, and if that influence represents altered reproductive function. The aim of this study was to review the existing literature on the effects of body mass index and weight loss on AMH levels. A PubMed literature keyword search with relevant terms was performed to identify studies that have reported on the AMH/BMI relationship in cohorts with or without polycystic ovarian syndrome (PCOS). A second search was performed to gather publications on weight loss and AMH. Both searches were filtered for all full-text, English-language, adult-female and human-only literature through 1 January 2022. The relationship between AMH and body mass index (BMI) in reproductive-aged women remains inconclusive, with studies in women with and without PCOS producing mixed results. Research in this area is currently limited by failure to analyse the full spectrum of obesity, hindering generalization to a global population increasingly affected by the condition. Some authors pointed to evidence of race/ethnicity as a confounding factor of the relationship, but results between studies are contradictory. Limited evidence on weight loss suggests it may decrease AMH levels despite improving fertility outcomes, particularly after bariatric surgery. The impact of BMI and weight loss on AMH levels has not been conclusively established. Future studies will require appropriate design and sample size calculations, consideration for additional potential confounding factors and inclusion of higher BMIs and a thorough analysis of the full range of obesity.
Collapse
Affiliation(s)
- Jacqueline Kloos
- Case Western Reserve University School of MedicineClevelandOhioUSA
| | - Kathryn Coyne
- Division of Reproductive Endocrinology and InfertilityUniversity Hospitals Cleveland Medical CenterClevelandOhioUSA
| | - Rachel Weinerman
- Division of Reproductive Endocrinology and InfertilityUniversity Hospitals Cleveland Medical CenterClevelandOhioUSA
| |
Collapse
|
6
|
Muffone ARMC, de Oliveira Lübke PDP, Rabito EI. Mediterranean diet and infertility: a systematic review with meta-analysis of cohort studies. Nutr Rev 2022:6811792. [DOI: 10.1093/nutrit/nuac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Abstract
Context
The Mediterranean diet (MD) is a dietary pattern with evidence of positive health impact, and some nutrients in this diet have already been researched for their effectiveness in fertility. However, there are still questions about whether high adherence to the MD could be a factor that contributes to positive fertility outcomes in infertile men and women.
Objective
A systematic review and meta-analysis were conducted to determine whether a greater adherence to the MD can improve fertility markers and outcomes in infertile men and women.
Data sources
The MEDLINE, BVS, SciELO, CENTRAL, and Embase databases and gray literature were searched from their inception to May 2022.
Study selection
Data were included from cohort studies that addressed MD and outcomes.
Data extraction
Data searches, article selection, data extraction, and risk-of-bias assessments were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results
A total of 11 studies met the inclusion criteria (n = 13 157 women and 1338 men). Greater adherence to the MD was associated with live births (I2 = 83.16%; odds ratio [OR], 0.652; 95%CI, 0.408–3.194), pregnancy rate (I2 = 93.83%; OR, 1.192; 95%CI, 0.349–4.325), sperm concentration >15 × 106/mL (I2 = 32.97%; OR 2.862; 95%CI, 1.583–5.174), and sperm count > 39 × 106/mL (I2 = 48.1%; OR, 2.543; 95%CI, 1.319–4.904); however, in an inconsistent scenario regarding the meta-analysis.
Conclusion
Current evidence of high adherence to MD and fertility markers is insufficient to support their clinical application, even though it indicates sperm improvement and a possibility of better pregnancy outcomes.
Systematic Review Registration
PROSPERO registration no. 169396.
Collapse
Affiliation(s)
| | | | - Estela I Rabito
- Department of Nutrition, Federal University of Paraná , Curitiba, Paraná, Brazil
| |
Collapse
|
7
|
Nilsson-Condori E, Mattsson K, Thurin-Kjellberg A, Hedenbro JL, Friberg B. Outcomes of in-vitro fertilization after bariatric surgery: a national register-based case-control study. Hum Reprod 2022; 37:2474-2481. [PMID: 35904469 PMCID: PMC9527453 DOI: 10.1093/humrep/deac164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/04/2022] [Indexed: 11/27/2022] Open
Abstract
STUDY QUESTION Does previous bariatric surgery (BS) in women affect cumulative live birth rate in IVF? SUMMARY ANSWER Women having had BS seem to have the same cumulative live birth rate as non-operated women of the same BMI at IVF treatment. WHAT IS KNOWN ALREADY Because of the perinatal risks of obesity to mother and infant as well as impaired outcomes of IVF, obese women are advised to reduce their weight, but it is not clear whether previous BS could affect IVF results. STUDY DESIGN, SIZE, DURATION This national register-based case–control study included all cases of BS (n = 30 436) undergoing IVF (n = 153) from 2007 until 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS Swedish women between 18 and 45 years operated with BS, with at least one first started cycle of IVF after surgery, were included. For each woman having IVF after BS (n = 153), up to five non-operated control women (n = 744) starting their first IVF cycle during the study period were matched for age, parity and BMI at treatment. The primary outcome in this study was the cumulative live birth rate (CLBR) after the first IVF cycle, defined as all live births after the first cycle including fresh and frozen embryo transfers. MAIN RESULTS AND THE ROLE OF CHANCE There was no significant difference in CLBR between the BS group and the matched controls (29.4% compared to 33.1%), even though the number of retrieved oocytes (7.6 vs 8.9, P = 0.005) and frozen embryos (1.0 vs 1.5, P = 0.041) were significantly fewer in the BS group. There was no association between cumulative live birth and BS, adjusted odds ratio 1.04, 95% CI (0.73, 1.51). However, the birth weight was significantly lower in the children born to mothers with previous BS, mean (SD) 3190 (690) vs 3478 (729) g, P = 0.037. LIMITATIONS, REASONS FOR CAUTION Confounders such as age, BMI and previous childbirth were accounted for by the matching design of the study, but there were no data on indication for IVF, anti-Müllerian hormone, smoking or previous comorbidities. The study was exploratory and did not reach sufficient power to detect potential smaller differences in live birth rates. WIDER IMPLICATIONS OF THE FINDINGS The findings concur with those in previously published smaller studies and provide somewhat reassuring results considering IVF outcomes after BS with a CLBR comparable to that of controls, despite a lower mean birth weight. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by grants from the Southern Health Care Region of Sweden. The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- E Nilsson-Condori
