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Bariatric surgery as a possible solution to female infertility

The prevalence  of obesity worldwide has nearly tripled since 1975 and currently there are 650 million people worldwide (11% male and 15% female) having obesity with a BMI of more than 30. 

Obesity contributes to female infertility and is also a factor in complications to both the mother and the offspring during pregnancy and childbirth.

One of the most effective methods to tackle obesity and its related comorbidity is bariatric surgery.

Polycystic ovarian syndrome and endometrial hyperplasia, which are associated with increased risk of endometrial cancer, have been identified as potential new indications for bariatric surgery.

Polycystic ovarian syndrome is the most common endocrine disorder in females in the productive age and is associated with several components of metabolic syndrome, such as obesity.

Many studies have shown that bariatric surgery can play an important role in the management of patients with polycystic ovarian syndrome and improve fertility.  After bariatric surgery, obese female with sub-fertility can achieve spontaneous pregnancy.

In fact, there is an increasing body of evidence pointing towards the beneficial effect of weight loss induced by bariatric surgery on female fertility prompting cause for recognition of female infertility as a qualifying comorbidity for patients with a BMI between 35 and 40.

Obesity is associated and does exert a negative influence on female fertility.  Obese women are more likely to have ovulatory dysfunction due to dysregulation of the hypothalamic-pituitary-ovarian axis.

Women with polycystic ovarian syndrome, who are also obese, demonstrate a more severe metabolic and reproductive phenotype.

Obese women are less likely than normal/weight women to achieve pregnancy.  Female obesity adversely affects reproductive function through alteration in the hypothalamic-pituitary-ovarian axis, oocyte quality and endometrial receptivity.

There is a mountain of evidence which indicates sustained weight loss through bariatric surgery improves reproductive potential in obese females.

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