Conception rates and contraceptive use after bariatric surgery among women with infertility: Evidence from a prospective multicenter cohort study

Marie N. Menke, Wendy C. King, Gretchen E. White, Gabriella G. Gosman, Anita P. Courcoulas, Gregory F. Dakin, David R. Flum, Molly J. Orcutt, Alfons Pomp, Walter J. Pories, Jonathan Purnell, Kristine J. Steffen, Bruce Wolfe, Susan Z. Yanovski

Research output: Contribution to journalArticle

Abstract

Background: Lack of prospective trials have resulted in a dearth of information regarding postbariatric surgery conception rates in women with a preoperative history of infertility. Objective: To examine associations between preoperative history of infertility and postbariatric surgery conception. Setting: A multicenter cohort study at 10 United States hospitals (2006–2009). Methods: Participants completed a preoperative reproductive health questionnaire, with annual postoperative assessments for up to 7 years until January 2015. This report was restricted to women 18- to 44-years old with no history of menopause, hysterectomy, or hormone replacement therapy. The primary outcomes were postoperative (0 to <90 mo) conception rate, early conception rate (0 < 18 mo), and postoperative unprotected intercourse with a male partner while not trying to conceive. Results: Of 740 eligible women, 650 (87.8%) provided required responses. Median interquartile range (IQR) preoperative age was 34 (30–39) years and follow-up was 6.5 (5.9–7.0) years. Nulliparous women with a preoperative history of infertility represented 8.0% (52/650) of the total cohort, 63.5% (33/52) of whom had never conceived. Compared with women without this history, these women had a higher postoperative conception rate (121.2 [95% confidence interval (CI), 102.3–143.5]/1000 versus 47.0 [95%CI, 34.2–62.9]/1000 woman-yr; P <.001), early conception rate (115.4 [95%CI, 96.1–138.5]/1000 versus 33.9 [95%CI, 23.6–47.1]/1,000 woman-yr; P <.01), and a higher risk of unprotected intercourse (ARR 1.48 [95% CI, 1.14-1.90], P = 0.003). Conclusion: After bariatric surgery, preoperative history of infertility and nulliparity was associated higher conception rates and unprotected intercourse.

Original languageEnglish (US)
JournalSurgery for Obesity and Related Diseases
DOIs
StatePublished - Jan 1 2019

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Bariatric Surgery
Contraceptive Agents
Infertility
Multicenter Studies
Cohort Studies
Confidence Intervals
State Hospitals
Hormone Replacement Therapy
Reproductive Health
Menopause
Parity
Hysterectomy
History

Keywords

  • Bariatric surgery
  • Conception
  • Contraception
  • Infertility

ASJC Scopus subject areas

  • Surgery

Cite this

Conception rates and contraceptive use after bariatric surgery among women with infertility : Evidence from a prospective multicenter cohort study. / Menke, Marie N.; King, Wendy C.; White, Gretchen E.; Gosman, Gabriella G.; Courcoulas, Anita P.; Dakin, Gregory F.; Flum, David R.; Orcutt, Molly J.; Pomp, Alfons; Pories, Walter J.; Purnell, Jonathan; Steffen, Kristine J.; Wolfe, Bruce; Yanovski, Susan Z.

In: Surgery for Obesity and Related Diseases, 01.01.2019.

Research output: Contribution to journalArticle

Menke, Marie N. ; King, Wendy C. ; White, Gretchen E. ; Gosman, Gabriella G. ; Courcoulas, Anita P. ; Dakin, Gregory F. ; Flum, David R. ; Orcutt, Molly J. ; Pomp, Alfons ; Pories, Walter J. ; Purnell, Jonathan ; Steffen, Kristine J. ; Wolfe, Bruce ; Yanovski, Susan Z. / Conception rates and contraceptive use after bariatric surgery among women with infertility : Evidence from a prospective multicenter cohort study. In: Surgery for Obesity and Related Diseases. 2019.
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title = "Conception rates and contraceptive use after bariatric surgery among women with infertility: Evidence from a prospective multicenter cohort study",
abstract = "Background: Lack of prospective trials have resulted in a dearth of information regarding postbariatric surgery conception rates in women with a preoperative history of infertility. Objective: To examine associations between preoperative history of infertility and postbariatric surgery conception. Setting: A multicenter cohort study at 10 United States hospitals (2006–2009). Methods: Participants completed a preoperative reproductive health questionnaire, with annual postoperative assessments for up to 7 years until January 2015. This report was restricted to women 18- to 44-years old with no history of menopause, hysterectomy, or hormone replacement therapy. The primary outcomes were postoperative (0 to <90 mo) conception rate, early conception rate (0 < 18 mo), and postoperative unprotected intercourse with a male partner while not trying to conceive. Results: Of 740 eligible women, 650 (87.8{\%}) provided required responses. Median interquartile range (IQR) preoperative age was 34 (30–39) years and follow-up was 6.5 (5.9–7.0) years. Nulliparous women with a preoperative history of infertility represented 8.0{\%} (52/650) of the total cohort, 63.5{\%} (33/52) of whom had never conceived. Compared with women without this history, these women had a higher postoperative conception rate (121.2 [95{\%} confidence interval (CI), 102.3–143.5]/1000 versus 47.0 [95{\%}CI, 34.2–62.9]/1000 woman-yr; P <.001), early conception rate (115.4 [95{\%}CI, 96.1–138.5]/1000 versus 33.9 [95{\%}CI, 23.6–47.1]/1,000 woman-yr; P <.01), and a higher risk of unprotected intercourse (ARR 1.48 [95{\%} CI, 1.14-1.90], P = 0.003). Conclusion: After bariatric surgery, preoperative history of infertility and nulliparity was associated higher conception rates and unprotected intercourse.",
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author = "Menke, {Marie N.} and King, {Wendy C.} and White, {Gretchen E.} and Gosman, {Gabriella G.} and Courcoulas, {Anita P.} and Dakin, {Gregory F.} and Flum, {David R.} and Orcutt, {Molly J.} and Alfons Pomp and Pories, {Walter J.} and Jonathan Purnell and Steffen, {Kristine J.} and Bruce Wolfe and Yanovski, {Susan Z.}",
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T2 - Evidence from a prospective multicenter cohort study

