Bariatric surgery may improve rates for spontaneous ovulation in patients with polycystic ovarian syndrome and obesity
1. Women in the surgical group reported 2.5 times more spontaneous ovulations than in medical therapy.
2. Those assigned to surgery had a higher rate of adverse events, although none led to long-term issues.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility and obesity exacerbates its reproductive complications. Despite this, effective obesity management in women with PCOS remains a challenge. This randomized controlled trial aimed to compare the safety and efficacy of bariatric surgery versus medical care on ovulation rates in women with PCOS, obesity, and oligomenorrhoea or amenorrhea. The primary outcome of this study was the number of biochemically confirmed ovulatory events over 52 weeks, while the key secondary outcome was safety. According to study results, bariatric surgery led to significantly more spontaneous ovulations than medical therapy. Although this study was well done, it was limited by a high dropout rate and more adverse events in the surgical group compared to the medical group.
Click to read the study in The Lancet
Relevant Reading: Randomized Trial of a Lifestyle Program in Obese Infertile Women
In-depth [randomized controlled trial]: Between Feb 20, 2020, and Feb 1, 2021, 100 patients were enrolled from 2 specialist obesity management centers in the UK. Included were patients ≥ 18 years old with a diagnosis of PCOS, BMI ≥ 35 kg/m², and oligomenorrhoea or amenorrhea. Altogether, 63 patients (30 in bariatric surgery [sleeve gastrectomy] and 33 in medical care) were included in the final analysis. The primary outcome of biochemical ovulations was significantly greater in the surgical group compared to medical therapy (6, interquartile range [IQR] 3.5-10.0 vs. 2, IQR 0.0-4.0). The same was true for the number of spontaneous ovulations (incidence rate ratio 2.5, 95% confidence interval 1.5-4.2, p<0.0007). However, patients in the surgical group also reported more adverse events than those in the medical group (66.7% vs. 30.0%). Findings from this study suggest that bariatric surgery is more effective than medical care for inducing spontaneous ovulation in women with PCOS, obesity, and oligomenorrhoea or amenorrhea.
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