Impact of Sleeve Gastrectomy on Obesity Indices, Reproductive Hormones, and Follicular Quality: A 12-Month Prospective Study

Impact of Sleeve Gastrectomy on Obesity Indices, Reproductive Hormones, and Follicular Quality: A 12-Month Prospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Sleeve Gastrectomy on Obesity Indices, Reproductive Hormones, and Follicular Quality: A 12-Month Prospective Study Kyriakos Bananis, Charambos Voros, Evangelos Menenakos, Georgios Zografos, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9050251/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Obesity impairs reproductive health through hormonal imbalances and insulin resistance. This prospective study evaluated the effects of laparoscopic sleeve gastrectomy on obesity indices, reproductive hormones, and ovarian reserve in 32 morbidly obese women over 12 months. Assessments at baseline, 6, and 12 months measured BMI, anti-Müllerian hormone (AMH), antral follicle count (AFC), follicle-stimulating hormone (FSH), luteinizing hormone (LH), sex hormone-binding globulin (SHBG), estradiol, free testosterone, and HOMA-IR. BMI decreased from 42.12 (± 0.45) to 25.65 (± 0.34), AMH from 3.0 to 2.0 ng/mL, and AFC from 11 to 6–7 per ovary (all p < 0.001). Concurrently, SHBG increased (36 to 64 nmol/L), free testosterone decreased (29 to 9 ng/dL), and HOMA-IR improved from 3.8 (± 0.9) to 1.2 (± 0.3) (p < 0.001). Despite reduced AMH and AFC, enhanced hormonal profiles and insulin sensitivity suggest improved follicular quality, indicating normalized ovarian function and reproductive potential post-surgery. Sleeve gastrectomy thus offers metabolic and reproductive benefits, prioritizing follicle quality over quantity, with implications for fertility management in obese women. Bariatric surgery sleeve gastrectomy reproductive hormones ovarian reserve follicular quality insulin resistance Figures Figure 1 Figure 2 Figure 3 1. Introduction Obesity disrupts reproductive health by altering ovarian function through hormonal imbalances—elevated androgens, reduced SHBG—and metabolic disturbances like insulin resistance and chronic inflammation [ 1 , 2 ]. These changes impair ovulation, oocyte quality, and fertility, particularly in morbidly obese women (BMI > 40 kg/m²) [ 3 ]. Sleeve gastrectomy, a cornerstone of bariatric surgery, promotes substantial weight loss and metabolic improvement, potentially restoring hormonal balance and reproductive function [ 4 , 5 ]. However, its effects on ovarian reserve markers, such as AMH and AFC, remain debated. While AMH reductions post-surgery are documented [ 6 ], their implications—diminished fertility or physiological normalization—require clarification. We hypothesized that sleeve gastrectomy enhances follicular quality despite AMH and AFC declines, driven by improved hormonal and metabolic profiles. This 12-month prospective study investigates these changes in 32 morbidly obese women, exploring the interplay between weight loss, reproductive hormones, and ovarian function. 2. Materials and Methods 2.1 Study Design This prospective observational study enrolled 32 morbidly obese women undergoing laparoscopic sleeve gastrectomy at Hippokration General Hospital, Athens, from January 2021 to February 2022. 2.2 Participants Inclusion criteria included women aged 18–50 years with BMI > 40 kg/m², no menopause history, and consent to participate. Exclusion criteria comprised polycystic ovary syndrome (PCOS), recent reproductive surgery (past 6 months), or medications affecting fertility. 