- Center for Reproductive Medicine, Skåne University Hospital, Malmö, Sweden.,Faculty of Medicine, Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.,Faculty of Medicine, Department of Translational Medicine, Reproductive Medicine, Lund University, Malmö, Sweden
| | - K Mattsson
- Faculty of Medicine, Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.,Faculty of Medicine, Department of Translational Medicine, Reproductive Medicine, Lund University, Malmö, Sweden
| | - A Thurin-Kjellberg
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg and Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J L Hedenbro
- Faculty of Medicine, Clinical Sciences Lund, Department of Surgery, Lund University, Lund, Sweden
| | - B Friberg
- Faculty of Medicine, Department of Translational Medicine, Reproductive Medicine, Lund University, Malmö, Sweden
| |
Collapse
|
8
|
Hosseini SV, Kasraei H, Khazraei H, AL-Hurry AMAH. The Effect of Sleeve Gastrectomy on Sexual Hormones and Fertility in Obese Patients in Shiraz. Bariatr Surg Pract Patient Care 2022. [DOI: 10.1089/bari.2021.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Seyed Vahid Hosseini
- Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hengameh Kasraei
- Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hajar Khazraei
- Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | | |
Collapse
|
9
|
Davidson S, Jahnke S, Jung AM, Burgess JL, Jacobs ET, Billheimer D, Farland LV. Anti-Müllerian Hormone Levels among Female Firefighters. Int J Environ Res Public Health 2022; 19:5981. [PMID: 35627519 PMCID: PMC9141260 DOI: 10.3390/ijerph19105981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 02/04/2023]
Abstract
Female firefighters have occupational exposures which may negatively impact their reproductive health. Anti-müllerian hormone (AMH) is a clinical marker of ovarian reserve. We investigated whether AMH levels differed in female firefighters compared to non-firefighters and whether there was a dose-dependent relationship between years of firefighting and AMH levels. Female firefighters from a pre-existing cohort completed a cross-sectional survey regarding their occupational and health history and were asked to recruit a non-firefighter friend or relative. All participants provided a dried blood spot (DBS) for AMH analysis. Linear regression was used to assess the relationship between firefighting status and AMH levels. Among firefighters, the influence of firefighting-related exposures was evaluated. Firefighters (n = 106) and non-firefighters (n = 58) had similar age and BMI. Firefighters had a lower mean AMH compared to non-firefighters (2.93 ng/mL vs. 4.37 ng/mL). In multivariable adjusted models, firefighters had a 33% lower AMH value than non-firefighters (-33.38%∆ (95% CI: -54.97, -1.43)). Years of firefighting was not associated with a decrease in AMH. Firefighters in this study had lower AMH levels than non-firefighters. More research is needed to understand the mechanisms by which firefighting could reduce AMH and affect fertility.
Collapse
Affiliation(s)
- Samantha Davidson
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (S.D.); (A.M.J.); (E.T.J.); (D.B.)
| | - Sara Jahnke
- Center for Fire, Rescue & EMS Health Research, NDRI-USA, Inc., Leawood, KS 66224, USA;
| | - Alesia M. Jung
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (S.D.); (A.M.J.); (E.T.J.); (D.B.)
- Department of Community, Environment & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
| | - Jefferey L. Burgess
- Department of Community, Environment & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
- Cancer Prevention and Control Program, University of Arizona Cancer Center, Tucson, AZ 85719, USA
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (S.D.); (A.M.J.); (E.T.J.); (D.B.)
- Cancer Prevention and Control Program, University of Arizona Cancer Center, Tucson, AZ 85719, USA
| | - Dean Billheimer
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (S.D.); (A.M.J.); (E.T.J.); (D.B.)
| | - Leslie V. Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (S.D.); (A.M.J.); (E.T.J.); (D.B.)
- Cancer Prevention and Control Program, University of Arizona Cancer Center, Tucson, AZ 85719, USA
- Department of Obstetrics and Gynecology, College of Medicine-Tucson, University of Arizona, Tucson, AZ 85724, USA
| |
Collapse
|
10
|
Tatarchuk T, Todurov I, Anagnostis P, Tutchenko T, Pedachenko N, Glamazda M, Koseii N, Regeda S. The Effect of Gastric Sleeve Resection on Menstrual Pattern and Ovulation in Premenopausal Women with Classes III-IV Obesity. Obes Surg 2021; 32:599-606. [PMID: 34817794 DOI: 10.1007/s11695-021-05820-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/14/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Bariatric surgery is very efficacious in treating severe obesity. However, its effect on menstruation and ovulation is currently unknown. The purpose of this study was to assess the effect of gastric sleeve resection (GSR) on menstrual pattern in women with stages III-IV obesity and ovulatory dysfunction compared with conventional management. METHODS This was a prospective, multicentre, non-randomized trial, in premenopausal women, who fulfilled the criteria for gastric sleeve resection (GSR). Both women with and without polycystic ovary syndrome (PCOS) were evaluated at 3, 6, 9, 12 and 15 months post-surgery. RESULTS Menstrual cycle irregularities were identified in 122 severely obese women (60 with PCOS; 62 without PCOS). The % total weight loss was greater with GSR than with conventional management (33.4% vs. 3.6% in PCOS; 24.8% vs. 3.6% in non-PCOS, respectively). Intermenstrual interval was shortened towards normal length (≤ 35 days) both in PCOS and non-PCOS GSR groups, by the 6th and 12th post-surgical month, respectively. Furthermore, ovulation at 6 months was achieved in 63.6% of PCOS and 45% of non-PCOS subjects post-GSR, which was higher than in controls (11.1% and 13.6%, respectively; p < 0.05). This percentage rose to 75.7% and 81.8% at 12 and 15 months in PCOS, respectively, but not in the non-PCOS group (55% and 52.5%, respectively; p < 0.05). CONCLUSIONS Weight reduction after GSR improved menstrual irregularity towards normality in women with severe obesity. Ovulation dysfunction was also resumed in more than half of these patients at 6-15 months. These effects were more evident in women with PCOS.
