Role of Metabolic Surgery in Polycystic Ovarian Disease with Obesity in the Asian Population: A Systematic Narrative Literature Review

Abstract

Polycystic ovarian syndrome is becoming more prevalent (up to 13%) among young women of reproductive age with obesity. Lifestyle modifications remain the first line of management of obesity in these individuals. Bariatric and metabolic surgery (BMS) has a role in achieving significant and sustained weight loss in cases where lifestyle modifications alone are not effective. A detailed systematic narrative literature review was undertaken to understand the role of BMS in this subset of individuals to help recommend management strategies in women with polycystic ovarian syndrome, obesity, and infertility among the Asian population. BMS has been documented to correct menstrual irregularities (from 81% to 15%, odds ratio = 0.03, 95% confidence interval: 0.01–0.08), hirsutism from 71% to 38% (odds ratio = 0.21, 95% confidence interval: 0.06–0.74), and endocrine abnormalities associated with polycystic ovarian syndrome. Improvement in infertility (high incidence of nearly 58%) was noted with normalization of the body mass index (BMI) postsurgery in some studies. Larger sample size studies with a longer follow-up are required to enable the development of guidelines on the role of BMS in the improvement of infertility in patients with polycystic ovarian syndrome. The superiority of one type of technique of BMS has not been demonstrated for improving the fertility rates (P = 0.9) among the different types of surgical procedures and pregnancy rates. Different regions of the world will need different BMI cutoffs while managing the endocrine abnormalities, menstrual irregularities, and associated infertility of women with polycystic ovarian syndrome and obesity. This systematic narrative literature review is an attempt to study the relevant literature in this field with a special focus on the Asian population.