Advertisement
JOGC

The Impact of Bariatric Surgery on Assisted Reproductive Technology Outcomes: A Systematic Review

      Abstract

      Objective

      There is a paucity of literature on the impact of bariatric surgery on artificial reproductive technology (ART) outcomes. This topic should be examined, given that most bariatric surgery candidates are of reproductive age and those with obesity are significantly more likely to experience poor fertility outcomes. This systematic review aimed to determine if bariatric surgery impacts ART outcomes and if effects vary between females and males.

      Data Sources

      MEDLINE, EMBASE, SCOPUS, and the Cochrane Central Register of Controlled Trials were searched for English studies published between January 1978 and May 2021.

      Study Selection

      Studies with participants who had received bariatric surgery and subsequently underwent ART (i.e., in vitro fertilization or intracytoplasmic sperm injection) were eligible for inclusion. Screening, data abstraction, and risk of bias assessment were conducted independently and in duplicate.

      Data Extraction and Synthesis

      Of the 279 articles screened for eligibility, 25 were sought for full text review, and 7 were included for analysis. Four studies (57%) examined ART interventions in females, while 3 (43%) examined interventions in males. Data on cumulative live birth rate (CLBR) was extracted for all 7 studies (N = 169). There were 50 live births with CLBRs ranging from 0.0% to 80.0%. Data on female secondary outcomes were varied. Data on male secondary outcomes were contradictory: 1 study indicated improved sperm parameters following bariatric surgery, while 2 showed decreased parameters, with certain participants seeing improvements after several months.

      Conclusion

      Bariatric surgery prior to ART may have an impact on CLBRs; however, high-quality research is needed to delineate the direct effects of bariatric surgery on ART outcomes. Various sex-specific outcomes should be considered prior to recommending ART after bariatric surgery. Future research should determine the optimal type of bariatric surgery and timing of ART following bariatric surgery.

      Résumé

      Objectif

      On accuse actuellement un manque de connaissances concernant les effets de la chirurgie bariatrique sur l’efficacité des technologies de procréation assistée (TPA). Ce sujet mérite d’être étudié étant donné que la plupart des candidats et candidates à la chirurgie bariatrique sont en âge de procréer et que l’obésité augmente significativement le risque de problèmes de fertilité. Cette revue systématique visait à déterminer si la chirurgie bariatrique influe sur l’efficacité des TPA et si les effets varient entre les femmes et les hommes.

      Sources de données

      Des recherches ont été effectuées dans les bases de données Medline, Embase, Scopus et Cochrane Central Register of Controlled Trials pour trouver des études pertinentes en anglais publiées entre janvier 1978 et mai 2021.

      Sélection des études

      Les études menées auprès de personnes ayant subi une intervention bariatrique et ayant par la suite eu recours aux TPA (c.-à-d., fécondation in vitro ou injection intracytoplasmique de spermatozoïde) ont été retenues. La sélection, l’extraction des données et le risque de biais ont été effectués indépendamment et en double.

      Extraction et synthèse des données

      Des 279 articles retenus, 25 ont fait l’objet d’une revue du texte intégral et 7 ont été inclus dans l’analyse. Des études analysées, 4 (57 %) concernaient les interventions en TPA chez les femmes et 3 (43 %), chez les hommes. Les données sur le taux cumulatif de naissances vivantes (TCNV) ont été extraites pour les 7 études (n = 169). Il y a eu 50 naissances vivantes, pour un TCNV variant de 0,0 % à 80,0 %. Les changements aux critères de jugement secondaires variaient chez les femmes. Les données sur les critères de jugement secondaires chez les hommes étaient contradictoires : 1 étude indique une amélioration des paramètres du spermogramme après l’intervention bariatrique, tandis que 2 ont observé une détérioration des paramètres, mais une amélioration chez certains participants après plusieurs mois.

