Abstract
Background: Due to exponential obesity prevalence, the number of bariatric surgery (BS) procedures has considerably increased. BS improves ovulatory function and natural fertility in some women. However, its effect on ovarian reserve is poorly known. The objective of this study was to carry out a systematic review of the literature to evaluate the impact of BS on ovarian reserve for women with obesity. Methods: In this systematic review, PubMed and EMBASE databases were searched for studies evaluating the results of ovarian reserve tests in obese women before and after BS, and published between January 1st, 2000, and March 1st, 2020. Results: Eight studies were included, totaling 355 women with serum antimullerian hormone (AMH) levels evaluated before and after BS. The majority of currently available studies report a decrease in AMH levels occurring 6 and/or 12 months after surgery, which could suggest an ovarian reserve impairment following BS. Conclusions: Although the pathophysiological mechanisms are poorly understood, this alteration raises concerns regarding long-term fertility following BS. Larger prospective controlled cohort studies will be necessary to provide a conclusion about the potential effect of BS on ovarian reserve. If a deleterious effect is confirmed, oocyte cryopreservation before surgery could be discussed.
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