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Médecine de la Reproduction

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Impact of bariatric surgery in women with polycystic ovarian syndrome Volume 23, issue 3, Juillet-Août-Septembre 2021

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Authors
1 Centre d’assistance médicale à la procréation, clinique Mathilde, Rouen, France
2 Centre de chirurgie de l’obésité, service de chirurgie digestive, clinique Mathilde, Rouen, France
* Tirés à part

Polycystic ovarian syndrome (PCOS), the most common endocrine disorder in women, is worsened by obesity; lifestyle modifications, the first line therapy, is however insufficient in severely obese women. Bariatric surgery is an effective weight loss treatment proposed to women with a Body mass index (BMI) greater than 40 kg/m2 but neither PCOS nor infertility are considered as comorbidities justifying to lower this threshold to 35 kg/m2. PCOS incidence after bariatric surgery decreases from 45.6% to 6.8%, as well as menstrual disorders (56.2% irregular cycles before surgery vs 7.1% after). Androgens levels are significantly reduced and SHBG increases, leading to a subsequent decrease in testosterone levels. All studies show an improvement in hirsutism symptoms and metabolic troubles resolve one year after the surgery for almost all patients. 22 % of PCOS patients become pregnant spontaneously after bariatric procedure. In In Vitro Fertilization, the cumulative live birth rates after bariatric surgery are comparable to those of patients without any history of surgery, and higher than those of obese patients (respectively 22.9%, 25.9% and 12 %). The BMI appears to be an independent predictive factor of live birth: 1-unit lower BMI increases chances of live birth by 9%. The dramatic weight loss induced by bariatric surgery reduces obstetrical and neonatal risks in obese women; however, pregnancies after bariatric surgery are at risk of low birth weight and micronutrients deficiencies. It is thus recommended to delay the pregnancy by 12 months after the surgical procedure and a multidisciplinary care is needed during these pregnancies.