THE IMPACT OF LARGE VOLUME LIPOSUCTIOM WITH ADRENALINE ONLY ON THE PREGNANCY AND AESTHETIC OUTCOMES OF INFERTILE OBESE WOMEN

Abstract

Background: Obesity dysregulates the hypothalamic-pituitary-ovarian axis resulting in ovulatory dysfunction and subsequent infertility. Tumescent liposuction comprised injection of a large volume of lactated Ringer's solution or normal saline, containing super-diluted epinephrine and lignocaine, in the subcutaneous fat. Even though this procedure accomplished accepted results as a body contouring surgery, the association between large-volume liposuction and infertility outcomes was not examined yet. Objectives: To reveal the aesthetic and reproductive outcomes of obese infertile female patients with established underlying hormonal irregularities and submitted to large-volume tumescent liposuction with the use of adrenaline only. Patients and Methods: The present prospective cohort study was conducted at Al-Azhar University Hospitals throughout September 2015 and August 2020. Obese or overweight infertile women within the reproductive age with menstrual irregularities, for at least one year were eligible for inclusion in the present study. These abnormalities were confirmed based on laboratory, and radiological evaluation. The procedure was done under general anesthesia and sterilization with betadine with small stabs in targeted areas. Post-operative pain was assessed using Visual analogue scale (VAS). Results: A total of 18 female patients with established infertility of more than one-year duration were included in this study. Patients were furtherly assorted based on fulfilling Rotterdam criteria into two groups: Group (A) including 10 patients with polycystic ovarian syndrome (PCOS), and group (B) encompassing eight patients without. Clinically, three cases of secondary infertility get pregnant after the procedure, one case get pregnant after eight months and two of them after one year. Furthermore, two cases of primary infertility with PCOS get pregnant after six months and the other after one year. Seven cases of secondary infertility developed dramatic improvement in hormonal profile preparing them for conception without pregnancy. Patients experienced a statistically significant decline in the body mass index (P<0.001, t=61.3). As for patients’ satisfaction, 15 (83.33%) gave a 4 or 5 score to their general appearance. This was reflected in the quality of life in which 13 (72.22%) patients were highly satisfied. No patient complained of uncomfortable postoperative pain. Conclusion: Large-volume tumescent liposuction with use of adrenaline only was a safe, effective, and promising procedure in amending the negative reproductive and aesthetic repercussions of obesity among infertile obese women. These findings were associated with satisfactory pregnancy and cosmetic outcomes, which reflected on patients’ satisfaction. No patient in our cohort experienced discomfort pain despite xylocaine non-use.