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
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Article info
Publication history
Published online: May 05, 2022
Accepted:
April 19,
2022
Received:
December 28,
2021
Footnotes
Disclosures: The authors declare they have nothing to disclose.
All authors have indicated they meet the journal’s requirements for authorship.
Identification
Copyright
© 2022 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
