Year: 2021
Type: dissertation
Study design: Observational Study
Abstract: Obesity is an increasing global epidemic with serious comorbidities leading to a shorter life expectancy.In women, obesity also causes problems related to the ability to conceive, to miscarriage and pregnancy complications.Bariatric surgery is the most effective treatment for obesity, but there is yet no consensus regarding recommending obese infertile women to undergo bariatric surgery due to lacking studies.The overarching aim of this thesis was to investigate patients' expectations and the effects of bariatric surgery on female fertility in terms of changes in body image, sexuality, sex hormones and IVF results, along with exploring patients' experiences of surgery.In the qualitative study I, 12 women were interviewed and answered HADS and FSFI questionnaires before and after bariatric surgery.In the prospective cohort study II, anthropometric and questionnaire data were analysed together with hormones in 48 women operated with bariatric surgery and followed for one year.Study III consists of a national population-based register-study where live-birth rate in first IVF cycle, and birth outcomes were compared between women previously operated with bariatric surgery and controls matched on post-surgery BMI, age, and parity.We found that young women seeking bariatric surgery seem to have high expectations on future childbearing, considering the operation as a mean to achieve normality including improved fertility.Hormonal imbalances were corrected after surgery, with a lowered free androgen index, but we also found decreased AMH levels below the expected normal age-related decline.Psychological and sexual quality of life outcomes were improved, related to improved body image and self-esteem.There was no difference in live-birth rate after IVF for women with previous bariatric surgery compared to non-operated control women matched for a BMI corresponding to post-surgery BMI, but the mean birth weight of the infants was lower in the bariatric surgery group.Improved psychological and sexual quality-of-life outcomes as well as correction of hormonal imbalances could contribute to increased fertility after bariatric surgery and are in line with the high expectations on future childbearing.When needing IVF, there was no negative effect of bariatric surgery on the live birth rate.
Author: Emma Nilsson-Condori
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3153197913