Clara Vincentelli1,2,3, Marie Maraninchi4, René Valéro5,6,4, Sophie Béliard5,6,4, Flavia Maurice5,6,4, Olivier Emungania6,7, Bruno Berthet6,8, Elise Lombard9,10, Anne Dutour5,6,4, Bénédicte Gaborit5,6,4, Blandine Courbiere11,12. 1. Pole ENDO, La Conception Hospital, APHM, Aix-Marseille University, Marseille, France. clara.vincentelli@ap-hm.fr. 2. Centre Spécialisé de l'Obésité (CSO) PACA Ouest, Marseille, France. clara.vincentelli@ap-hm.fr. 3. Aix-Marseille University, INSERM, INRA, C2VN, Marseille, France. clara.vincentelli@ap-hm.fr. 4. Aix-Marseille University, INSERM, INRA, C2VN, Marseille, France. 5. Pole ENDO, La Conception Hospital, APHM, Aix-Marseille University, Marseille, France. 6. Centre Spécialisé de l'Obésité (CSO) PACA Ouest, Marseille, France. 7. Digestive Surgery Department, Nord Hospital, APHM, Aix-Marseille University, Marseille, France. 8. Digestive Surgery Department, La Conception Hospital, APHM, Aix-Marseille University, Marseille, France. 9. Aix Marseille University, INSERM, GMGF, AP-HM, Marseille, France. 10. Laboratory of Biochemistry, AP-HM La Conception Hospital, Marseille, France. 11. Department of Gynaecology, Obstetric and Reproduction, La Conception Hospital, AP-HM, Marseille, France. 12. Aix Marseille University, CNRS, IRD, Avignon University, IMBE UMR 7263, Marseille, France.
Abstract
INTRODUCTION: Although bariatric surgery seems to increase spontaneous fertility by improving ovulatory function in young women, its impact on ovarian reserve remains largely unknown. OBJECTIVE: To evaluate changes in serum anti-Mullerian hormone (AMH) levels in reproductive-age severely obese women after bariatric surgery (BS). METHODS: AMH levels were measured retrospectively in 39 women (mean age 34.6 ± 1.1 years, range 18-45) that underwent a sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) at baseline, and 6 and 12 months after BS. Metabolic and micronutrient status, including fasting plasma insulin and glucose, HOMA-IR, leptin, adiponectin, calcium, albumin, transthyretin, ferritin, vitamins (B9, B12, B1, A, E, D), zinc, and selenium, were assessed in all patients before and 1 year after BS. RESULTS: Of the patients, 79% had class-3 obesity. At 6 and 12 months, mean total weight losses (TWL) were 26 and 30%; mean excess weight losses (EWL) were 61.7 and 70.2%. Compared to baseline, AMH levels significantly decreased by 18% at 6 months, and 32% at 12 months post-operatively (p = 0.010 and p = 0.001, respectively). There was no correlation between AMH variation and changes in metabolic parameters or micronutrient levels. Remarkably, changes in AMH levels did not differ between sleeve and RYGB patients and were not correlated with EWL. CONCLUSION: 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.
INTRODUCTION: Although bariatric surgery seems to increase spontaneous fertility by improving ovulatory function in young women, its impact on ovarian reserve remains largely unknown. OBJECTIVE: To evaluate changes in serum anti-Mullerian hormone (AMH) levels in reproductive-age severely obesewomen after bariatric surgery (BS). METHODS:AMH levels were measured retrospectively in 39 women (mean age 34.6 ± 1.1 years, range 18-45) that underwent a sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) at baseline, and 6 and 12 months after BS. Metabolic and micronutrient status, including fasting plasma insulin and glucose, HOMA-IR, leptin, adiponectin, calcium, albumin, transthyretin, ferritin, vitamins (B9, B12, B1, A, E, D), zinc, and selenium, were assessed in all patients before and 1 year after BS. RESULTS: Of the patients, 79% had class-3 obesity. At 6 and 12 months, mean total weight losses (TWL) were 26 and 30%; mean excess weight losses (EWL) were 61.7 and 70.2%. Compared to baseline, AMH levels significantly decreased by 18% at 6 months, and 32% at 12 months post-operatively (p = 0.010 and p = 0.001, respectively). There was no correlation between AMH variation and changes in metabolic parameters or micronutrient levels. Remarkably, changes in AMH levels did not differ between sleeve and RYGB patients and were not correlated with EWL. CONCLUSION: This pilot study shows a drastic reduction in AMH levels at 1 year after BS in reproductive-age severely obesewomen, which was not related to weight loss: this suggests a negative impact of BS on ovarian reserve, at least in the short term.
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