Resum
Objective:
A reduction in anti-Mullerian hormone (AMH) levels after bariatric surgery (BS) has been recently described. This may be related to decreased ovarian reserve, metabolic changes or a lack of precursors for the synthesis of the AMH. This study includes for the first time a simultaneous analysis of reproductive hormones, adipokines, nutritional parameters and ultrasound ovarian reserve markers.
Design:
A prospective cohort study of 20 women followed postoperatively for 12 months.
Materials and Methods:
Women aged 19-40 years with a mean body mass index (BMI) 43.9 (CI 41.6; 46.1) kg/m2 with indication of BS were studied baseline (BL), 1 month after BS (BS1), 4 months after BS (BS2) and 12 months after BS (BS3). Antropometrical parameters were measured and blood samples were obtained in each point of study to determine: 1) reproductive hormones (AMH, FSH, LH, estradiol, testosterone, SHBG, androstenedione); 2) metabolic parameters (adiponectin, leptin, ghrelin, insulin); 3) nutritional data (vitamins and ions). We also performed a 2D/3D ultrasound to assess the antral follicular count (AFC) and the ovarian volume. Mixed models were used for analysis of longitudinal data using SAS 9.2 software (SAS Institute, Cary, NC, USA).
Results:
The mean AMH level was 3.9 ng/ml (95% CI 2.6;5.2) at BL and decreased significantly 12 months after BS (mean: 2.6 ng/ml, CI 1.3;3.9) (p=0.034). We also observed a nonsignificant decrease in AFC: mean 24.2 at BL (CI 17.9;30.5), mean 16.8 at BS3 (CI 10.5;23.1) (p=0.095). A longitudinal analysis using mixed models revealed the following associations: (a) a change in 10 kg was associated with an average (95%CI) change of 0.357 (0.074,0.639) ng/ml in AMH, p=0.014; (b) a change in 1 BMI point was associated with an average (95%CI) change of 0.109 (0.035,0.184) ng/ml in AMH, p=0.005; (c) a change in 1 microgr/ml adiponectin was associated with an average (95%CI) inverse change of 0.091 (0.009,0.173) ng/ml in AMH, p=0.041.
Conclusions:
This study confirms the reduction of AMH levels after BS and demonstrates, for the first time, a non-significant tendency in AFC reduction. We also found an association between reproductive and metabolic changes. Our investigation has allowed us to study new parameters related to the origins and clinical effects of AMH reduction after BS.
A reduction in anti-Mullerian hormone (AMH) levels after bariatric surgery (BS) has been recently described. This may be related to decreased ovarian reserve, metabolic changes or a lack of precursors for the synthesis of the AMH. This study includes for the first time a simultaneous analysis of reproductive hormones, adipokines, nutritional parameters and ultrasound ovarian reserve markers.
Design:
A prospective cohort study of 20 women followed postoperatively for 12 months.
Materials and Methods:
Women aged 19-40 years with a mean body mass index (BMI) 43.9 (CI 41.6; 46.1) kg/m2 with indication of BS were studied baseline (BL), 1 month after BS (BS1), 4 months after BS (BS2) and 12 months after BS (BS3). Antropometrical parameters were measured and blood samples were obtained in each point of study to determine: 1) reproductive hormones (AMH, FSH, LH, estradiol, testosterone, SHBG, androstenedione); 2) metabolic parameters (adiponectin, leptin, ghrelin, insulin); 3) nutritional data (vitamins and ions). We also performed a 2D/3D ultrasound to assess the antral follicular count (AFC) and the ovarian volume. Mixed models were used for analysis of longitudinal data using SAS 9.2 software (SAS Institute, Cary, NC, USA).
Results:
The mean AMH level was 3.9 ng/ml (95% CI 2.6;5.2) at BL and decreased significantly 12 months after BS (mean: 2.6 ng/ml, CI 1.3;3.9) (p=0.034). We also observed a nonsignificant decrease in AFC: mean 24.2 at BL (CI 17.9;30.5), mean 16.8 at BS3 (CI 10.5;23.1) (p=0.095). A longitudinal analysis using mixed models revealed the following associations: (a) a change in 10 kg was associated with an average (95%CI) change of 0.357 (0.074,0.639) ng/ml in AMH, p=0.014; (b) a change in 1 BMI point was associated with an average (95%CI) change of 0.109 (0.035,0.184) ng/ml in AMH, p=0.005; (c) a change in 1 microgr/ml adiponectin was associated with an average (95%CI) inverse change of 0.091 (0.009,0.173) ng/ml in AMH, p=0.041.
Conclusions:
This study confirms the reduction of AMH levels after BS and demonstrates, for the first time, a non-significant tendency in AFC reduction. We also found an association between reproductive and metabolic changes. Our investigation has allowed us to study new parameters related to the origins and clinical effects of AMH reduction after BS.
| Idioma original | Anglès |
|---|---|
| Pàgines (de-a) | E122-E122 |
| Nombre de pàgines | 1 |
| Revista | Fertility and Sterility |
| Volum | 110 |
| Número | 4 |
| DOIs | |
| Estat de la publicació | Publicada - de set. 2018 |