Bariatric Surgery as a Molecular Modulator: The Role of FSHR Polymorphisms in Enhancing eNOS Expression and Reproductive Hormone Dynamics in Women with Severe Obesity

This study examines the effects of bariatric surgery on women with severe obesity (BMI > 40 kg/m²), with a focus on eNOS expression and reproductive hormone modulation across follicle-stimulating hormone receptor (FSHR) polymorphism groups. Among 29 patients, significant increases in eNOS expression after surgery were seen across all polymorphism groups (p < 0.0001), with the Ser/Ser group demonstrating the most heterogeneity. Pre-surgery, the Ser/Ser group had significantly higher FSH levels (7.41 ± 0.60 mIU/mL) than the Asn/Asn group (5.20 ± 0.63 mIU/mL, p < 0.001). After surgery, FSH levels were higher in the Ser/Ser group (9.45 ± 0.87 mIU/mL), with significant differences between Ser/Ser and Asn/Ser groups (mean difference = 0.97, p = 0.019). SHBG levels showed a strong negative connection with eNOS expression after surgery (r = -0.365, p = 0.049), while ovarian reserve markers like AMH and AFC were consistent between polymorphism groups. BMI reduction was consistent across groups, with an average decrease of 15.2 ± 1.8 kg six months after surgery. These findings underscore the dual function of bariatric surgery in improving vascular health and regulating reproductive hormones, particularly in patients with the Ser/Ser genotype. The findings highlight the potential for combining genetic testing with surgical intervention to customize infertility treatment in obese women.