Is Bariatric Surgery a “Cure” for PCOS
Women with Polycystic Ovary Syndrome (PCOS) often wonder if they should have bariatric surgery to cure their PCOS and improve their fertility? Recent research on weight loss surgery provided some answers.
What is PCOS?
PCOS is an endocrine system disorder affecting about 10% of woman worldwide with a wide variety of symptoms, including:
- Enlarged ovaries with small collections of cysts that can be seen during an ultrasound exam
- Infrequent or prolonged menstrual periods
- Hirsutism (excess male pattern hair growth)
- Insulin and glucose abnormalities
The role of weight in PCOS is a bit of a chicken and egg situation. Does obesity cause PCOS or is it a symptom of PCOS. Keep in mind that some women with PCOS are not overweight.
The exact cause of Polycystic Ovary Syndrome is unknown, but we do know that weight loss, even a relatively modest loss, likely will reduce the symptoms and the risk of long-term complications, such as diabetes and heart disease.
PCOS and Bariatric Surgery- Latest Research
Is bariatric surgery a cure for PCOS? PCOS does not have a “cure” yet, but weight loss, including weight loss as the result of bariatric surgery, has been shown to improve the symptoms.
A longitudinal study reported at ASRM in Oct. 2016 followed 33 women with PCOS from 2009 through 2015 after bariatric surgery at the Cleveland Clinic . Researchers found that the women’s post-operative weight and BMI had reduced dramatically. After surgery, ovarian volume declined and total testosterone, free testosterone and DHEAS decreased.
A retrospective survey of several earlier studies of women with PCOS found that after bariatric surgery most women regained normal menstrual function and began ovulating normally. Patients also showed significant improvement in abnormal hair growth and androgen profiles.
In another study of 24 women with PCOS who underwent bariatric surgery, all resumed normal menstrual cycles, and half had resolution of their hirsutism. Their metabolic dysfunction also almost completely resolved. Interestingly, within a short time frame, 5 women became pregnant spontaneously after surgery.
Does Bariatric Surgery Improve Pregnancy Rates
The research on bariatric surgery improving pregnancy rates both without fertility treatment and with fertility treatment is promising. Studies have shown a higher conception rate and lower miscarriage rate following surgery.
In one of the largest data sets, a retrospective study found that in 110 obese patients with infertility prior to bariatric surgery, 69 became pregnant following bariatric surgery. A BMI drop greater than 5 kg/m2 was a significant predictor of fertility within 2.5 years of follow up after surgery. The type of bariatric procedure did not impact fertility. A small case series describes successful in vitro fertilization outcomes in women who underwent previous surgery. It reported no treatment complications and high pregnancy rates. There was also a trend to a reduced need for fertility treatment in women attempting pregnancy within 3 years of bariatric surgery compared to their need for fertility treatment prior to surgery and reports show previously anovulatory women conceiving post-operatively without ovulation induction agents and with in vitro fertilization.
Risks of Bariatric Surgery
Bariatric surgery, as with any major surgery, poses potential health risks, both in the short term and long term. According to the Mayo Clinic, risks associated with bariatric surgery can include:
- Excessive bleeding
- Adverse reactions to anesthesia
- Blood clots
- Lung or breathing problems
- Leaks in your gastrointestinal system
- Death (rare)
Longer term risks and complications of weight-loss surgery vary depending on the type of surgery. They can include:
- Bowel obstruction
- Dumping syndrome, causing diarrhea, nausea or vomiting
- Low blood sugar (hypoglycemia)
- Stomach perforation
- Death (rare)
Is Bariatric Surgery a Cure for Infertility from PCOS
Several years ago, researchers concluded:
At the current time and with current surgical risks, bariatric surgery should not be considered a “fertility treatment” for ovulation induction. However, pregnancy risks in woman with MS are high. These women face difficulty in managing diabetes, pre-eclampsia, growth disorders, higher rates of cesarean delivery, higher maternal mortality and increase their children’s risks for metabolic disease in the future.
Only a woman and her doctor can decide if bariatric surgery is warranted as a treatment for PCOS. Keep in mind that from an infertility perspective, even a modest weight loss is enough to improve fertility.
Have you ever considered bariatric surgery? Why?
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