From the Guidelines
Bariatric surgery is a viable surgical treatment option for Polycystic Ovary Syndrome (PCOS), particularly for women with excess weight, as it can improve anthropometric, metabolic, and reproductive outcomes, as evidenced by a systematic review and meta-analysis published in 2024 1.
Overview of PCOS Surgical Treatment Options
Surgical treatment for PCOS is typically considered when other treatments have failed or for specific complications. The primary goal of surgical intervention is to improve symptoms, fertility, and overall quality of life.
Bariatric Surgery for PCOS
Bariatric surgery has emerged as a potential adjunct therapy for PCOS, particularly for women with excess weight. A systematic review and meta-analysis published in 2024 found that bariatric surgery can improve body weight, BMI, fasting glucose, fasting insulin, and reproductive outcomes in women with PCOS 1. The study also found that bariatric surgery can reduce the incidence of PCOS symptoms, such as menstrual irregularity, hirsutism, and infertility.
Key Findings
The meta-analysis found significant improvements in:
- Body weight: -30.03 kg (95% CI: -19.80, -40.25)
- BMI: -11.29 kg/m2 (95% CI: -7.73, -14.86)
- Fasting glucose: -0.79 mmol/L (95% CI: -0.23, -1.36)
- Fasting insulin: -12.77 mU/L (95% CI: -5.23, -20.31)
- Total testosterone: -0.54 nmol/L (95% CI: -0.16, -0.91)
Other Surgical Options
Other surgical options for PCOS include:
- Laparoscopic ovarian drilling (LOD): a procedure that involves making small punctures in the ovaries to destroy small amounts of testosterone-producing tissue
- Ovarian cystectomy: a procedure that involves removing individual cysts while preserving ovarian tissue
- Oophorectomy: a procedure that involves removing the ovaries, typically considered for older women with severe symptoms who have completed childbearing
Recommendation
Bariatric surgery should be considered as a viable surgical treatment option for women with PCOS and excess weight, as it can improve anthropometric, metabolic, and reproductive outcomes, as evidenced by the systematic review and meta-analysis published in 2024 1. However, it is essential to weigh the potential benefits and risks of bariatric surgery and to consider individual patient factors, such as age, medical history, and fertility goals.
From the Research
Surgical Treatment Options for PCOS
- Laparoscopic ovarian drilling (LOD) is a surgical treatment option for women with polycystic ovary syndrome (PCOS) who are resistant to clomiphene citrate 2, 3, 4.
- LOD involves making small holes in the ovaries using a laparoscope, which can help stimulate ovulation and improve fertility 2, 3, 4.
- The procedure can be done on an outpatient basis with less trauma and fewer postoperative adhesions than with traditional surgical approaches 2, 3.
- LOD may decrease live birth rates slightly when compared with medical ovulation induction alone, but it probably reduces multiple pregnancy rates 4.
- The effectiveness of LOD can be predicted by various clinical, biochemical, and ultrasonographic parameters, such as body mass index (BMI), duration of infertility, basal luteinizing hormone (LH) levels, and anti-Müllerian hormone (AMH) levels 5.
Advantages and Disadvantages of LOD
- Advantages of LOD include its effectiveness in inducing ovulation and improving fertility, as well as its ability to reduce the risk of ovarian hyperstimulation syndrome and multiple pregnancies 3, 6.
- Disadvantages of LOD include the potential risks of iatrogenic adhesions and ovarian insufficiency, as well as the need for careful patient selection to ensure the best outcomes 5, 6.
- LOD is not recommended for unselected cases of PCOS or for non-fertility indications due to the potential risks involved 6.
Comparison with Other Treatments
- LOD has been compared with other treatments for PCOS, including medical ovulation induction with clomiphene citrate, gonadotropins, and aromatase inhibitors 3, 4.
- The results of these comparisons suggest that LOD may be a viable alternative to medical ovulation induction, particularly for women who are resistant to clomiphene citrate 3, 4.
- However, the choice of treatment should be individualized based on the specific needs and circumstances of each patient 5, 6.