Laparoscopic sleeve gastrectomy in the treatment of obesity-associated infertility: analysis of reproductive outcomes
https://doi.org/10.17749/2313-7347/ob.gyn.rep.2026.700
Abstract
Aim: to evaluate an effect of laparoscopic sleeve gastrectomy (LSG) on fertility in obese reproductive age women and to identify factors associated with subsequent pregnancy.
Materials and Methods. This single-center observational retrospective comparative study included 48 women aged 25–36 years who underwent LSG. Body mass index (BMI), insulin resistance index HOMA-IR (Homeostasis Model Assessment of Insulin Resistance), anti-Müllerian hormone (AMH), and antral follicle count (AFC) were assessed before and 12 months post-surgery. Smoking history, family history of premature menopause, and prior ovarian surgery were analyzed. After 3 years post-surgery, patients planning pregnancy were stratified as follows: Group 1 – achieved pregnancy (n = 16, including 10 spontaneous and 6 through assisted reproductive technologies), Group 2 – no pregnancy (n = 14).
Results. Following LSG, significant reductions were observed in BMI (from 44.2 to 31.3 kg/m2; p = 0.001) and HOMA-IR index (from 8.3 to 5.1; p = 0.001). Pregnancy occurred in 53.3 % of patients. Women who did not conceive had higher baseline BMI (47.1 kg/m2 vs. 41.5 kg/m2; p = 0.025), HOMA-IR index (10.2 vs. 5.8; p = 0.005), and more pronounced decline in ovarian reserve post-LSG: AMG level was 0.89 vs. 2.65 ng/ml (p = 0.001). Significant risk factors included familial history of premature menopause (85.7 %), ovarian surgery (42.9 %), and smoking (78.6 %). Correlation analysis revealed significant negative associations between pregnancy likelihood and baseline BMI (r = –0.42; p = 0.02) and HOMA-IR (r = –0.52; p = 0.003), whereas AFC showed positive correlation (r = 0.38; p = 0.04). Statistically significant associations were found between pregnancy and smoking (p = 0.02), prior ovarian surgery (p = 0.02), and familial history of early menopause (p = 0.04).
Conclusion. LSG use was associated with improved metabolic parameters and fertility recovery in 53.3 % of patients. However, given the small sample size, these findings require validation in larger-scale cohorts. The likelihood of achieving pregnancy depends on a complex interplay between the examined factors, underscoring a need for individualized risk assessment and a personalized approach to therapy.
About the Authors
Z. V. Shvets
Pavlov First Saint Petersburg State Medical University, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Zlata V. Shvets, MD
6–8 Lev Tolstoy Str., Saint Petersburg 197022
S. V. Dora
Pavlov First Saint Petersburg State Medical University, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Svetlana V. Dora, MD, Dr Sci Med, Prof.
6–8 Lev Tolstoy Str., Saint Petersburg 197022
Yu. Sh. Khalimov
Pavlov First Saint Petersburg State Medical University, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Yuri Sh. Khalimov, MD, Dr Sci Med, Prof.
Scopus Author ID: 55531165300
6–8 Lev Tolstoy Str., Saint Petersburg 197022
A. V. Lisker
Pavlov First Saint Petersburg State Medical University, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Anna V. Lisker, MD, PhD.
Scopus Author ID: 37004518800
6–8 Lev Tolstoy Str., Saint Petersburg 197022
A. B. Kolyabina
Pavlov First Saint Petersburg State Medical University, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Alexandra B. Kolyabina, MD.
6–8 Lev Tolstoy Str., Saint Petersburg 197022
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What is already known about this subject?
► Bariatric surgery, particularly laparoscopic sleeve gastrectomy (LSG), is highly effective for obesity treatment, reducing body mass index (BMI) by over 14 kg/m2 within 12 months.
► Patients subjectively link post-bariatric weight loss to improved fertility, yet reported pregnancy rates vary widely (22–92 %).
► Currently, the key pregnancy predictor is the post-operative BMI achieved: BMI reduction by > 5 kg/m2 is significantly associated with successful conception, increasing its chances by 20.2-fold.
What are the new findings?
► A significant postoperative decline in anti-Müllerian hormone (AMH) and antral follicle count (AFC) is a novel negative post-LSG pregnancy predictor emphasizing a role for ovarian reserve dynamics beyond achieved BMI.
► Patient’s profile at high infertility risk post-surgery has been identified: smoking, a family history of early or premature menopause, and a history of ovarian surgery.
► It was found that patients with higher baseline BMI and insulin resistance achieved pregnancy post-surgery more often using assisted reproductive technologies, despite greater absolute weight loss.
How might it impact on clinical practice in the foreseeable future?
► The results obtained justify a need for applying a predictive approach: pre-LSG assessment of insulin resistance, ovarian reserve, and reproductive history enables personalized fertility prognosis and treatment planning for each patient.
Review
For citations:
Shvets Z.V., Dora S.V., Khalimov Yu.Sh., Lisker A.V., Kolyabina A.B. Laparoscopic sleeve gastrectomy in the treatment of obesity-associated infertility: analysis of reproductive outcomes. Obstetrics, Gynecology and Reproduction. 2026;20(2):260-270. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2026.700
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