AU - Menke, Marie N.

AU - King, Wendy C.

AU - White, Gretchen E.

AU - Gosman, Gabriella G.

AU - Courcoulas, Anita P.

AU - Dakin, Gregory F.

AU - Flum, David R.

AU - Orcutt, Molly J.

AU - Pomp, Alfons

AU - Pories, Walter J.

AU - Purnell, Jonathan

AU - Steffen, Kristine J.

AU - Wolfe, Bruce

AU - Yanovski, Susan Z.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Lack of prospective trials have resulted in a dearth of information regarding postbariatric surgery conception rates in women with a preoperative history of infertility. Objective: To examine associations between preoperative history of infertility and postbariatric surgery conception. Setting: A multicenter cohort study at 10 United States hospitals (2006–2009). Methods: Participants completed a preoperative reproductive health questionnaire, with annual postoperative assessments for up to 7 years until January 2015. This report was restricted to women 18- to 44-years old with no history of menopause, hysterectomy, or hormone replacement therapy. The primary outcomes were postoperative (0 to <90 mo) conception rate, early conception rate (0 < 18 mo), and postoperative unprotected intercourse with a male partner while not trying to conceive. Results: Of 740 eligible women, 650 (87.8%) provided required responses. Median interquartile range (IQR) preoperative age was 34 (30–39) years and follow-up was 6.5 (5.9–7.0) years. Nulliparous women with a preoperative history of infertility represented 8.0% (52/650) of the total cohort, 63.5% (33/52) of whom had never conceived. Compared with women without this history, these women had a higher postoperative conception rate (121.2 [95% confidence interval (CI), 102.3–143.5]/1000 versus 47.0 [95%CI, 34.2–62.9]/1000 woman-yr; P <.001), early conception rate (115.4 [95%CI, 96.1–138.5]/1000 versus 33.9 [95%CI, 23.6–47.1]/1,000 woman-yr; P <.01), and a higher risk of unprotected intercourse (ARR 1.48 [95% CI, 1.14-1.90], P = 0.003). Conclusion: After bariatric surgery, preoperative history of infertility and nulliparity was associated higher conception rates and unprotected intercourse.

AB - Background: Lack of prospective trials have resulted in a dearth of information regarding postbariatric surgery conception rates in women with a preoperative history of infertility. Objective: To examine associations between preoperative history of infertility and postbariatric surgery conception. Setting: A multicenter cohort study at 10 United States hospitals (2006–2009). Methods: Participants completed a preoperative reproductive health questionnaire, with annual postoperative assessments for up to 7 years until January 2015. This report was restricted to women 18- to 44-years old with no history of menopause, hysterectomy, or hormone replacement therapy. The primary outcomes were postoperative (0 to <90 mo) conception rate, early conception rate (0 < 18 mo), and postoperative unprotected intercourse with a male partner while not trying to conceive. Results: Of 740 eligible women, 650 (87.8%) provided required responses. Median interquartile range (IQR) preoperative age was 34 (30–39) years and follow-up was 6.5 (5.9–7.0) years. Nulliparous women with a preoperative history of infertility represented 8.0% (52/650) of the total cohort, 63.5% (33/52) of whom had never conceived. Compared with women without this history, these women had a higher postoperative conception rate (121.2 [95% confidence interval (CI), 102.3–143.5]/1000 versus 47.0 [95%CI, 34.2–62.9]/1000 woman-yr; P <.001), early conception rate (115.4 [95%CI, 96.1–138.5]/1000 versus 33.9 [95%CI, 23.6–47.1]/1,000 woman-yr; P <.01), and a higher risk of unprotected intercourse (ARR 1.48 [95% CI, 1.14-1.90], P = 0.003). Conclusion: After bariatric surgery, preoperative history of infertility and nulliparity was associated higher conception rates and unprotected intercourse.

KW - Bariatric surgery

KW - Conception

KW - Contraception

KW - Infertility

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