      Conclusion

      L’intervention bariatrique avant le recours aux TPA peut avoir une incidence sur le TCNV; toutefois, d’autres recherches de haute qualité sont nécessaires pour comprendre les effets directs de la chirurgie bariatrique sur l’efficacité des TPA. Il y a lieu de prendre en compte les issues propres à chaque sexe avant de recommander le recours aux TPA chez les personnes ayant subi une intervention bariatrique. Il faudrait que les recherches futures déterminent le type d’intervention bariatrique le mieux indiqué et le temps d’attente post-chirurgical optimal avant de recourir aux TPA.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Obstetrics and Gynaecology Canada
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Grzegorczyk-Martin V.
        • Fré Our T.
        • De Bantel Finet A.
        • et al.
        IVF outcomes in patients with a history of bariatric surgery: a multicenter retrospective cohort study.
        Hum Reprod. 2020; 35: 1-8
        • Ogunwole S.M.
        • Zera C.A.
        • Stanford F.C.
        Obesity management in women of reproductive age.
        JAMA. 2021; 325: 433-434
        • Pasquali R.
        • Patton L.
        • Gambineri A.
        Obesity and infertility.
        Curr Opin Endocrinol Diabetes Obes. 2007; 14: 482-487
        • Hammoud A.O.
        • Gibson M.
        • Peterson C.M.
        • et al.
        Impact of male obesity on infertility: a critical review of the current literature.
        Fertil Steril. 2008; 90: 897-904
        • Christofolini J.
        • Bianco B.
        • Santos G.
        • et al.
        Bariatric surgery influences the number and quality of oocytes in patients submitted to assisted reproduction techniques.
        Obesity. 2014; 22: 939-942
        • Tan O.
        • Carr B.R.
        The impact of bariatric surgery on obesity-related infertility and in vitro fertilization outcomes.
        Semin Reprod Med. 2012; 30: 517-527
        • Sermondade N.
        • Huberlant S.
        • Bourhis-Lefebvre V.
        • et al.
        Female obesity is negatively associated with live birth rate following IVF: a systematic review and meta-analysis.
        Hum Reprod Update. 2019; 25: 439-451
        • Koning A.M.H.
        • Mutsaerts M.A.Q.
        • Kuchenbecher W.K.H.
        • et al.
        Complications and outcome of assisted reproduction technologies in overweight and obese women.
        Hum Reprod. 2012; 27: 457-467
        • Graham Y.N.H.
        • Mansour D.
        • Small P.K.
        • et al.
        A survey of bariatric surgical and reproductive health professionals’ knowledge and provision of contraception to reproductive-aged bariatric surgical patients.
        Obes Surg. 2016; 26: 1918-1923
        • Maggard M.A.
        • Yermilov I.
        • Li Z.
        • et al.
        Pregnancy and fertility following bariatric surgery: a systematic review.
        JAMA. 2008; 300: 2286-2296
        • Johansson K.
        • Cnattingius S.
        • Näslund I.
        • et al.
        Outcomes of pregnancy after bariatric surgery.
        N Engl J Med. 2015; 372: 814-824
        • Page M.J.
        • McKenzie J.E.
        • Bossuyt P.M.
        • et al.
        The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
        BMJ. 2021; 372: n71
        • Alibhai K.
        • Churchill I.
        • Vause T.
        • et al.
        The impact of bariatric surgery on assisted reproductive technology outcomes: a systematic review protocol.
        Syst Rev. 2022; 11: 1-7
        • Steptoe P.C.
        • Edwards R.G.
        Birth after the reimplantation of a human embryo.
        Lancet. 1978; 312: 366
        • Maheshwari A.
        • McLernon D.
        • Bhattacharya S.
        Cumulative live birth rate: time for a consensus?.
        Hum Reprod. 2015; 30: 2703-2707
        • National Institutes of Health
        Study quality assessment tools. Quality assessment tool for observational cohort and cross-sectional studies.
        (Available at:) (Accessed on May 29, 2021)
        • Hirshfeld-Cytron J.
        • Kim H.H.
        Empty follicle syndrome in the setting of dramatic weight loss after bariatric surgery: case report and review of available literature.
        Fertil Steril. 2008; 90 (1199.e21–3)
        • Milone M.
        • Fernandez L.M.S.
        • Fernandez L.V.S.
        • et al.
        Does bariatric surgery improve assisted reproductive technology outcomes in obese infertile women?.
        Obes Surg. 2017; 27: 2106-2112
        • Lazaros L.
        • Hatzi E.
        • Markoula S.
        • et al.
        Dramatic reduction in sperm parameters following bariatric surgery: report of two cases.
        Andrologia. 2012; 44: 428-432
        • Doblado M.A.
        • Lewkowksi B.M.
        • Odem R.R.
        • et al.
        IVF after bariatric surgery.
        Fertil Steril. 2010; 94: 2812-2814
        • Sermondade N.
        • Massin N.
        • Boitrelle F.
        • et al.
        Sperm parameters and male fertility after bariatric surgery: three case series.
        Reprod Biomed. 2012; 24: 206-210
        • Vasan S.S.
        Semen analysis and sperm function tests: how much to test?.
        Indian J Urol. 2011; 27: 41
      1. World Health Organization. WHO laboratory manual for the examination and processing of human semen, fifth edition. Available at: https://www.who.int/docs/default-source/reproductive-health/srhr-documents/infertility/examination-and-processing-of-human-semen-5ed-eng.pdf. Accessed on April 2, 2022.

        • Velotti N.
        • De Palma F.D.E.
        • Fernandez L.M.S.
        • et al.
        Effect of bariatric surgery on in vitro fertilization in infertile men with obesity.
        Surg Obes Relat Dis. 2021; 17: 1752-1759
        • Dağ Z.Ö.
        • Dilbaz B.
        Impact of obesity on infertility in women.
        J Turkish Ger Gynecol Assoc. 2015; 16: 111
        • Dobbs K.E.
        • Dumesic D.A.
        • Dumesic J.A.
        • et al.
        Differences in serum follicle-stimulating hormone uptake after intramuscular and subcutaneous human menopausal gonadotropin injection.
        Fertil Steril. 1994; 62: 978-983
        • Chan C.C.W.
        • Ng E.H.Y.
        • Chan M.M.Y.
        • et al.
        Bioavailability of hCG after intramuscular or subcutaneous injection in obese and non-obese women.
        Hum Reprod. 2003; 18: 2294-2297
        • Biertho L.
        • Hong D.
        • Gagner M.
        Canadian adult obesity clinical practice guidelines- bariatric surgery: surgical options and outcomes.
        (Available at:) (Accessed on April 18, 2022)