Background

Polycystic ovarian syndrome (PCOS), a metabolic disease for which weight loss is a mainstay of treatment, is a significant public health problem and a leading cause of infertility. Bariatric surgery presents a potential avenue for resolution of PCOS and its symptoms.

Methods

A retrospective chart review of patients with PCOS who had bariatric surgery at our institution between 2014 and 2023 was performed. This was supplemented with an optional phone survey to determine the efficacy of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for PCOS resolution. Post-operative weight loss, improvement of PCOS symptoms including infertility, and discontinuation of PCOS treatment were analyzed using multivariable regression analysis.

Results

In total, 41 patients were identified, 22 SG vs. 19 RYGB. Seven of these patients were available for telephonic survey, five of whom described PCOS symptoms as a primary motivator in pursuing bariatric surgery. Significant improvement was seen with regard to abnormal menstruation (n=28, 60.7%), especially in those with lower pre-operative BMI (p=0.02). In patients of child-bearing age with infertility pre-operatively, 100% achieved pregnancy post-operatively (n=11). Of 29 patients with pre-operative PCOS treatment, 48.3% discontinued treatment post-operatively. Surgical method was not a statistically significant factor.

Conclusions

Bariatric surgery offers the most effective available treatment for patients with obesity and PCOS, particularly those with infertility. SG and RYGB are equally successful, and earlier operations may benefit those wishing to conceive. In order to better track outcomes in this important patient population, PCOS should be added as a variable to the MBSAQIP database