High Pregnancy and Live Birth Rates After Bariatric Surgery in PCOS Patients

By Lisa Rappaport

August 11, 2020

(Reuters Health) - Women with polycystic ovary syndrome (PCOS) often struggle to conceive, but a new study links weight loss following bariatric surgery in very obese PCOS patients to high rates of pregnancy and live births.

For the study, researchers examined data on 49 women with PCOS and 120 women without the condition who underwent bariatric surgery between 2005 and 2016 were followed through 2019.

Among women in the study who tried to conceive, pregnancy rates were similar for the group with and without PCOS (95.2% and 76.9%, respectively, p=0.096) and so were live birth rates (81% and 69.2%, respectively, p=0.403).

"Fertility and chance for conception, often unassisted, is high after bariatric surgery, but that doesn't mean a full term normal weight baby for women with PCOS," said Dr. Richard Legro, chair of obstetrics and gynecology at Penn State College of Medicine and Penn State Health in Hershey, Pennsylvania.

"The pregnancy is still high risk," Dr. Legro, who wasn't involved in the study, said by email.

Women with and without PCOS had a similar mean age before surgery (32.1 and 32.4 years, respectively), and they also had similar BMI pre-surgery (44.6 and 45.5, respectively) and post-surgery (28.5 and 29.3, respectively).

Among women with PCOS, free testosterone levels "normalized" following weight loss, the authors note in Journal of Clinical Endocrinology & Metabolism.

For women trying to conceive, there was no significant difference between women with and without PCOS in time needed to achieve first pregnancy (34 months v 32 months, respectively). There was also no difference in the mean weeks of gestation for live births, the number of preterm deliveries, or the number of maternal complications.

Mean birth weight, however, was lower for women with PCOS than for other women (2,763 grams v 3,155 grams, respectively, p=0.040).

Beyond its small size, the study is limited by the fact that women were not randomized to different types of bariatric surgery, so it's not clear whether one type of procedure might be better or worse for fertility and pregnancy outcomes, the study team writes. Senior study author Dr. Jose Botella-Carretero of the Ramon Y Cajal University Hospital in Madrid did not respond to emails seeking comment.

Another limitation is that women with PCOS who were eligible for bariatric surgery were not randomized to proceed with these operations, said Dr. Legro.

"The best control group for this study are women with PCOS and obesity who would have qualified for bariatric surgery in terms of weight but chose to pursue fertility without weight loss," Dr. Legro said.

It's also possible that the study was too small to detect statistically meaningful differences between women with and without PCOS for certain pregnancy outcomes, Dr. Legro said.

"There are strong data that obese women who conceive and deliver after bariatric surgery are more likely to have spontaneous preterm delivery and smaller babies than obese women who conceive and deliver without surgery," Dr. Legro added.

SOURCE: https://bit.ly/3kuNLdh Journal of Clinical Endocrinology & Metabolism, online July 7, 2020.