Collapse
Affiliation(s)
- Tetiana Tatarchuk
- Institute of Pediatrics, Obstetrics and Gynecology of the Academy of Medical Sciences of Ukraine, 8 Platon Mayboroda St, Kyiv, 04050, Ukraine
| | - Ivan Todurov
- Center for Innovative Medical Technologies, Academy of Sciences of Ukraine, 22 Voznesenskiy Uzviz St, Kyiv, 04053, Ukraine
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Tetiana Tutchenko
- Institute of Pediatrics, Obstetrics and Gynecology of the Academy of Medical Sciences of Ukraine, 8 Platon Mayboroda St, Kyiv, 04050, Ukraine
| | - Natalia Pedachenko
- Department of Obstetrics, Gynecology and Perinatology, P.L. Shupik National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Marina Glamazda
- Institute of Pediatrics, Obstetrics and Gynecology of the Academy of Medical Sciences of Ukraine, 8 Platon Mayboroda St, Kyiv, 04050, Ukraine
| | - Natalia Koseii
- Institute of Pediatrics, Obstetrics and Gynecology of the Academy of Medical Sciences of Ukraine, 8 Platon Mayboroda St, Kyiv, 04050, Ukraine
| | - Svetlana Regeda
- Institute of Pediatrics, Obstetrics and Gynecology of the Academy of Medical Sciences of Ukraine, 8 Platon Mayboroda St, Kyiv, 04050, Ukraine
| |
Collapse
|
11
|
Snoek KM, Steegers-Theunissen RPM, Klaassen RA, Laven JSE, Schoenmakers S. Impact of Bariatric surgery on EmbrYONic, fetal and placental Development (BEYOND): protocol for a prospective cohort study embedded in the Rotterdam periconceptional cohort. BMJ Open 2021; 11:e051110. [PMID: 34475184 PMCID: PMC8413945 DOI: 10.1136/bmjopen-2021-051110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/19/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The worldwide obesity epidemic has resulted in a rise of bariatric surgery in women of reproductive age, which can lead to 'iatrogenic undernutrition'. Long-lasting undernutrition can affect maternal health, pregnancy outcomes and offspring. We hypothesise that embryonic and placental growth are impaired in pregnancies after bariatric surgery due to the changed nutritional and microbiome dynamics. Therefore, our aim is to conduct the Bariatrics and EmbrYONic Development (BEYOND) study to investigate parameters of maternal nutritional and health status after bariatric surgery, both periconceptionally and during pregnancy, particularly concentrating on embryonic and fetal growth trajectories as well as placental development. METHODS AND ANALYSIS We designed a single-centre prospective, observational cohort, which investigates the iatrogenic nutritional and health status of women after bariatric surgery, periconceptionally and during pregnancy. The BEYOND study is embedded in the Rotterdam Periconceptional Cohort, a tertiary hospital-based birth cohort study. Eligible participants are women planning pregnancy or <12+0 weeks pregnant, ≥18 and ≤45 years of age, who have undergone bariatric surgery (cases) or without prior bariatric surgery (controls) and their male partners. Medical charts will be reviewed and questionnaires regarding general health, lifestyle and food intake will be collected. Moreover, we will perform serial three-dimensional ultrasounds to assess embryonic growth and placental development and two-dimensional ultrasounds for fetal growth assessment. The microbiome, including the virome, and blood samples will be sampled during the preconception period and in each trimester. Multivariable linear mixed model analyses will be used to assess the associations between bariatric surgery and pregnancy outcomes. ETHICS AND DISSEMINATION This proposal was approved by the Medical Ethics Committee from the Erasmus MC, Rotterdam, The Netherlands. Study results will be submitted for publication in high-impact journals, presented at scientific conferences, implemented into guidelines and communicated through the Erasmus MC and collaborating partners. TRIAL REGISTRATION NUMBER NL8217 (www.trialregister.nl).
Collapse
Affiliation(s)
- Katinka M Snoek
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - René A Klaassen
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Sam Schoenmakers
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, The Netherlands
| |
Collapse
|
12
|
Snoek KM, Steegers-Theunissen RPM, Hazebroek EJ, Willemsen SP, Galjaard S, Laven JSE, Schoenmakers S. The effects of bariatric surgery on periconception maternal health: a systematic review and meta-analysis. Hum Reprod Update 2021; 27:1030-1055. [PMID: 34387675 PMCID: PMC8542997 DOI: 10.1093/humupd/dmab022] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 05/26/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Worldwide, the prevalence of obesity in women of reproductive age is increasing. Bariatric surgery is currently viewed as the most effective, long-term solution for this problem. Preconception bariatric surgery can reduce the prevalence of obesity-related subfertility and adverse maternal, pregnancy and birth outcomes. Maternal health during the periconception period is crucial for optimal gametogenesis and for embryonic and fetal development which also affects health in the later lives of both mother and offspring. Although preconception bariatric surgery improves several pregnancy outcomes, it can also increase the prevalence of pregnancy complications due to excessive and rapid weight loss. This can lead to iatrogenic malnutrition with vitamin deficiencies and derangements in metabolic and endocrine homeostasis. Thus, bariatric surgery can greatly influence periconception maternal health with consequences for reproduction, pregnancy and health in later life. However, its influence on periconception maternal health itself has never been reviewed systematically. OBJECTIVE AND RATIONALE The aim of this review was to investigate associations between bariatric surgery and determinants of periconception maternal health such as endocrine changes, fertility, vitamin status, irregular menstrual cycles, miscarriages and congenital malformations. SEARCH METHODS Medline, Embase, PubMed, Web of Science, Google Scholar and the Cochrane databases were used for the literature search until 1 November 2020. The search strategy terms included, among others, bariatric surgery, hormones, fertility, malformations, miscarriages and vitamin status. We searched for human studies that were written in English. Abstracts, reviews, meta-analyses and conference papers were excluded. The ErasmusAGE score was used to assess the quality of the included studies. OUTCOMES A total of 51 articles were analysed. The mean quality score was 5 (range 2-8). After bariatric surgery, hormonal axes normalized and menstrual cycle regularity was restored, resulting in increased fertility. Overall, there were no short-term risks for reproductive outcomes such as the increased risk of miscarriages or congenital malformations. However, the risk of vitamin deficiencies was generally increased after bariatric surgery. A meta-analysis of 20 studies showed a significant decrease in infertility (risk difference (RD) -0.24, 95% confidence interval (CI) -0.42, -0.05) and menstrual cycle irregularities (RD -0.24, 95% CI -0.34, -0.15) with no difference in rates of miscarriage (RD 0.00, 95% CI -0.09, 0.10) and congenital malformations (RD 0.01, 95% CI -0.02, 0.03). WIDER IMPLICATIONS The current systematic review and meta-analysis show associations between bariatric surgery and periconception maternal health and underlines the need for providing and personalizing preconception care for women after bariatric surgery. We recommend preconception care including the recommendation of postponing pregnancy until weight loss has stabilized, irrespective of the surgery-to-pregnancy interval, and until vitamin status is normalized. Therefore, regular monitoring of vitamin status and vitamin supplementation to restore deficiencies is recommended. Furthermore, this systematic review emphasizes the need for a long-term follow-up research of these women from the periconception period onwards as well as their pregnancies and offspring, to further improve care and outcomes of these mothers and children.