2.3 Assessments Data were collected at baseline (pre-surgery), 6 months, and 12 months post-surgery: Hormonal Analysis : Blood samples, drawn during the follicular phase (days 2–5), measured AMH (ELISA, Beckman Coulter, sensitivity 0.08 ng/mL), FSH, LH, SHBG, estradiol, and free testosterone (chemiluminescent immunoassays, Roche Diagnostics). Insulin resistance was assessed via HOMA-IR: [insulin (µU/L) × glucose (mg/dL)] / 405. Ovarian Function : See Section 2.4 for transvaginal ultrasound details. BMI : Calculated as weight (kg) / height (m²). 2.4 Transvaginal Ultrasound Monitoring Ovarian function was assessed using transvaginal ultrasound (TVUS) with a GE Voluson E8 system (6–9 MHz probe). Scans were performed by a single experienced ultrasonographer during the early follicular phase (days 2–5) to count antral follicles (2–10 mm diameter) in both ovaries. Three scans were conducted per participant: pre-surgery (baseline), 6 months post-surgery, and 12 months post-surgery. Each session lasted approximately 15 minutes, with patients in the lithotomy position. AFC was recorded as the sum of follicles per ovary, ensuring consistency across time points. The procedure adhered to standard gynecological ultrasound protocols, with minimal discomfort reported. Ethical oversight ensured participant safety and data confidentiality, with ultrasound findings anonymized and stored securely. 2.5 Statistical Analysis Data were analyzed using SPSS v.27. Descriptive statistics (mean ± SD) summarized baseline and follow-up measures. Due to non-normal distributions (Shapiro-Wilk test, p < 0.05), Wilcoxon signed-rank tests assessed paired differences, and Spearman correlations evaluated associations. Significance was set at p < 0.05 (two-sided). 3. Results 3.1 Baseline Characteristics Participants (n = 32) had a mean age of 33.0 (± 4.0) years and BMI of 42.12 (± 0.45) kg/m². Baseline reproductive parameters included AMH (3.0 ± 0.0 ng/mL), AFC (11.0 ± 2.0 right, 11.0 ± 1.0 left), FSH (6.0 ± 1.0 mIU/mL), LH (7.0 ± 1.0 mIU/mL), SHBG (36.0 ± 7.0 nmol/L), estradiol (31.0 ± 4.0 pg/mL), free testosterone (29.0 ± 9.0 ng/dL), and HOMA-IR (3.8 ± 0.9) (Table 1 ). Table 1 Baseline Characteristics of 32 Morbidly Obese Women Parameter Mean SD Age (years) 33.0 4.0 BMI (kg/m²) 42.12 0.45 AMH (ng/mL) 3.0 0.0 AFC—Right Ovary 11.0 2.0 AFC—Left Ovary 11.0 1.0 FSH (mIU/mL) 6.0 1.0 LH (mIU/mL) 7.0 1.0 SHBG (nmol/L) 36.0 7.0 Estradiol (pg/mL) 31.0 4.0 Free Testosterone (ng/dL) 29.0 9.0 HOMA-IR 3.8 0.9 Table 2 Changes in Parameters at 6 Months Post-Sleeve Gastrectomy Parameter Baseline (Mean ± SD) 6 Months (Mean ± SD) Difference (Mean ± SD) P-value BMI (kg/m²) 42.12 ± 0.45 32.87 ± 1.01 -9.24 ± 0.91 < 0.001 AMH (ng/mL) 3.0 ± 0.2 2.5 ± 0.3 -0.62 ± 0.25 < 0.001 AFC—Right Ovary 11.0 ± 2.0 9.0 ± 1.0 -2.63 ± 1.66 < 0.001 AFC—Left Ovary 11.0 ± 1.0 8.0 ± 1.0 -3.03 ± 1.47 < 0.001 Table 3 Changes in Parameters at 12 Months Post-Sleeve Gastrectomy Parameter Baseline (Mean ± SD) 12 Months (Mean ± SD) Difference (Mean ± SD) P-value BMI (kg/m²) 42.12 ± 0.45 25.65 ± 0.34 -16.47 ± 0.66 < 0.001 AMH (ng/mL) 3.0 ± 0.2 2.0 ± 0.2 -0.92 ± 0.30 < 0.001 AFC—Right Ovary 11.0 ± 2.0 7.0 ± 1.0 -4.31 ± 2.01 < 0.001 AFC—Left Ovary 11.0 ± 1.0 6.0 ± 1.0 -4.88 ± 1.52 < 0.001 FSH (mIU/mL) 6.0 ± 1.0 9.0 ± 1.0 + 2.83 ± 1.03 < 0.001 LH (mIU/mL) 7.0 ± 1.0 9.0 ± 1.0 + 2.04 ± 1.46 < 0.001 SHBG (nmol/L) 36.0 ± 7.0 64.0 ± 12.0 + 27.51 ± 8.72 < 0.001 Estradiol (pg/mL) 31.0 ± 4.0 49.0 ± 4.0 + 18.16 ± 4.75 < 0.001 Free Testosterone (ng/dL) 29.0 ± 9.0 9.0 ± 2.0 -19.35 ± 8.70 < 0.001 HOMA-IR 3.8 ± 0.9 1.2 ± 0.3 -2.60 ± 0.78 < 0.001 3.2 Post-Surgery Changes At 6 months, BMI decreased to 32.87 (± 1.01) kg/m², AMH to 2.5 (± 0.3) ng/mL, and AFC to 9.0 (± 1.0) and 8.0 (± 1.0) for right and left ovaries, respectively (all p < 0.001, Table 2 ). By 12 months, BMI fell to 25.65 (± 0.34) kg/m², AMH to 2.0 (± 0.2) ng/mL, and AFC to 7.0 (± 1.0) and 6.0 (± 1.0) (p < 0.001). Hormonal shifts included FSH rising to 9.0 (± 1.0) mIU/mL, LH to 9.0 (± 1.0) mIU/mL, SHBG to 64.0 (± 12.0) nmol/L, estradiol to 49.0 (± 4.0) pg/mL, free testosterone dropping to 9.0 (± 2.0) ng/dL, and HOMA-IR improving to 1.2 (± 0.3) (p < 0.001, Table 3 ). Trends are visualized in Fig. 1 . 