One-year impact of bariatric surgery on serum anti-Mullerian-hormone levels in severely obese women

Vincentelli, Clara; Maraninchi, Marie; Valéro, René; Béliard, Sophie; Maurice, F.; Emungania, Olivier; Berthet, B.; Lombard, Elise; Dutour, Anne; Gaborit, Bénédicte; Courbière, Blandine

doi:10.1007/s10815-018-1196-3

Cited by 19 publications

(18 citation statements)

References 48 publications

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“…Importantly, the reported AMH decrease was not associated with subfertility in post-bariatric women. The post-bariatric decrease in AMH could be linked with malnutrition, however, no relationship between AMH and nutritional deficiencies was found ( Vincentelli et al , 2018 ). The AMH decrease could reflect a decreased ovarian reserve, although it is unknown how bariatric surgery should affect the ovarian follicle pool.…”

Section: Discussionmentioning

confidence: 99%

The effects of bariatric surgery on periconception maternal health: a systematic review and meta-analysis

Snoek

Steegers‐Theunissen

Hazebroek

et al. 2021

Human Reproduction Update

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BACKGROUND Worldwide, the prevalence of obesity in women of reproductive age is increasing. Bariatric surgery is currently viewed as the most effective, long-term solution for this problem. Preconception bariatric surgery can reduce the prevalence of obesity-related subfertility and adverse maternal, pregnancy and birth outcomes. Maternal health during the periconception period is crucial for optimal gametogenesis and for embryonic and fetal development which also affects health in the later lives of both mother and offspring. Although preconception bariatric surgery improves several pregnancy outcomes, it can also increase the prevalence of pregnancy complications due to excessive and rapid weight loss. This can lead to iatrogenic malnutrition with vitamin deficiencies and derangements in metabolic and endocrine homeostasis. Thus, bariatric surgery can greatly influence periconception maternal health with consequences for reproduction, pregnancy and health in later life. However, its influence on periconception maternal health itself has never been reviewed systematically. OBJECTIVE AND RATIONALE The aim of this review was to investigate associations between bariatric surgery and determinants of periconception maternal health such as endocrine changes, fertility, vitamin status, irregular menstrual cycles, miscarriages and congenital malformations. SEARCH METHODS Medline, Embase, PubMed, Web of Science, Google Scholar and the Cochrane databases were used for the literature search until 1 November 2020. The search strategy terms included, among others, bariatric surgery, hormones, fertility, malformations, miscarriages and vitamin status. We searched for human studies that were written in English. Abstracts, reviews, meta-analyses and conference papers were excluded. The ErasmusAGE score was used to assess the quality of the included studies. OUTCOMES A total of 51 articles were analysed. The mean quality score was 5 (range 2–8). After bariatric surgery, hormonal axes normalized and menstrual cycle regularity was restored, resulting in increased fertility. Overall, there were no short-term risks for reproductive outcomes such as the increased risk of miscarriages or congenital malformations. However, the risk of vitamin deficiencies was generally increased after bariatric surgery. A meta-analysis of 20 studies showed a significant decrease in infertility (risk difference (RD) −0.24, 95% confidence interval (CI) −0.42, −0.05) and menstrual cycle irregularities (RD −0.24, 95% CI −0.34, −0.15) with no difference in rates of miscarriage (RD 0.00, 95% CI −0.09, 0.10) and congenital malformations (RD 0.01, 95% CI −0.02, 0.03). WIDER IMPLICATIONS The current systematic review and meta-analysis show associations between bariatric surgery and periconception maternal health and underlines the need for providing and personalizing preconception care for women after bariatric surgery. We recommend preconception care including the recommendation of postponing pregnancy until weight loss has stabilized, irrespective of the surgery-to-pregnancy interval, and until vitamin status is normalized. Therefore, regular monitoring of vitamin status and vitamin supplementation to restore deficiencies is recommended. Furthermore, this systematic review emphasizes the need for a long-term follow-up research of these women from the periconception period onwards as well as their pregnancies and offspring, to further improve care and outcomes of these mothers and children.

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Section: Discussionmentioning

confidence: 99%

The effects of bariatric surgery on periconception maternal health: a systematic review and meta-analysis

Snoek

Steegers‐Theunissen

Hazebroek

et al. 2021

Human Reproduction Update

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“…Obesity has a significant impact on reproductive health, as excess body weight is the main cause for ovulatory infertility 30 . Recent studies have shown serum AMH level was increasingly being recognized as the most important biomarker for ovarian reserve and was used to counsel patients regarding in their reproductive outcomes 6,9,31 . Although the relationship of AMH and obesity has been described before, findings of these studies are controversial.…”

