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减肥手术治疗女性不孕症的有效性——一项系统评价和荟萃分析

The Effectiveness of Bariatric Surgery on Treating Infertility in Women-A Systematic Review and Meta-Analysis.

作者信息

Almutairi Hadeel, Aldhalea Mohammad Sulaiman, Almaaz Muhammad Abdulghani, Aljuhani Sama Abdalaziz, Aloraini Rena Ibrahim, Alamoudi Abdulrahman Abdullah, Alkhalifah Wajd Fahad, Alrushaid Leen Ahmed, Alanzy Haneen Wadi, Alzuwayyid Meshal, Alrumaih Flora Abdulaziz, Al-Harbi Moneerah Madeallah, Al-Aboudi Alaa Ahmad, Alqadi Faisal Salem, Alshammari Reem Salem

机构信息

Department of Surgery, College of Medicine, Qassim University, Buraydah 52571, Saudi Arabia.

Buraidah Central Hospital, Qassim Cluster, Ministry of Health, Buraydah 52367, Saudi Arabia.

出版信息

J Clin Med. 2024 Sep 19;13(18):5569. doi: 10.3390/jcm13185569.

Abstract

Obesity is a growing global health concern, which increases the risk of various diseases and has seen a rising prevalence over time. The global prevalence of obesity among adults has doubled over time. Obesity significantly impacts health by increasing the risk of a range of severe medical conditions. Cardiovascular diseases, such as heart attacks and strokes, are more prevalent in individuals with obesity due to factors like high blood pressure and abnormal cholesterol levels. This systematic review and meta-analysis sought to establish the effectiveness of bariatric surgery in treating infertility in women. This systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A broad electronic search was conducted through PubMed, Web Science, and Medline databases for studies published between April 2017 and October 2023. The search strategy used the following terms: bariatric surgery, metabolic surgery, bariatric surgical procedures, stomach stapling, infertility, and fertility issues. The data were analyzed using the Revman version 5.1.2 software. The results of the study show that despite the heterogeneity found in the studies, irregular menstrual cycles were found to reduce significantly in patients who underwent bariatric surgery ( = 0.01), with an RR of 0.22, at a 95% CI (0.06, 0.74). With regards to infertility, the results indicate that bariatric surgery reduced the level of infertility among the patients significantly ( = 0.00001), with an RR of 0.55, at a 95% CI (0.45, 0.68). Further, the results show bariatric surgery reduced rate of miscarriages among patients ( = 0.01), with an RR of 0.51, at a 95% CI (0.30, 0.86). Moreover, bariatric surgery reduced the level of congenital malfunction, but the effect was not statistically significant ( = 0.16), with an RR of 0.39, at a 95% CI (0.10, 1.45). However, the overall effect of bariatric surgery on treating infertility was found to be significantly effective ( = 0.0001), with an RR of 0.54, at a 95% CI (0.43, 0.68). This implies that bariatric surgery helps in weight loss, which improves ovulatory dysfunction and irregular menstruation while boosting spontaneous conception. This study found that bariatric surgery helps infertile women of a reproductive age to lose weight, which improves ovulatory dysfunction and irregular menstruation while boosting spontaneous conception. On the other hand, the study noted that after bariatric surgery, spontaneous conception can occur because of a decreased rate of miscarriage, increased fertility, reduced levels of congenital malfunction, and the restoration of regular menstrual cycles. Therefore, this study highlights the need to offer adequate preconception care and counselling to women who are about to be pregnant, both before and after bariatric surgery. Further, based on the fact that this study focused on general bariatric surgery, future research should focus on specific types of bariatric surgery to establish the most effective type of bariatric surgery in treating infertility in women.

摘要

肥胖是一个日益严重的全球健康问题,它增加了患各种疾病的风险,且患病率一直呈上升趋势。全球成年人肥胖患病率随时间推移已翻了一番。肥胖通过增加一系列严重疾病的风险对健康产生重大影响。心血管疾病,如心脏病发作和中风,在肥胖个体中更为普遍,原因包括高血压和胆固醇水平异常等因素。这项系统评价和荟萃分析旨在确定减肥手术治疗女性不孕症的有效性。 本系统评价和荟萃分析是按照系统评价和荟萃分析的首选报告项目(PRISMA)指南进行的。通过PubMed、Web Science和Medline数据库对2017年4月至2023年10月发表的研究进行了广泛的电子检索。检索策略使用了以下术语:减肥手术、代谢手术、减肥手术程序、胃吻合术、不孕症和生育问题。使用Revman 5.1.2版软件对数据进行分析。 研究结果表明,尽管研究中存在异质性,但接受减肥手术的患者月经周期不规律的情况显著减少(P = 0.01),相对危险度为0.22,95%置信区间为(0.06,0.74)。关于不孕症,结果表明减肥手术显著降低了患者的不孕水平(P = 0.00001),相对危险度为0.55,95%置信区间为(0.45,0.68)。此外,结果显示减肥手术降低了患者的流产率(P = 0.01),相对危险度为0.51,95%置信区间为(0.30,0.86)。此外,减肥手术降低了先天性疾病的发生率,但效果无统计学意义(P = 0.16),相对危险度为0.39,95%置信区间为(0.10,1.45)。然而,减肥手术治疗不孕症的总体效果被发现具有显著疗效(P = 0.0001),相对危险度为0.54,95%置信区间为(0.43,0.68)。这意味着减肥手术有助于体重减轻,改善排卵功能障碍和月经不规律,同时提高自然受孕率。 本研究发现减肥手术有助于育龄期不孕女性体重减轻,改善排卵功能障碍和月经不规律,同时提高自然受孕率。另一方面,研究指出减肥手术后,由于流产率降低、生育能力增强、先天性疾病发生率降低以及月经周期恢复正常,自然受孕可能会发生。因此,本研究强调需要在减肥手术前后为即将怀孕的女性提供充分的孕前护理和咨询。此外,基于本研究聚焦于一般减肥手术这一事实,未来的研究应聚焦于特定类型的减肥手术,以确定治疗女性不孕症最有效的减肥手术类型。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0c80/11433424/3e9f33e9c0f3/jcm-13-05569-g001.jpg

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