3.3 Correlations HOMA-IR negatively correlated with SHBG (r=-0.45, p = 0.01) and positively with free testosterone (r = 0.55, p = 0.004), while AMH and AFC showed a strong positive association (r = 0.65, p = 0.001) at 12 months (Fig. 2 ). Hormonal and metabolic improvements are summarized in Fig. 3 . 4. Discussion The reductions in AMH and AFC post-sleeve gastrectomy, alongside hormonal restoration, suggest a normalization of ovarian function rather than diminished fertility. Our study revealed an apparent paradox: while hormonal profiles improved, AMH and AFC decreased. However, a closer analysis of the data and existing literature indicates that these changes are not necessarily linked to negative reproductive outcomes. 4.1 Controversial Findings on AMH and Weight Loss AMH serves as a marker of ovarian reserve, produced by granulosa cells of developing follicles. In most studies, AMH correlates directly with antral follicle count (AFC) and typically reflects the number of available follicles in the ovaries [26]. In patients with polycystic ovary syndrome (PCOS), AMH levels are often elevated due to an increased number of small follicles [ 8 ]. Regarding weight loss following bariatric surgery, the data are conflicting. Some studies report a decrease in AMH post-surgery, potentially due to a reduction in overall ovarian mass and the number of small follicles, particularly in women with PCOS who initially exhibit elevated AMH levels [ 6 , 7 ]. This reduction may result from the gradual normalization of ovarian function and the elimination of excessive folliculogenesis commonly observed in PCOS [26]. Conversely, other studies suggest AMH may increase post-bariatric surgery, reflecting individual variability or different surgical impacts [ 9 ]. Our findings align with the former, showing a consistent AMH decline (3.0 to 2.0 ng/mL) alongside AFC reductions, suggesting a quantitative shift in ovarian dynamics. 4.2 Follicular Quality Despite the decline in AMH levels and follicle count, hormonal changes—such as the restoration of FSH (6.0 to 9.0 mIU/mL), LH (7.0 to 9.0 mIU/mL), and SHBG (36.0 to 64.0 nmol/L)—may indicate a qualitative improvement in follicles [ 10 ]. Enhanced hormonal profiles likely contribute to better overall ovarian function and the development of higher-quality follicles, as weight loss is often accompanied by improvements in metabolic health and insulin sensitivity [ 13 ]. The higher quality of remaining follicles could imply improved oocyte maturation and enhanced reproductive prospects, even with a reduced follicle count. Specifically, the observed increase in SHBG and decrease in free testosterone (29.0 to 9.0 ng/dL) post-surgery suggest significantly improved hormonal conditions, creating a more favorable environment for the development of better follicles and potentially superior reproductive outcomes [ 11 ]. These findings are consistent with reports that weight loss mitigates hyperandrogenism, a key barrier to ovulation [ 15 ]. 4.3 Metabolic Health and Fertility Another key finding is the direct link between metabolic health and reproductive function. Bariatric surgery markedly improves metabolic function, reducing insulin resistance (HOMA-IR from 3.8 to 1.2) and associated endocrine disturbances tied to obesity [ 14 ]. These metabolic improvements are well-documented to support the restoration of ovulation and enhance fertility, even in women without PCOS [ 12 ]. As noted elsewhere, despite AMH reductions post-weight loss, women undergoing bariatric surgery often exhibit overall improvements in reproductive health, reinforcing the idea that follicle and oocyte quality improve [27]. The strong negative correlation between HOMA-IR and SHBG (r=-0.45, p = 0.01) and positive correlation with free testosterone (r = 0.55, p = 0.004) underscore how metabolic correction drives hormonal normalization. 