Collapse
Affiliation(s)
- Katinka M Snoek
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre , Rotterdam, The Netherlands
| | | | | | - Sten P Willemsen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre , Rotterdam, The Netherlands.,Department of Biostatistics, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Sander Galjaard
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre , Rotterdam, The Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Sam Schoenmakers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre , Rotterdam, The Netherlands
| |
Collapse
|
13
|
Dupont C, Didon S, Ciangura C, Selleret L, Bachelot A, Lévy R, Sermondade N. Impact of Bariatric Surgery-Induced Weight Loss on Ovarian Reserve in Women with Obesity: A Systematic Review. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2021.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charlotte Dupont
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne-Université, Paris, France
- Sorbonne Université, Centre de Recherche Saint-Antoine, Paris, France
| | - Samia Didon
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne-Université, Paris, France
| | - Cécile Ciangura
- Service de Nutrition, Institute of Cardiometabolism and Nutrition, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Paris, France
| | - Lise Selleret
- Service de Gynécologie, Obstétrique et Médecine de la Reproduction, Hôpital Tenon (AP-HP), Sorbonne-Université, Paris, France
| | - Anne Bachelot
- Service d'Endocrinologie et Médecine de la Reproduction, IE3M, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Maladies Gynécologiques Rares, Institute of Cardiometabolism and Nutrition, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Paris, France
| | - Rachel Lévy
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne-Université, Paris, France
- Sorbonne Université, Centre de Recherche Saint-Antoine, Paris, France
| | - Nathalie Sermondade
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne-Université, Paris, France
- Sorbonne Université, Centre de Recherche Saint-Antoine, Paris, France
| |
Collapse
|
14
|
Dong L, Karantanis W, Suh H, Magdy M, Loi KW. A Case Report of Subfertility Post Bariatric Surgery-a Rare Yet Significant Complication. Obes Surg 2021; 31:3312-4. [PMID: 33728576 DOI: 10.1007/s11695-021-05317-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/13/2021] [Accepted: 02/23/2021] [Indexed: 10/21/2022]
|
15
|
Akbari Sene A, Ashrafi M, Alaghmand-Fard N, Mohammadi N, Mortezapour Alisaraie M, Alizadeh A. Anti-Müllerian Hormone Predictive Levels to Determine The Likelihood of Ovarian Hyper-Response in Infertile Women with Polycystic Ovarian Morphology. Int J Fertil Steril 2021; 15:115-122. [PMID: 33687164 PMCID: PMC8052798 DOI: 10.22074/ijfs.2020.134614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 09/16/2020] [Indexed: 11/13/2022]
Abstract
Background The objective of this study was to investigate serum levels of anti-Müllerian hormone (AMH) in
normal-ovulatory infertile women with polycystic ovarian morphology (PCOM) and their association with ovarian
hyper-response. Materials and Methods This prospective cohort study was carried out on 100 infertile women with PCOM who
were treated with an antagonist/agonist triggered stimulation protocol at Shahid Akbar-Abadi Hospital IVF Centre,
Tehran, Iran. Serum AMH levels were measured before starting the assisted reproductive technology (ART) cycle
and the ovarian hyper-response was evaluated by retrieved oocyte numbers, ooestradiol levels on the triggering
day, and the incidence of ovarian hyper-stimulation syndrome (OHSS) clinical signs and symptoms. Logistic re-
gression and the area under the curve (AUC) were used to estimate the effects of AMH and the accuracy of the test. Results Receiver operating characteristic (ROC) curve analysis showed that AMH could significantly predict ovar-
ian hyper-response in PCOM patients (AUC=0.73). The estimated threshold value was 4.95 ng/ml, with a specificity
of 74.58% (95% confidence interval [CI]: 50.85, 93.22) and sensitivity of 73.17% (95% CI: 48.78, 92.68). Logistic
regression results showed a significant interaction between AMH and body mass index (BMI, P=0.008), which indi-
cated that BMI had a moderation effect. Conclusion Individualized stimulation protocols for patients with isolated PCOM and AMH greater than 4.95 ng/ml
may significantly reduce the chances of developing OHSS. However, the AMH cut-off values to predict ovarian hyper-
response differ for different BMI categories among PCOM patients; thus, it becomes a more precise predictive marker
with increasing BMI.
