The impact of laparoscopic sleeve gastrectomy on ovarian reserve markers in obese female patients of reproductive age

BACKGROUND. Obesity is associated with a decrease in ovarian reserve in women of reproductive age, which contributes to the development of infertility. It is assumed that weight loss may improve female fertility. Bariatric surgery is the most effective treatment for morbid obesity; however, data on its impact on ovarian reserve parameters remain limited and conflicting. AIM. To evaluate the impact of laparoscopic sleeve gastrectomy (LSG) on ovarian reserve markers in women of reproductive age with obesity.

MATERIALS AND METHODS. Women aged 18 to 40 years underwent anthropometric assessments, evaluation of carbohydrate metabolism, and indirect ovarian reserve parameters (plasma anti-Müllerian hormone [AMH] and antral follicle count [AFC]) at baseline and 12 months after LSG. According to the level of AMH after LSG, patients were divided into two groups: Group 1 — women with AMH <1.1 ng/mL, indicating a decrease in ovarian reserve (n=19), Group 2 — those with AMH ≥1.1 ng/mL (n=30).

RESULTS. The study included 49 women with a median age of 31.0 [29.0–33.0] years. 12 months after LSG, all participants achieved weight loss and improved carbohydrate metabolism parameters. Initially, the AMH in all women were ≥1.1 ng/mL, which indirectly indicates a preserved ovarian reserve. Plasma AMH levels increased from 2.2 [1.5–3.0] ng/ml to 2.5 [0.9–3.0] ng/ml after LSG, but this change was not statistically significant. Both groups, stratified by postoperative AMH dynamics, were comparable in age. Group 1 (demonstrating postoperative AMH reduction) exhibited significantly higher body mass index (BMI) and HOMA-IR values both pre- and postoperatively, along with a more prolonged history of obesity. These patients also presented with lower baseline AMH and AFC values, with all patients (100%) reporting maternal history of early or premature menopause.

Correlation analysis revealed an inverse relationship between postoperative AMH and baseline BMI, BMI dynamics after breast cancer, HOMA-IR index before and after surgery, as well as with the duration of obesity. At the same time, a direct correlation was found between postoperative AMH and preoperative AMH levels, as well as with AFC before and after the intervention. Correlation analysis demonstrated significant inverse associations between postoperative AMH levels and: preoperative BMI, postoperative BMI reduction, preoperative and postoperative HOMA-IR indices, and duration of obesity. Conversely, we observed positive correlations between postoperative AMH and both preoperative AMH levels and AFC measurements obtained before and after the surgical intervention.

CONCLUSION. The impact of LSG on ovarian reserve in reproductive-age women remains insufficiently studied. The observed decline in ovarian reserve markers in some patients highlights the need for further research to optimize personalized treatment strategies for obese women of childbearing age.

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