Influence of sleeve gastrectomy on menstrual function and ovarian reserve in patients with obesity

BACKGROUND: Obesity is associated with development of menstrual disorders (MD), a decrease in ovarian reserve and infertility. Treatment of obesity contributes to the normalization of the reproductive function of women. Bariatric surgery is known to be the most effective method of obesity treatment, while the most common intervention is the sleeve gastrectomy (SG), the effect of which on menstrual function and ovarian reserve has not been studied enough.

AIM: To study the effect of SG on menstrual function and ovarian reserve in obese women of reproductive age

MATERIALS AND METHODS: Female patients with BMI ≥ 35 kg/m2 aged 25 to 36 years were examined. At baseline and 6 months after SG, the characteristics of menstrual function were determined, BMI and HOMA-IR were calculated, and the level of anti-Müllerian hormone (AMH) was measured. The obtained parameters were compared in patients with and without MD

RESULTS: . In all patients, 6 months after SG, there was a decrease in BMI: 30.1 kg/m2 (29.3–32.1) and 39.3 kg/m2 (37.3–41.0) (p<0.001), HOMA -IR: 5.0 (4.1–5.9) and 2.8 (2.1–3.2) (p=0.001). The initial level of AMH in patients with MD (n=12) was lower than in patients with normal menstrual function (n=10): 2.4 ng/ml (1.9–2.0) and 3.2 ng/ml (2.6–4.2), respectively (p=0.032). A significant increase in AMH levels occurred only in the group of patients with MD (p=0.04). MD remained only in 3 women.

CONCLUSION: SG in patients of reproductive age with obesity is associated with the normalization of menstrual function and an increase in AMH, as well as a decrease in the degree of insulin resistance.

1. World health statistics 2022: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO. URL: http://apps.who.int/iris.

2. World Obesity Federation. Obesity: missing the 2025 global targets. Trends, Costs and Country Reports. March 2020. URL: https://www.worldobesity.org/news/world-obesity-day-all-countries-significantly-off-track-to-meet-2025-who-targets-on-obesity].

3. Spradley FT. Metabolic abnormalities and obesity’s impact on the risk for developing preeclampsia. Am J Physiol Regul Integr Comp Physiol. 2017; 312(1):R5–12. https://doi.org/10.1152/ajpregu.00440.

4. Venkatesh S.S., Ferreira T., Benonisdottir S., et al. Obesity and risk of female reproductive conditions: A Mendelian randomisation study. PLoS Med. 2022 Feb 1;19(2):e1003679. doi: 10.1371/journal.pmed.1003679

5. Dixon SC, Nagle CM, Thrift AP, et al. Adult body mass index and risk of ovarian cancer by subtype: a Mendelian randomization study. Int J Epidemiol. 2016; 45(3):884–95. https://doi.org/10.1093/ije/dyw158

6. Volkova N.I., Degtyareva Yu.S. Mechanisms of fertility disorders in women with obesity // Medical Bulletin of the South of Russia. 2020. 11 (3). С.15-19

7. Chaika V.K., Lutsik V.V., Popova M.V. Anti-Müllerian hormone as an indicator of various gynecological diseases (literature review) // Medico-social problems of the family. 2018; 23 (2). С.

8. Grigoryan O.R., Mikheev R.K., Andreeva E.N., Dedov I.I. Ovarian reserve in obese women // Obesity and metabolism. 2019;16(3). С. 69-75. https://doi.org/10.14341/omet9862

9. Sim K., Dezarnaulds G., Denyer G. et al. Weight loss improves reproductive outcomes in obese women undergoing fertility treatment: a randomized controlled trial. // Clin Obes. – 2014. – V.4(2). – P.61-68. https://doi.org/10.1111/ cob.12048

10. Silvestris E., de Pergola G., Rosania R., et al. Obesity as disruptor of the female fertility. // Reproductive Biology and Endocrinology. – 2018. – V. 16(1). – P.22. https://doi.org/10.1186/ s12958-018-0336-z

11. Seventh IFSO Global Registry Report 2022 / The International Federation for the Surgery of Obesity and Metabolic Disorder. URL: https://www.ifso.com/ifso-registry.php].

12. Khatsiev B.B., Kuzminov A.N., Dzhanibekova M.A., Uzdenov N.A. Technique for performing laparoscopic longitudinal resection of the stomach in morbid obesity // Endoscopic surgery. 2018;24(1):38-41].

13. Lv B, Xing C, He B. Effects of bariatric surgery on the menstruation- and reproductive-related hormones of women with obesity without polycystic ovary syndrome: a systematic review and meta-analysis. Surg Obes Relat Dis. 2022 Jan;18(1):148-160. doi: 10.1016/j.soard.2021.09.008. Epub 2021 Sep 10. PMID: 34756568. URL: https://pubmed.ncbi.nlm.nih.gov/34756568/

14. Teitelman M., Grotegut C., Williams N., Lewis J. The Im- pact of Bariatric Surgery on Menstrual Patterns. // Obes Surg. – 2006. – V.16(11). – P.1457-1463. https://doi. org/10.1381/096089206778870148.

15. Pilone V, Tramontano S, Renzulli M, Monda A, Cutolo C, Romano M, Schiavo L. Evaluation of anti-Müller hormone AMH levels in obese women after sleeve gastrectomy. Gynecol Endocrinol. 2019 Jun;35(6):548-551. doi: 10.1080/09513590.2018.1559285. Epub 2019 Jan 22. PMID: 30668195