Collapse
Affiliation(s)
- Azadeh Akbari Sene
- Shahid Akbar-Abadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mahnaz Ashrafi
- Shahid Akbar-Abadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Nasim Alaghmand-Fard
- Department of Obstetrics and Gynaecology, Shahid Akbar-Abadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Mohammadi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ahad Alizadeh
- Metabolic Diseases Research Centre, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
| |
Collapse
|
16
|
Guo Y, Liu S, Hu S, Li F, Jin L. High Serum Anti-Müllerian Hormone Concentrations Are Associated With Poor Pregnancy Outcome in Fresh IVF/ICSI Cycle but Not Cumulative Live Birth Rate in PCOS Patients. Front Endocrinol (Lausanne) 2021; 12:673284. [PMID: 34122349 PMCID: PMC8187895 DOI: 10.3389/fendo.2021.673284] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/23/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the association between baseline serum Anti-Müllerian hormone (AMH) levels and IVF/ICSI outcomes in women with polycystic ovary syndrome (PCOS). DESIGN Retrospective study. SETTING Reproductive medicine center in a hospital. POPULATION 2436 PCOS patients (Rotterdam criteria) who underwent their first fresh IVF/ICSI cycles were divided into three groups on the basis of the <25th (Group 1, n=611), 25 to 75th (Group 2, n=1216), or >75th (Group 3, n=609) percentile of baseline serum AMH level. INTERVENTIONS Baseline serum AMH levels measured on the 2-3 days of spontaneous menstrual cycle before IVF/ICSI treatment. MAIN OUTCOME MEASURES Live birth rate (LBR), cumulative live birth rate (CLBR), clinical pregnancy rate (CPR), and normal fertilization rate (FR). RESULTS The LBR, CPR, and FR were significantly increased in Group 1 than Group 2 and Group 3, however, CLBR was similar between the three groups. The LBR were 46.6%, 40.5%, and 39.4% in Group 1, Group 2, and Group 3 respectively. The CPR were 53.0%, 47.0%, and 45.5%, respectively. The FR was highest in Group 1 (61.7%, P<0.05), but there was no uniform reverse trend with the AMH level. CLBR were 68.7%, 70.4%, and 71.3%, respectively. Although women in Group 1 were older (p < 0.05) and had higher body mass index (BMI) (p < 0.05), binomial logistic regression analysis used age, BMI, FSH, and AMH as independent variables indicated that only AMH was significantly associated with LBR and CPR. Nevertheless, binomial logistic regression analysis used age, BMI, FSH, AMH, and the number of retrieved oocytes as independent variables indicated that only the number of retrieved oocytes was significantly correlated with CLBR. After stratifying by age, the negative relationship between baseline AMH level and LBR and CPR remained only in the patients <30 years old. CONCLUSIONS Higher baseline AMH level in PCOS women resulted in lower LBR, CPR, and FR but did not influence CLBR.
Collapse
Affiliation(s)
| | | | | | - Fei Li
- *Correspondence: Lei Jin, ; Fei Li,
| | - Lei Jin
- *Correspondence: Lei Jin, ; Fei Li,
| |
Collapse
|
17
|
Luo E, Zhang J, Song J, Feng D, Meng Y, Jiang H, Li D, Fang Y. Serum Anti-Müllerian Hormone Levels Were Negatively Associated With Body Fat Percentage in PCOS Patients. Front Endocrinol (Lausanne) 2021; 12:659717. [PMID: 34149614 PMCID: PMC8213015 DOI: 10.3389/fendo.2021.659717] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/13/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Obesity is a state of excess body fat accumulation, and appears to be closely associated with polycystic ovary syndrome (PCOS). Notably, plausible biological pathways through which obesity can regulate anti-Müllerian hormone (AMH) production have been proposed, and women with PCOS characteristically have an increased AMH level. Body fat accumulation can be described by body fat percentage (BFP). However, the relationship between BFP and AMH still remains unclear. MATERIALS AND METHODS A total of 87 controls and 156 PCOS patients were divided into lean and overweight/obese groups, and the PCOS patients were further divided into hyper-AMH and normal-AMH subgroups. Univariate regression was used to assess the unadjusted relationship between AMH and outcome variables, multivariable regression analysis was performed to test whether and how serum AMH levels were associated with BFP after adjusting for other co-variables. Receiver-operating characteristic (ROC) curve analyses were used to test the utility of BFP for the diagnosis of PCOS. RESULTS BFP was higher in PCOS patients compared with controls, regardless of obesity. Serum AMH levels were negatively associated with BFP in the PCOS group (r = -0.371; P < 0.001) but not in the control group (r = -0.095; P = 0.385). Multivariable logistic regression analysis showed that elevated BFP was associated with a high risk of PCOS (odds ratio, 1.290; 95% confidence interval, 1.084-1.534, P = 0.004). Furthermore, the combination of BFP and serum AMH into a multivariate model gave an improved area under the curve (AUC) of 88.5%, with a sensitivity of 72.4% and specificity of 87.4%; the positive and negative predictive values were 91.2% and 63.9%, respectively. One limitation of this study is all the conclusion reported was based on small sample size. CONCLUSIONS Herein, we described the negative correlation between BFP and serum AMH levels for the first time, and the present results highlight the importance of further investigation into the role of BFP, especially in body fat-related AMH change as it relates to the underlying pathogenesis of PCOS.
