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Tag: fertility

Bariatric Surgery effects on PCOS

May 17, 2017 11:02 am

Women with Polycystic Ovary Syndrome (PCOS) often feel hopeless and depressed with their diagnosis. Bariatric Surgery improves metabolic syndrome, diabetes resolution, cardiac improvement, quality of life, and increased life expectancy. Bariatric Surgery effects on PCOS are positive in many aspects. However, there isn’t a consensus regarding recommendation for bariatric surgery for PCOS other than morbidly obesity with co-morbities.

PCOS has been shown to effect approximately 10% of women of childbearing age with symptoms of menstrual abnormalities, poly cystic ovaries, and excess androgen (male sex hormone). PCOS should be diagnosed by ensuring there are no other underlying endocrine issues. There are several associated disease processes that seem to be related to PCOS, such as Type 2 Diabetes, higher depression and anxiety, increased cardiovascular risks, stroke, hyperlipidemia, sleep apnea, overall inflammation, and endometrial cancer.

Bariatric surgery can improve several issues related to PCOS such are Type 2 Diabetes, lower weight, sleep apnea, infertility, and hyperlipidemia. Duodenal Switch has the highest rate of Type 2 Diabetes resolution of all weight loss surgeries available at this time.  Duodenal Switch also significantly improves hyperlipidemia.Weight loss surgery has been shown to improve and in some cases resolved PCOS in general. A recent meta-analysis of the effects of bariatric surgery in more than 22,000 procedures found an average weight loss of 61%, associated with the complete resolution or improvement of diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea in more than 60% of the patients. Another study looked just at PCOS patients and their metabolic improvement from 47% of the PCOS population to only 21% post Bariatric Surgery. 

Several recent article have described how Bariatric Surgery effects PCOS with positive aspects related to fertility. The range of improved fertility in post Bariatric PCOS patients is a wide range of 33-100% with in the literature. It is thought that the loss of fat mass improves hormone levels and insulin resistance in PCOS and has a positive effect on fertility. One study of only 6 omen had a 100% improvement of infertility. American Society of Metabolic and Bariatric Surgery as well as the American College of Obstetricians and Gynecologist have a statement that bariatric surgery is should not be considered a treatment for infertility. The graphic below demonstrates the overlap of some of the symptomatology between PCOS, obesity and metabolic syndrome.

There are several documented positive effects and improvement in co-morbidilties related to PCOS post Bariatric Surgery. These include lipid profile, lower weight, cardiovascular risk, hypertension, and fertility. It is important to note that certain bariatric surgeries have better resolution of these co-morbidities or symptoms of PCOS. Always discuss with your physicians and surgeon what your options are and which treatments may work best for you.

In Summary, PCOS is a metabolic disease condition affecting different organ systems.  Weight loss surgery should be considered as a viable treatment option and should be discussed with your OB/GYN and Infertility specialist.

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Vitamin D status for Infertility Treatment

August 03, 2016 8:02 pm

Many people with obesity face infertility issues and seek infertility treatment or procedures. A recent article linked Vitamin D status to improved success rate of IVF (in-vito fertilization) & ICSI (interacytoplasmic sperm injection) in The Journal of Maternal-Fetal & Neonatal Medicine. It is important to check Vitamin D status for infertility treatment.

Here are the researchers results:

  • Of the 252 females that completed the ICSI cycle, 42% became pregnant (n = 108).
  • The mean vitamin D status was significantly higher in the pregnant group compared to the non-pregnant group (17.74 ng/ml vs 9 ng/ml, respectively; p = < 0.01).
  • Vitamin D status was positively associated with both pregnancy (p = 0.001) and endometrial thickness (p < 0.01).
  • Higher vitamin D levels was associated with a 21% increase odds of clinical pregnancy (p < 0.05).
Keshishian IVF

The researchers concluded,

“Deficiency of 25-OHD in females hinders the accomplishment of optimal endometrial thickness required for implantation of embryo after ICSI.”

Following weight loss surgery (WLS) there can be improvement of fertility and for that reason we recommend two forms of birth control methods during the first 18-24 months following WLS or until weight loss has stabilized for several months. This helps to ensure the best outcome and health for the mother and infant.

In our office we continue to stress the importance of Vitamin D3 for bone and dental health, pregnancy, breastfeeding and several auto-immune diseases. Vitamin D has also been shown to reduce pre-term birth Duodenal Switch patients require a dry water miscible form of Vitamin D3 due to the fat malabsorption of the DS procedure. There are several past blog posts on the topic of Vitamin D and it’s associated nutrients.