The Dynamics of the Hypothalamic-Pituitary-Ovarian Axis, ReproductivePerformance and Sexuality Following Bariatric Surgery

Obesity has reached epidemic proportions globally. Multi-system and morbid ramifications of obesity arerecognized in both sexes that are at least partly reversible following significant and sustained weight reduction. Bariatricsurgery is a relatively recent intervention in the therapeutic armamentarium for the management of morbid obesity andutilization of bariatric surgery as an option for weight loss is escalating. We provide an overview of the effects of morbid obesity on the hypothalamic-pituitary-ovarian (HPO) axis, reproductiveand sexual performance. This review focuses on the alterations in reproductive physiology, with specific regard to thealterations in fertility status, efficacy of oral contraception and sexuality following bariatric surgery. Our perusal of thepublished literature reveals that although non-surgical weight loss in morbidly obese improves fertility, data onreproductive performance after weight loss by bariatric surgery is sparse and somewhat controversial. In the currentsetting of an increasing utilization of this therapeutic modality in the reproductive age population, this underscores a needfor better appreciation of the alterations in physiology following bariatric surgery by well-designed trials. The suboptimalefficacy of oral contraceptives after weight loss by bariatric surgery needs to be further evaluated and in the interim, whenprescribing OCP's to patients anticipating undergoing bariatric procedures, counseling should include a discussion onpotential contraceptive failure after surgery. Although an improvement in sexual performance and satisfaction may followdramatic weight reductions, the possibility of a detrimental influence specifically after bariatric surgery remains to bedetermined by future trials.