Pregnancy Following Metabolic-Bariatric Surgery in a Woman With Potential Premature Ovarian Failure: A Case Report

Abstract

Premature ovarian insufficiency (POI) is associated with decreased ovulation in the precursor stage which leads to ovarian failure in the end stage. Metabolic-bariatric surgery (MBS) can improve women's reproductive status, including the release of sex hormones, ovulation, and fertilization. Here, we report a spontaneous pregnancy following MBS despite potential ovarian insufficiency. A 38-year-old woman with severe obesity underwent three cycles of assisted reproduction that were not successful. Oligomenorrhea ≥ 4 months, laboratory indices, and previous poor ovarian response approved the diagnosis of diminished ovarian reserve and could be considered as the precursor stage of POI. Then a gastric bypass was applied, and a spontaneous pregnancy occurred in the 22^nd month after surgery, with 45.80% reduction in body mass index. MBS in women with obesity and idiopathic ovarian insufficiency may increase the chance of spontaneous ovulation and successful pregnancy.

Keywords: bariatric surgery; case reports; fertility; pregnancy; primary ovarian insufficiency.

Figure 1

Trend of body mass index (BMI), percent total weight loss (%TWL), and percent excess weight loss (%EWL) from day of metabolic–bariatric surgery (MBS) to delivery.

Figure 2

The spontaneous ovulation before (I) and after (II) metabolic–bariatric surgery (MBS). In primary stages of ovarian insufficiency, MBS in women with obesity can increase the chance of spontaneous ovulation and potential pregnancy by weight loss and metabolic correction without interrupting the progressive ovarian insufficiency.