Pg Baharuddin Dg Marshitah, Leik Nang Kham Oo, Hayati Firdaus, Mohd Daud Mohd Nazri, See Edwin, Sharif Siti Zubaidah, Nik Lah Nik Amin Sahid
Reproductive Health Department, Faculty of Medicine and Science Health, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.
Department of Surgery, Faculty of Medicine and Science Health, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.
Int J Surg Case Rep. 2021 Aug;85:106235. doi: 10.1016/j.ijscr.2021.106235. Epub 2021 Jul 24.
Obesity has been proven to have adverse effects on fertility and is one of the predisposing factors for delay in pregnancy even with the use of assisted reproductive technique. There are many pathways in which obesity can affect fertility such as anovulation, poor implantation and low-quality oocyte.
We report a case of a 40-year-old lady with primary infertility for six years with underlying polycystic ovary syndrome (PCOS) and BMI 45.7 whom was successfully conceived twice following bariatric surgery procedure in which reduction of 70% of her BMI prior to bariatric surgery lead to her spontaneous conception without fertility intervention and successful live birth.
Obese PCOS needs multidisciplinary approaches which include weight loss program such as dietary advice, exercise intervention as part of preliminary treatment prior to ovulation induction and counselling.
Bariatric surgery has been a mainstay treatment in patients with morbid obesity and those with BMI more than 35 associated with obesity related problems such as joint pain, hypertension or diabetes mellitus. Bariatric surgery such as laparoscopic sleeve gastrectomy should be considered more often in contrast to lifestyle modification for morbidly obese lady with PCOS and infertility prior to the use of standard ovulation induction regime for treating infertility.
肥胖已被证明对生育有不利影响，是即使使用辅助生殖技术仍导致妊娠延迟的诱发因素之一。肥胖影响生育的途径有很多，如无排卵、着床不佳和卵母细胞质量差。
我们报告一例40岁女性，原发性不孕6年，患有多囊卵巢综合征（PCOS），体重指数（BMI）为45.7。在减重手术后，她成功受孕两次，减重手术前BMI降低了70%，使其在未进行生育干预的情况下自然受孕并成功分娩活婴。
肥胖型PCOS需要多学科方法，包括减重计划，如饮食建议、运动干预，作为诱导排卵和咨询前初步治疗的一部分。
减重手术一直是病态肥胖患者以及BMI超过35且伴有肥胖相关问题（如关节疼痛、高血压或糖尿病）患者的主要治疗方法。对于患有PCOS和不孕症的病态肥胖女性，在使用标准诱导排卵方案治疗不孕症之前，与生活方式改变相比，应更频繁地考虑腹腔镜袖状胃切除术等减重手术。
