Impact of bariatric surgery on female reproduction

Objective: To evaluate the current literature on the impact and potential mechanisms of surgical weight loss on female reproduction, with a focus on changes in reproductive hormone profile, fertility status, measures of ovarian reserve, efficacy of oral contraception, sexuality, and pregnancy. Design: Appraisal of articles relevant to surgical weight loss and female reproduction. Result(s): The altered reproductive hormone profile associated with morbid obesity seems to reverse, either partially or totally, after surgical weight loss. Although bariatric surgery seems to improve fertility status and many of the complications associated with obesity in pregnancy, it may be linked to oral contraceptive failure. Although mullerian-inhibiting substance is a direct measure of ovarian reserve, its level changes with obesity and after surgical weight loss. There is a decrease or no change in the risk of miscarriage after bariatric surgery. An improvement in sexual function may follow dramatic surgical weight reduction; however, the possibility of a detrimental influence afterward can occur. Conclusion(s): The increasing popularity of bariatric surgery in reproductive-age women calls for greater clinician awareness of its impact on female reproduction. (Fertil Steril (R) 2009;92:1501-8. (C) 2009 by American Society for Reproductive Medicine.)