BARIATRIC SURGERY INFLUENCES THE OUTCOMES OF WOMEN UNDERGOING ASSISTED REPRODUCTIVE TECHNOLOGIES

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 561-585-Ovarian & Uterine Function II
Basic/Clinical
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-577
Juliana Christofolini1, Gustavo Bruno Nascimento1, Bianca Bianco2, Denise Christofolini*1 and Caio Parente Barbosa1
1Faculdade de Medicina do ABC, Santo Andre, Brazil, 2Faculdade de Medicina do ABC, Sao Paulo, Brazil
Introduction: The increasing prevalence of obesity worldwide is alarming and has a potential impact on reproduction. Bariatric surgery has been shown as an effective strategy for weight loss in a short period of time; however, the effects of this surgery on fertility are poorly understood.

Objectives: To observe if there are differences in follicle stimulation, oocyte, recovery, maturation and fertilization among patients who performed bariatric surgery, obese patients and eutrophic patients undergoing to assisted reproductive technologies (ART).

Material and methods: We evaluated 2852 charts of patients undergoing ART and selected, according to inclusion criteria, 29 patients that underwent bariatric surgery (GI), 57 obese patients (GII) and 94 eutrophic patients (GIII), paired by age and submitted to ART.

Results: The medium distribution of BMI observed among the three groups was: GI BMI=26.6; GII BMI=32.8; GIII BMI= 23.5. Considering the data about oocytes obtained for these three different groups we observed a decreased number of follicles on ultrasound (p=0.0063), oocytes retrieved (p=0.0130) and metaphase II follicles (p=0.0006) in patients of GI when compared to controls and when compared to obese patients of Group II. No differences were observed for metaphase I, prophase I, degenerated/abnormal or inseminated oocytes. The median time between surgery and infertility treatment was 4.81 years (0.4–10) and the weight loss till the beginning of infertility treatment was 46.04 kg (23-90).

Discussion: Outcomes of ovarian stimulation in obese women are usually characterized by worse results than in eutrophic women. The cause of this phenomenon is unclear, but recent research suggests that lipotoxicity causes endoplasmic reticulum stress and dysfunction of mitochondrial and apoptotic pathways. Change in insulin adipokines, glucose and free fatty acid levels may also a roll in disrupting oocyte development and maturation. Bariatric surgery is an alternative for these women to lose weight. After surgery studies have demonstrated varied degrees of relative fertility for these women when compared to non-obese controls. However, no study about the effects on the oocyte production has been published till now.

Conclusion: Here we observed a worse result in ART for patients undergoing to bariatric surgery, even when compared to obese patients. This information is extremely valuable and can help in the clinical decision for obese patients with reproductive desire.

Nothing to Disclose: JC, GBN, BB, DC, CPB

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm