Kyriakos Bananis, Charalampos Voros, Evangelos Menenakos, Georgios Zografos, Georgios Daskalakis, Dimitrios Theodorou
Sleeve gastrectomy was associated with marked improvements in insulin resistance and androgenic profiles, accompanied by progressive increases in SHBG and reductions in FAI, AMH, and AFC over 12 months. Rather than suggesting deterioration of ovarian function, the overall hormonal pattern appears more consistent with normalization of obesity-associated dysregulated folliculogenesis within an improved metabolic environment. While direct reproductive outcomes were not assessed, these findings support the concept that metabolic bariatric surgery may substantially remodel the endocrine milieu linked to ovarian physiology. Larger prospective studies incorporating fertility-related endpoints are required to clarify the reproductive significance of these changes.
BACKGROUND: Severe obesity is associated with hormonal imbalances, hyperandrogenism, and insulin resistance, all of which adversely affect reproductive physiology. Metabolic and bariatric surgery (MBS) produces durable weight loss and metabolic improvement, but its effects on ovarian reserve markers and reproductive hormones in women of reproductive age remain incompletely characterized.
OBJECTIVE: To prospectively evaluate the impact of laparoscopic sleeve gastrectomy on obesity indices, reproductive hormones, ovarian reserve markers, and insulin resistance over 12 months in women with severe obesity.
METHODS: Thirty-two women with severe obesity (BMI > 40 kg/m²) undergoing laparoscopic sleeve gastrectomy were assessed at three time points: baseline (2-4 weeks before surgery, prior to the standard pre-operative very-low-calorie diet), 6 months, and 12 months post-operatively. Anthropometric, reproductive-hormone (anti-Müllerian hormone [AMH], antral follicle count [AFC], follicle-stimulating hormone [FSH], luteinizing hormone [LH], estradiol, sex hormone-binding globulin [SHBG], total testosterone, calculated free androgen index [FAI]), and metabolic (HOMA-IR) parameters were measured. Non-parametric tests (Wilcoxon signed-rank, Spearman correlation) were applied.
RESULTS: BMI decreased from 42.38 ± 1.41 to 25.65 ± 0.34 kg/m² at 12 months (p < 0.001). AMH declined from 3.13 ± 0.17 to 2.24 ± 0.44 ng/mL; AFC fell from 11.22 ± 1.60 to 7.16 ± 1.63 (right ovary) and from 11.09 ± 1.30 to 6.19 ± 0.86 (left ovary). FSH, LH, and estradiol increased; SHBG nearly doubled (36.26 → 63.77 nmol/L); total testosterone decreased markedly (27.76 → 9.34 ng/dL); FAI fell from 2.73 ± 0.85 to 0.53 ± 0.19; HOMA-IR declined from 3.94 ± 0.46 to 1.66 ± 0.56 (all p < 0.001). Spearman correlations among change scores showed inverse associations between ΔSHBG and ΔFAI (ρ = -0.420, p = 0.017), and between ΔHOMA-IR and Δtotal testosterone (ρ = -0.374, p = 0.035).
CONCLUSIONS: Sleeve gastrectomy was associated with marked improvements in insulin resistance and androgenic profiles, accompanied by progressive increases in SHBG and reductions in FAI, AMH, and AFC over 12 months. Rather than suggesting deterioration of ovarian function, the overall hormonal pattern appears more consistent with normalization of obesity-associated dysregulated folliculogenesis within an improved metabolic environment. While direct reproductive outcomes were not assessed, these findings support the concept that metabolic bariatric surgery may substantially remodel the endocrine milieu linked to ovarian physiology. Larger prospective studies incorporating fertility-related endpoints are required to clarify the reproductive significance of these changes.