Abstract

Context: 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. Design: 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. Setting: The study was conducted at an academic health center. Patients: Twenty-nine obese, reproductive-aged women not using confounding medications participated in the study. Main Outcome Measures: 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.

Original languageEnglish (US)
Pages (from-to)4540-4548
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Volume97
Issue number12
DOIs
StatePublished - Dec 1 2012

Fingerprint

Gastric Bypass
Surgery
Pregnanediol
Hyperandrogenism
Follicular Phase
Bariatric Surgery
Morbid Obesity
Ovulation
Sebum
Hirsutism
Abdominal Fat
Uterine Hemorrhage
Luteal Phase
Acne Vulgaris
Progestins
Fats
Bone Density
Cohort Studies
X-Rays
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

@article{b3d9be9a60d247eeaa25d16fca471f8a,
title = "Effects of gastric bypass surgery on female reproductive function",
abstract = "Context: 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. Design: 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. Setting: The study was conducted at an academic health center. Patients: Twenty-nine obese, reproductive-aged women not using confounding medications participated in the study. Main Outcome Measures: 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.",
author = "Legro, {Richard S.} and Dodson, {William C.} and Gnatuk, {Carol L.} and Estes, {Stephanie J.} and Kunselman, {Allen R.} and Meadows, {Juliana W.} and Kesner, {James S.} and Krieg, {Edward F.} and Rogers, {Ann M.} and Haluck, {Randy S.} and Cooney, {Robert N.}",
year = "2012",
month = "12",
day = "1",
doi = "10.1210/jc.2012-2205",
language = "English (US)",
volume = "97",
pages = "4540--4548",
journal = "Journal of Clinical Endocrinology and Metabolism",
issn = "0021-972X",
publisher = "The Endocrine Society",
number = "12",

}

Effects of gastric bypass surgery on female reproductive function. / Legro, Richard S.; Dodson, William C.; Gnatuk, Carol L.; Estes, Stephanie J.; Kunselman, Allen R.; Meadows, Juliana W.; Kesner, James S.; Krieg, Edward F.; Rogers, Ann M.; Haluck, Randy S.; Cooney, Robert N.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 97, No. 12, 01.12.2012, p. 4540-4548.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effects of gastric bypass surgery on female reproductive function

AU - Legro, Richard S.

AU - Dodson, William C.

AU - Gnatuk, Carol L.

AU - Estes, Stephanie J.

AU - Kunselman, Allen R.

AU - Meadows, Juliana W.

AU - Kesner, James S.

AU - Krieg, Edward F.

AU - Rogers, Ann M.

AU - Haluck, Randy S.

AU - Cooney, Robert N.

PY - 2012/12/1

Y1 - 2012/12/1

N2 - Context: 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. Design: 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. Setting: The study was conducted at an academic health center. Patients: Twenty-nine obese, reproductive-aged women not using confounding medications participated in the study. Main Outcome Measures: 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.

AB - Context: 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. Design: 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. Setting: The study was conducted at an academic health center. Patients: Twenty-nine obese, reproductive-aged women not using confounding medications participated in the study. Main Outcome Measures: 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.

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