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IMPACT OF ENDOSCOPIC BARIATRIC AND METABOLIC THERAPY ON REPRODUCTIVE OUTCOMES IN WOMEN WITH OBESITY: A 8-YEAR RETROSPECTIVE ANALYSIS
Kimberly F. Schuster
*1,2, Alexandra Goad
3, Cem Simsek
4, Christopher C. Thompson
11Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; 2Tufts Medical Center, Boston, MA; 3University of Louisville Hospital, Louisville, KY; 4Hacettepe Universitesi, Ankara, Ankara, Turkey
BackgroundObesity contributes significantly to infertility and pregnancy complications through its effects on hormonal regulation and metabolic health. Endoscopic Bariatric and Metabolic Therapy (EBMT) offers a minimally invasive weight-loss option, but its impact on reproductive health remains underexplored. This study assesses the effects of EBMT on fertility and pregnancy outcomes.
MethodsThis was a retrospective study of reproductive-aged women (18-45 years) who underwent EBMT between 2015 and 2023. Patients were excluded if they did not attempt conception or had pre-existing conditions independently impairing fertility. Primary outcomes included post-EBMT conception rates and pregnancy complications. Secondary outcomes included time-to-conception, %TBWL, and perinatal outcomes. Statistical tests included Spearman correlation, Wilcoxon signed-rank, and multivariate regression (p<0.05).
ResultsA total of 249 women (mean age 35.1 ± 3.2 years) were included, with 32.9% White, 45.0% Hispanic, and 22.1% Black, and a mean pre-EBMT BMI of 38.9 ± 9.1 kg/m2. Of these, 43.8% underwent primary weight-loss procedures (ESG, POSE, intragastric balloon) and 56.2% had revisional procedures (TORe, ROSE). Median %TBWL was 13.5% (IQR 11.0–16.8%) at 6 months, 18.2% (IQR 15.1–20.5%) at 12 months, and 19.1% (IQR 17.4–21.3%) at 24 months. PCOS rates declined from 22.1% pre-EBMT to 16.5% (n=41) at 2 years, with menstrual regularity restored in 77.1% of patients with prior oligoamenorrhea. Among 112 women with prior pregnancies, miscarriage rates declined from 34.4% to 12.5% (p=0.014). Approximately 25% of patients utilized in-vitrofertilization both before and after EBMT, however success rates rose from 38.0% to 59.1% (p=0.02). Median time to conception was 14 months (IQR 10–19 months). Cesarean delivery rates decreased from 51.0% to 25.0% (p=0.04), correlating with greater %TBWL (r=0.35, p=0.03). Preeclampsia rates significantly decreased (p<0.001), while gestational diabetes and placenta previa showed no significant changes. Higher %TBWL was associated with increased rate of infants born small for gestational age (SGA) (p=0.04). Regression analysis revealed primary weight loss procedures (p=0.02) and greater %TBWL at 12 months (p=0.04) as predictors of higher post-EBMT conception rates. Median follow-up time was 25 months (IQR 19-30).
DiscussionEBMT improves reproductive outcomes in women with obesity, reducing miscarriage and complication rates while increasing IVF success. Primary weight-loss procedures and greater %TBWL at 12 months were key predictors of higher conception rates. The rise in SGA infants highlights the need for careful nutritional monitoring. These findings support EBMT as a valuable tool for addressing obesity-related infertility and providing hope to patients facing infertility's physical and emotional toll.
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