The Dynamics of the Hypothalamic-Pituitary-Ovarian Axis, Reproductive Performance and Sexuality Following Bariatric Surgery

Obesity has reached epidemic proportions globally. Multi-system and morbid ramifications of obesity are recognized in both sexes that are at least partly reversible following significant and sustained weight reduction. Bariatric surgery is a relatively recent intervention in the therapeutic armamentarium for the management of morbid obesity and utilization of bariatric surgery as an option for weight loss is escalating. We provide an overview of the effects of morbid obesity on the hypothalamic-pituitary-ovarian (HPO) axis, reproductive and sexual performance. This review focuses on the alterations in reproductive physiology, with specific regard to the alterations in fertility status, efficacy of oral contraception and sexuality following bariatric surgery. Our perusal of the published literature reveals that although non-surgical weight loss in morbidly obese improves fertility, data on reproductive performance after weight loss by bariatric surgery is sparse and somewhat controversial. In the current setting of an increasing utilization of this therapeutic modality in the reproductive age population, this underscores a need for better appreciation of the alterations in physiology following bariatric surgery by well-designed trials. The suboptimal efficacy of oral contraceptives after weight loss by bariatric surgery needs to be further evaluated and in the interim, when prescribing OCP's to patients anticipating undergoing bariatric procedures, counseling should include a discussion on potential contraceptive failure after surgery. Although an improvement in sexual performance and satisfaction may follow dramatic weight reductions, the possibility of a detrimental influence specifically after bariatric surgery remains to be determined by future trials.