Pole ENDO, La Conception Hospital, APHM, Aix-Marseille University, Marseille, France.
Centre Spécialisé de l'Obésité (CSO) PACA Ouest, Marseille, France.
J Assist Reprod Genet. 2018 Jul;35(7):1317-1324. doi: 10.1007/s10815-018-1196-3. Epub 2018 May 12.
Although bariatric surgery seems to increase spontaneous fertility by improving ovulatory function in young women, its impact on ovarian reserve remains largely unknown.
To evaluate changes in serum anti-Mullerian hormone (AMH) levels in reproductive-age severely obese women after bariatric surgery (BS).
AMH levels were measured retrospectively in 39 women (mean age 34.6 ± 1.1 years, range 18-45) that underwent a sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) at baseline, and 6 and 12 months after BS. Metabolic and micronutrient status, including fasting plasma insulin and glucose, HOMA-IR, leptin, adiponectin, calcium, albumin, transthyretin, ferritin, vitamins (B9, B12, B1, A, E, D), zinc, and selenium, were assessed in all patients before and 1 year after BS.
Of the patients, 79% had class-3 obesity. At 6 and 12 months, mean total weight losses (TWL) were 26 and 30%; mean excess weight losses (EWL) were 61.7 and 70.2%. Compared to baseline, AMH levels significantly decreased by 18% at 6 months, and 32% at 12 months post-operatively (p = 0.010 and p = 0.001, respectively). There was no correlation between AMH variation and changes in metabolic parameters or micronutrient levels. Remarkably, changes in AMH levels did not differ between sleeve and RYGB patients and were not correlated with EWL.
This pilot study shows a drastic reduction in AMH levels at 1 year after BS in reproductive-age severely obese women, which was not related to weight loss: this suggests a negative impact of BS on ovarian reserve, at least in the short term.
尽管减重手术似乎通过改善年轻女性的排卵功能来提高自发性生育能力，但它对卵巢储备的影响在很大程度上尚不清楚。
评估减重手术（BS）后生育期肥胖女性血清抗苗勒管激素（AMH）水平的变化。
回顾性分析 39 例接受袖状胃切除术或 Roux-en-Y 胃旁路术（RYGB）的女性（平均年龄 34.6±1.1 岁，范围 18-45 岁）的 AMH 水平，在基线、BS 后 6 个月和 12 个月时进行测量。所有患者在 BS 前后及 1 年均评估代谢和微量营养素状况，包括空腹血浆胰岛素和血糖、HOMA-IR、瘦素、脂联素、钙、白蛋白、转甲状腺素、铁蛋白、维生素（B9、B12、B1、A、E、D）、锌和硒。
患者中 79%患有 3 级肥胖症。在 6 个月和 12 个月时，平均总体重减轻（TWL）分别为 26%和 30%；平均超重减轻（EWL）分别为 61.7%和 70.2%。与基线相比，AMH 水平在术后 6 个月时下降了 18%，在术后 12 个月时下降了 32%（p=0.010 和 p=0.001）。AMH 变化与代谢参数或微量营养素水平的变化之间没有相关性。值得注意的是，袖状胃切除术和 RYGB 患者之间 AMH 水平的变化没有差异，也与 EWL 无关。
本研究表明，生育期肥胖女性在 BS 后 1 年 AMH 水平明显下降，与体重减轻无关：这表明 BS 对卵巢储备至少在短期内产生负面影响。