Collapse
|
18
|
Benito E, Gómez-Martin JM, Vega-Piñero B, Priego P, Galindo J, Escobar-Morreale HF, Botella-Carretero JI. Fertility and Pregnancy Outcomes in Women with Polycystic Ovary Syndrome Following Bariatric Surgery. J Clin Endocrinol Metab 2020; 105:5868099. [PMID: 32754732 DOI: 10.1210/clinem/dgaa439] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/02/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT Restoration of ovulation is quite common in women with polycystic ovary syndrome (PCOS) after surgically induced weight loss. Whether or not this results in an improvement of PCOS-associated infertility is uncertain. OBJECTIVE To study fertility and gestational outcomes in women with PCOS after bariatric surgery. DESIGN Unicenter cohort study. SETTING Academic hospital. PATIENTS Two hundred and sixteen premenopausal women were screened for PCOS before bariatric surgery. Women were followed-up after the intervention until mid-2019 regardless of having or not PCOS. INTERVENTIONS All participants underwent bariatric surgery from 2005 to 2015. MAIN OUTCOME MEASURES Pregnancy and live birth rates in the PCOS and control groups. RESULTS In women seeking fertility, pregnancy rates were 95.2% in PCOS and 76.9% in controls (P = 0.096) and live birth rates were 81.0% and 69.2%, respectively (P = 0.403). The time to achieve the first pregnancy after surgery was 34 ± 28 months in women with PCOS and 32 ± 25 months in controls. Albeit the mean birth weight was lower (P = 0.040) in newborns from women with PCOS (2763 ± 618 g) compared with those from controls (3155 ± 586 g), the number of newborns with low birth weight was similar in both groups (3 in the PCOS group and 1 in the controls, P = 0.137). Maternal (17.6% in PCOS and 22.2% in controls, P = 0.843) and neonatal (23.5% in PCOS and 14.8% in controls, P = 0.466) complications were rare, showing no differences between groups. CONCLUSIONS Pregnancy and fertility rates in very obese women with PCOS after bariatric surgery were high, with few maternal and neonatal complications.
Collapse
Affiliation(s)
- Estela Benito
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Jesús M Gómez-Martin
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Belén Vega-Piñero
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Pablo Priego
- Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Julio Galindo
- Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
| | - Héctor F Escobar-Morreale
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) & Instituto Ramón y Cajal de Investigación Sanitaria (IRyCIS), Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
| | - José I Botella-Carretero
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN) & IRyCIS, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
| |
Collapse
|
19
|
Soriano-Maldonado A, Martínez-Forte S, Ferrer-Márquez M, Martínez-Rosales E, Hernández-Martínez A, Carretero-Ruiz A, Villa-González E, Barranco-Ruiz Y, Rodríguez-Pérez MA, Torrente-Sánchez MJ, Carmona-Rodríguez L, Soriano-Maldonado P, Vargas-Hitos JA, Casimiro-Andújar AJ, Artero EG, Fernández-Alonso AM. Physical Exercise following bariatric surgery in women with Morbid obesity: Study protocol clinical trial (SPIRIT compliant). Medicine (Baltimore) 2020; 99:e19427. [PMID: 32195937 PMCID: PMC7220774 DOI: 10.1097/md.0000000000019427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Severe and morbid obesity are increasing globally, particularly in women. As BMI increases, the likelihood of anovulation is higher. The primary aim of the EMOVAR clinical trial is to examine, over the short (16 weeks) and medium (12 months) term, the effects of a supervised physical exercise program (focused primarily on aerobic and resistance training) on ovarian function in women with severe/morbid obesity who have undergone bariatric surgery. Secondary objectives are to examine the effects of the intervention on chronic inflammation, insulin resistance, arterial stiffness, physical fitness, and health-related quality of life. METHODS This is a randomized controlled trial in which ∼40 female bariatric surgery patients, aged between 18 and 45 years old, will be included. Participants assigned to the experimental group will perform a total of 48 sessions of supervised concurrent (strength and aerobic) training (3 sessions/week, 60 min/session) spread over 16 weeks. Patients assigned to the control group will receive lifestyle recommendations. Outcomes will be assessed at baseline, week 16 (i.e., after the exercise intervention) and 12 months after surgery. The primary outcome is ovarian function using the Sex-Hormone Binding Globuline, measured in serum. Secondary outcomes are serum levels of anti-mullerian hormone, TSH, T4, FSH, LH, estradiol, prolactine, and free androgen index, as well as oocyte count, the diameters of both ovaries, endometrial thickness, and uterine arterial pulsatility index (obtained from a transvaginal ultrasound), the duration of menstrual bleeding and menstrual cycle duration (obtained by personal interview) and hirsutism (Ferriman Gallwey Scale). Other secondary outcomes include serum markers of chronic inflammation and insulin resistance (i.e., C-reactive protein, interleukin 6, tumor necrosis factor-alpha, leptin, glomerular sedimentation rate, glucose, insulin and the HOMA-IR), arterial stiffness, systolic, diastolic and mean blood pressure, body composition, and total weight loss. Physical fitness (including cardiorespiratory fitness, muscular strength, and flexibility), health-related quality of life (SF-36 v2) and sexual function (Female Sexual Function Index) will also be measured. DISCUSSION This study will provide, for the first time, relevant information on the effects of exercise training on ovarian function and underlying mechanisms in severe/morbid obese women following bariatric surgery. TRIAL REGISTRATION NUMBER ISRCTN registry (ISRCTN27697878).
