PREGNANCY AND ASSOCIATED OUTCOMES AMONG PATIENTS FOLLOWING SLEEVE GASTRECTOMY: A RETROSPECTIVE COMPARATIVE ANALYSIS OF BARIATRIC SURGERY PATIENTS FOLLOWED IN A REPRODUCTIVE INFERTILITY CLINIC
Kelly Hathorn*1, Thomas R. McCarty1, Alicia Corwin1, Thomas J. Wang2, Ahmad Najdat Bazarbashi1, Christopher C. Thompson1
1Brigham & Women's Hospital, Boston, MA; 2Massachusetts General Hospital, Boston, MA
Background:
Obesity carries a well-known association with a reduction in reproductive health among women of child-bearing years. Despite these associations, little evidence is available to guide clinicians for patients struggling with infertility after sleeve gastrectomy. The primary aim of this study was to evaluate pregnancy-related outcomes of sleeve gastrectomy patients followed in a reproductive infertility clinic.
Methods:
This was a retrospective observational study of adult women with a history of sleeve gastrectomy who were followed in reproductive infertility clinic. Patient demographics, surgical history, weight loss post-bariatric surgery, subsequent weight trends, hemoglobin A1c at the time of referral to infertility clinic, trial of clomiphene, use of in vitro fertilization (IVF), and successful pregnancy outcome were recorded. Differences in the two groups for categorical variables were compared using chi-square test with t-test used for continuous variables. A multivariable logistic regression controlling for age at time of surgery, pre-BMI, percent total weight loss (%TWL) at nadir, weight regain at 3 years, hemoglobin A1C, referral to nutrition, trial of clomiphene, and use of IVF was then performed to determine significant predictors of pregnancy. A P value <0.05 considered statistically significant.
Results:
Eighty-three female patients were included in this study; of which, 54 patients (65.06%) had a successful pregnancy after referral to infertility clinic. Baseline characteristics were similar between the groups – Table 1. More patients in the unsuccessful pregnancy group were referred to nutrition (38.89% vs 62.07%), P=0.044) and there was an increased use of IVF in the successful pregnancy group (33.33% vs 68.97%), P=0.002). On multivariable logistic regression (Table 2), only age at time of sleeve gastrectomy and use of IVF were significant predictors for successful pregnancy [OR 0.73 (95% CI, 0.56 to 0.96); P=0.025 and OR 25.31 (95% CI, 1.54 to 414.83); P=0.024, respectively]. Weight loss and regain as well as initial BMI were not significant predictors of pregnancy.
Conclusion:
This study demonstrated that age at time of bariatric surgery and use of IVF were successful predictors of pregnancy. Interestingly, initial post-surgical weight loss, as well as weight regain from the nadir, did not seem to predict successful pregnancy. Future studies should continue to investigate the timing of IVF in this high-risk patient population.
Table 1: Baseline Characteristics of Sleeve Gastrectomy Patients Followed in a Reproductive Infertility Clinic
Table 2: Multivariable Logistic Regression Analysis: Independent Predictors of Successful Pregnancy Outcomes
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