Section: Pcos Shares Many Similarities With Ms In Clinical Features and Pathophysiologymentioning

confidence: 99%

“…It plays a mediator role particularly in the development of primordial follicles and the selection of follicles 7 . Since serum AMH levels are proportional to the number of developing follicles in the ovaries and it differs only slightly during the menstrual cycle, serum concentration of AMH in females may represent both the quality and quantity of the ovarian follicle pool 8,9 . The large amount of data has showed that AMH levels are generally much higher in women with PCOS than in normal women.…”

Section: Introductionmentioning

confidence: 99%

Anti-Müllerian hormone was independently associated with central obesity but not with general obesity in women with PCOS

Zeng

Huang

Zhang

et al. 2022

Endocrine Connections

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Objective: Anti-Müllerian hormone (AMH) is recognized as the most important biomarker for ovarian reserve. In this cross-sectional study, we aimed to explore the potential association of AMH with central obesity or general obesity in women with polycystic ovary syndrome (PCOS). Methods: In this cross-sectional study, 179 patients with PCOS were enrolled and underwent anthropometric measurements (BMI and waist circumference (WC)) and serum AMH level detection. Pearson's correlation and multivariable logistic regression analyses were performed to determine associations of AMH with central obesity and general obesity. Results: Subjects with the increasing of body mass index (BMI) showed significantly lower values of AMH (median (IQR) 8.95 (6.03-13.60) ng/mL in normal weight group, 6.57 (4.18-8.77) ng/mL in overweight group, and 6.03 (4.34-9.44) ng/mL in obesity group, respectively, p=0.001), but higher levels of systolic blood pressure, fasting insulin, total cholesterol, triglycerides, low-density lipoprotein cholesterol, and obesity indices (WC, hip circumferences, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and Chinese visceral adiposity index (CVAI)) respectively. Compared with the group of PCOS women without central obesity, the group with central obesity had significantly lower value of AMH (median (IQR) 8.56(5.29-12.96) vs. 6.22(4.33-8.82) ng/mL; p=0.003). Pearson’s correlation analysis showed that AMH were significantly and negatively correlated with BMI (r=-0.280; p<0.001), WC (r=-0.263; p<0.001), WHtR (r=-0.273; p<0.001), and CVAI (r=-0.211; p=0.006) respectively. Multivariate logistic regression analysis with adjustment for potential confounding factors showed that AMH was independently and negatively associated with central obesity, but was not significantly associated with general obesity. Conclusions: AMH was independently and negatively associated with central obesity. Closely monitoring WC and AMH should be addressed in terms of assessing ovarian reserve in women with PCOS.

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“…AMH levels were measured before and 6 and 12 months after surgery. A strong decrease in AMH values was detected 12 months after surgery without a relation with loss in weight and the authors of the study postulated a negative influence of surgery on the ovarian reserve [ 35 ]. They hypothesized that postoperative stress of growth follicles in ovaries may be the reason for the reduction in AMH values, indicating the need for prolonged observational studies in order to clarify observed changes.…”

Section: Bariatric Surgery and Obesitymentioning

confidence: 99%

Reproductive outcomes after bariatric surgery in women

Micić

Toplak

Mićić

et al. 2021

Wien Klin Wochenschr

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SummaryThe presence of obesity may significantly influence female fertility through various mechanisms. Impairment of the hypothalamic-pituitary-ovarian axis in obese women may induce anovulation and infertility. Obesity may have an effect on women’s spontaneous and assisted conception rates, increased miscarriage rates, premature labor, stillbirth and perinatal risks, and menstrual irregularity. It has been suggested that weight loss improves reproductive outcomes due to fertility amelioration and an improvement in menstrual irregularity and ovulation. It is still not known which weight reduction procedures (changes in lifestyle, pharmacological management or bariatric intervention) result in optimal outcome on infertility. Currently, bariatric surgery is defined as the best available method for the management of obesity and its associated diseases.We have analyzed literature facts about effects of bariatric surgery on the function of the hypothalamic-pituitary-ovarian axis, polycystic ovary syndrome (PCOS), anti-Mullerian hormone (AMH) and sexual dysfunction in obesity and pregnancy in obesity. Immediate positive effects of bariatric surgery are evident at the moment, while for long-term outcomes more prolonged follow-up investigations should be done.

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One-year impact of bariatric surgery on serum anti-Mullerian-hormone levels in severely obese women

Abstract: This pilot study shows a drastic reduction in AMH levels at 1 year after BS in reproductive-age severely obese women, which was not related to weight loss: this suggests a negative impact of BS on ovarian reserve, at least in the short term.

Cited by 19 publications

References 48 publications

The effects of bariatric surgery on periconception maternal health: a systematic review and meta-analysis

The effects of bariatric surgery on periconception maternal health: a systematic review and meta-analysis

Anti-Müllerian hormone was independently associated with central obesity but not with general obesity in women with PCOS

Reproductive outcomes after bariatric surgery in women

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