Collapse
Affiliation(s)
- Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences; and SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería
| | | | - Manuel Ferrer-Márquez
- Bariatric Surgery Department, Torrecárdenas University Hospital, Almería
- Obesidad Almería, Hospital Mediterráneo, Almería
| | - Elena Martínez-Rosales
- Department of Education, Faculty of Education Sciences; and SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería
| | - Alba Hernández-Martínez
- Department of Education, Faculty of Education Sciences; and SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería
| | - Alejandro Carretero-Ruiz
- Department of Education, Faculty of Education Sciences; and SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería
| | - Emilio Villa-González
- Department of Physical and Sports Education, PROFITH “PROmoting FITness and Health through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Faculty of Education and Sport Sciences, University of Granada, Melilla
| | - Yaira Barranco-Ruiz
- Department of Physical and Sports Education, PROFITH “PROmoting FITness and Health through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Faculty of Education and Sport Sciences, University of Granada, Melilla
| | - Manuel A. Rodríguez-Pérez
- Department of Education, Faculty of Education Sciences; and SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería
| | | | - Lorena Carmona-Rodríguez
- Department of Macromolecular Structures, Proteomics Unit, Centro Nacional de Biotecnología (CNB/CSIC)
| | | | - José A. Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, “Virgen de las Nieves” University Hospital, Granada, Spain
| | - Antonio J. Casimiro-Andújar
- Department of Education, Faculty of Education Sciences; and SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería
| | - Enrique G. Artero
- Department of Education, Faculty of Education Sciences; and SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería
| | | |
Collapse
|
20
|
Xu B, Zhou M, Cheng M, Zhang D, Wu X, Si C, Xia L, Xu H, Li J, Chang HM, Leung PCK, Zhang A. Transvaginal ovarian drilling followed by controlled ovarian stimulation from the next day improves ovarian response for the poor responders with polycystic ovary syndrome during IVF treatment: a pilot study. Reprod Biol Endocrinol 2020; 18:7. [PMID: 31980027 PMCID: PMC6982383 DOI: 10.1186/s12958-019-0559-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/24/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Poor response patients with PCOS who are not susceptible to gonadotropin stimulation are more likely to have canceled cycles or poor clinical outcomes during IVF treatment. However, some limitations exist in the present therapies. In this study, we evaluated the effects of using the transvaginal ovarian drilling (TVOD) followed by controlled ovarian stimulation (COS) from the second day of these poor responders. METHODS During IVF, 7 poor responders with PCOS and 28 PCOS patients (14 normal and 14 high responders) were recruited. All patients received COS with the gonadotropin-releasing hormone antagonist protocol. For the poor responders, after undergoing 10 to 14 days of ovulation induction with no response, the TVOD was applied and then ovarian stimulation was performed from the next day at the same gonadotropin dose. Serum samples during COS and follicular fluid samples from the dominant follicles on the oocyte pick-up (OPU) day in all three groups were collected. Besides, follicular fluid from small follicles (diameter < 1 cm) in the normal and high responders on the OPU day and those in the poor responders on the TVOD day were gathered. Hormonal levels were examined in all samples using immunometric assays. RESULTS All the poor responders restored ovary response after receiving TVOD. There was no significant difference in the stimulation duration, total gonadotrophin dose used and the clinical outcomes among the three groups. The body mass index, serum and follicular levels of anti-Müllerian hormone (AMH) and testosterone in poor responders were higher than those in the other two groups, and the application of TVOD significantly decreased the levels of AMH and testosterone in both serum and follicular fluid. CONCLUSIONS TVOD followed by ovulation induction from the next day is effective and convenient for poor responders with PCOS. The decline of AMH and testosterone resulted from TVOD may be the main reason resulting in the recovery of ovary sensitivity to gonadotropins. The small sample size is the primary limitation of this study, future studies using a large population cohort and monitoring the long-term outcomes of this strategy will be required. TRIAL REGISTRATION ChiCTR1900023612. Registered 04 June 2019-Retrospectively registered.
Collapse
Affiliation(s)
- Bufang Xu
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2nd Road, Shanghai, 200025, China.
| | - Mingjuan Zhou
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2nd Road, Shanghai, 200025, China
| | - Meiyu Cheng
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2nd Road, Shanghai, 200025, China
| | - Dan Zhang
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2nd Road, Shanghai, 200025, China
| | - Xian Wu
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2nd Road, Shanghai, 200025, China
| | - Chenchen Si
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2nd Road, Shanghai, 200025, China
| | - Lan Xia
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2nd Road, Shanghai, 200025, China
| | - Huihui Xu
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2nd Road, Shanghai, 200025, China
| | - Jian Li
- Clinical research center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hsun-Ming Chang
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter C K Leung
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aijun Zhang
- Reproductive Medical Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2nd Road, Shanghai, 200025, China.
- Department of Histo-Embryology, Genetics and Developmental Biology, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Reproductive Medicine, 280 South Chongqing Road, Shanghai, 200025, China.
| |
Collapse
|
21
|
Kulkarni SD, Patil AN, Gudi A, Homburg R, Conway GS. Changes in diet composition with urbanization and its effect on the polycystic ovarian syndrome phenotype in a Western Indian population. Fertil Steril 2019; 112:758-63. [DOI: 10.1016/j.fertnstert.2019.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 05/18/2019] [Accepted: 05/20/2019] [Indexed: 11/19/2022]
|
22
|
Dave DM, Clarke KO, Manicone JA, Kopelan AM, Saber AA. Internal hernias in pregnant females with Roux-en-Y gastric bypass: a systematic review. Surg Obes Relat Dis 2019; 15:1633-1640. [PMID: 31378635 DOI: 10.1016/j.soard.2019.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/02/2019] [Accepted: 06/07/2019] [Indexed: 12/27/2022]
Abstract
Improved fertility following a Roux-en-Y gastric bypass (RYGB) can lead to pregnancy and increase the risk of internal herniation. A developing fetus and symptoms of pregnancy can mask the diagnosis and delay intervention, leading to deleterious maternal and fetal consequences. The aim of this systematic review is to summarize the literature regarding internal hernias during pregnancy, their management, and patient outcomes. A comprehensive literature search was undertaken on PubMed and Google Scholar to identify cases of internal hernias presenting during pregnancy after RYGB. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for eligibility and inclusion of articles. Twenty-seven articles, with a total of 59 patients, regarding internal herniation during pregnancy after RYGB were identified. Epigastric pain and nausea and vomiting was the most common presentation. Regardless of orientation of the Roux limb and despite previous closure of mesenteric defects, internal herniation can still occur. A triad of epigastric pain, pregnancy, and a history of RYGB should be a red flag for clinicians to consider internal hernias as a top differential diagnosis. Prompt bariatric consultation and rapid intervention will improve maternal and fetal outcomes.
Collapse
Affiliation(s)
- Devangi M Dave
- Department of Surgery, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, New Jersey; St. George's University School of Medicine, Grenada, West Indies
| | - Kevin O Clarke
- Department of Surgery, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, New Jersey
| | - John A Manicone
- Department of Surgery, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, New Jersey
| | - Adam M Kopelan
- Department of Surgery, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, New Jersey
| | - Alan A Saber
- Department of Surgery, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, New Jersey.
| |
Collapse
|
23
|
Abstract
INTRODUCTION The link between obesity epidemic in fertile age and fertility reduction, in relation with BMI increase, has been demonstrated. An inverse proportionality between BMI and anti-Müller hormone (AMH) has been investigated. This hormone is strictly related to ovarian function. It has been demonstrated that it is significantly decreased in obese women. SCOPE The aim of this study was evaluation of AMH levels in 53 obesity women with BMI >35, at 3 and 6 months after laparoscopic sleeve gastrectomy (LSG). Specific evaluation of comorbidities and of gynecological effects of weight loss was also evaluated. RESULTS Cohort of 53 women was considered, treated with LSG. A progressive increase of AMH levels after LSG was confirmed, with statistically significant results at followup of 6 months. In these patients, we also observed an improvement in the menstrual cycle and resolution of dysmenorrhea. All considered comorbidities were ameliorated at both followup. CONCLUSION LSG determined a significant increase of AMH level in women, at early followup, with a comprehensive amelioration of gynecological status. Larger cohorts and a better evaluation of ovarian function after LSG will lead to more powerful results of the effect of weight loss on women.
Collapse
Affiliation(s)
- Vincenzo Pilone
- a Department of Medicine, Surgery, and Dentistry , University of Salerno , Salerno , Italy
- b General, Bariatric and Emergency Surgical Unit of Fucito Hospital , University Hospital of Salerno , Salerno , Italy
| | - Salvatore Tramontano
- a Department of Medicine, Surgery, and Dentistry , University of Salerno , Salerno , Italy
- b General, Bariatric and Emergency Surgical Unit of Fucito Hospital , University Hospital of Salerno , Salerno , Italy
| | - Michele Renzulli
- a Department of Medicine, Surgery, and Dentistry , University of Salerno , Salerno , Italy
- b General, Bariatric and Emergency Surgical Unit of Fucito Hospital , University Hospital of Salerno , Salerno , Italy
| | - Angela Monda
- a Department of Medicine, Surgery, and Dentistry , University of Salerno , Salerno , Italy
- b General, Bariatric and Emergency Surgical Unit of Fucito Hospital , University Hospital of Salerno , Salerno , Italy
| | - Carmen Cutolo
- a Department of Medicine, Surgery, and Dentistry , University of Salerno , Salerno , Italy
- b General, Bariatric and Emergency Surgical Unit of Fucito Hospital , University Hospital of Salerno , Salerno , Italy
| | - Mafalda Romano
- a Department of Medicine, Surgery, and Dentistry , University of Salerno , Salerno , Italy
- b General, Bariatric and Emergency Surgical Unit of Fucito Hospital , University Hospital of Salerno , Salerno , Italy
| | - Luigi Schiavo
- c Department of Cardio-Thoracic and Respiratory Science , University of Campania "Luigi Vanvitelli ," Naples , Italy
- d IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology , Naples University Polyclinic , Naples , Italy
| |
Collapse
|
24
|
Glueck CJ, Goldenberg N. Characteristics of obesity in polycystic ovary syndrome: Etiology, treatment, and genetics. Metabolism 2019; 92:108-120. [PMID: 30445140 DOI: 10.1016/j.metabol.2018.11.002] [Citation(s) in RCA: 184] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/22/2018] [Accepted: 11/05/2018] [Indexed: 01/01/2023]
Abstract
Polycystic ovary syndrome (PCOS) has multiple etiologies including ovarian and adrenal hyperandrogenism, neuro-endocrine and hypothalamic-pituitary dysfunction, and disorders of peripheral insulin resistance. Obesity is neither necessary nor sufficient for the PCOS phenotype, and the association of PCOS with obesity is not universal, with national, cultural, and ethnic differences. Obesity, particularly visceral adiposity which is common in obese and non-obese women with PCOS, amplifies and worsens all metabolic and reproductive outcomes in PCOS. Obesity increases insulin resistance and compensatory hyperinsulinemia, which in turn increases adipogenesis and decreases lipolysis. Obesity sensitizes thecal cells to LH stimulation and amplifies functional ovarian hyperandrogenism by upregulating ovarian androgen production. Obesity increases inflammatory adipokines which, in turn, increase insulin resistance and adipogenesis. Lifestyle interventions focused on diet-weight loss and concurrent exercise are central to therapy which also commonly subsequently needs to include pharmacologic therapy. PCOS symptoms commonly improve with 5% to 10% weight loss, but 25% to 50% weight loss, usually achievable only through bariatric surgery, may be required for morbid obesity unresponsive to lifestyle-medical treatment. Bariatric surgery is a valuable approach to weight loss in PCOS where BMI is ≥40 kg/m2 when non-surgical treatment and/or induction of pregnancy have failed, and can be an initial treatment when BMI is ≥50 kg/m2. Further research in PCOS is needed to better understand the fundamental basis of the disorder, to ameliorate obesity, to correct hyperandrogenism, ovulation, hyperinsulinemia, and to optimize metabolic homeostasis.
Collapse
Affiliation(s)
- Charles J Glueck
- The Cholesterol, Metabolism, and Thrombosis Research Center, 3906 Middleton Avenue, Cincinnati, OH 45220, United States of America.
| | - Naila Goldenberg
- The Cholesterol, Metabolism, and Thrombosis Research Center, 3906 Middleton Avenue, Cincinnati, OH 45220, United States of America
| |
Collapse
|
25
|
Stringer JM, Swindells EOK, Zerafa N, Liew SH, Hutt KJ. Multidose 5-Fluorouracil is Highly Toxic to Growing Ovarian Follicles in Mice. Toxicol Sci 2018; 166:97-107. [DOI: 10.1093/toxsci/kfy189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jessica M Stringer
- Ovarian Biology Laboratory, Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria 3800, Australia
| | - Elyse O K Swindells
- Ovarian Biology Laboratory, Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria 3800, Australia
| | - Nadeen Zerafa
- Ovarian Biology Laboratory, Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria 3800, Australia
| | - Seng H Liew
- Ovarian Biology Laboratory, Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria 3800, Australia
| | - Karla J Hutt
- Ovarian Biology Laboratory, Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria 3800, Australia
| |
Collapse
|