4.4 Quality as a Critical Factor The enhancement of the hormonal profile post-surgery is a pivotal finding. Increased FSH, LH, and SHBG, alongside reduced free testosterone, contribute to better follicular quality [ 10 ]. Studies demonstrate that follicles remaining after surgery are often of superior quality, despite their reduced number, due to more favorable hormonal conditions for normal oocyte development and maturation [ 13 ]. Furthermore, the reduction in free testosterone and rise in SHBG alleviate hyperandrogenism, which frequently hinders ovulation, resulting in follicles with improved maturation and fertilization potential [28]. The rise in estradiol (31.0 to 49.0 pg/mL) further supports enhanced follicular development, aligning with improved ovarian steroidogenesis post-weight loss [ 16 ]. 4.5 Clinical Implications AMH and AFC reductions post-surgery should be interpreted as physiological normalization, not infertility markers. Clinicians should prioritize follicular quality over quantity when assessing reproductive potential post-bariatric surgery, using hormonal profiles as key indicators. 4.6 Limitations and Future Directions Limitations : Small sample size (n = 32), 12-month follow-up, and focus on sleeve gastrectomy limit generalizability. Future Directions : Larger cohorts, longer follow-ups (e.g., 18 months), and fertility outcome assessments (e.g., pregnancy rates) are needed. Comparative studies with other bariatric procedures could further elucidate effects. 5. Conclusion Bariatric surgery markedly improves metabolic and reproductive health in morbidly obese women. Over 12 months, BMI, AMH, and AFC decreased, while SHBG, FSH, LH, and insulin sensitivity (HOMA-IR: 3.8 to 1.2) improved, alongside reduced free testosterone (all p < 0.001). These changes suggest enhanced follicular quality despite lower ovarian reserve markers, reflecting normalized ovarian function and potential fertility gains. By prioritizing quality over quantity, sleeve gastrectomy offers a dual benefit—metabolic correction and reproductive optimization—highlighting its value in obesity management. Long-term studies are needed to confirm these reproductive outcomes. Declarations Author Contribution K.B. conceived and designed the study, performed the statistical analysis, interpreted the data, and wrote the main manuscript text. C.V. was responsible for patient sample collection and contributed to data analysis, along with G.D.E.M. contributed to patient recruitment and provided clinical guidance throughout the study. G.Z. and D.T. supervised the research project and provided critical revisions of the manuscript. All authors reviewed and approved the final version of the manuscript. Data Availability The datasets generated and analyzed during the current study are not publicly available due to patient privacy and institutional ethical restrictions but are available from the corresponding author on reasonable request. References Lin X, Li H, Obesity. Epidemiology, pathophysiology, and therapeutics. Front Endocrinol (Lausanne). 2021;12:706978. 10.3389/fendo.2021.706978 . Ylli D, Sidhu S, Parikh T, Burman KD. Endocrine changes in obesity. In: Feingold KR, Anawalt B, Blackman MR, et al. editors. Endotext. South Dartmouth (MA). MDText.com, Inc.; 2022. (NCBI Bookshelf). Al Qurashi AA, Qadri SH, Lund S, et al. The effects of bariatric surgery on male and female fertility: a systematic review and meta-analysis. Ann Med Surg (Lond). 2022;80:103881. 10.1016/j.amsu.2022.103881 . Aderinto N, Olatunji G, Kokori E, et al. Recent advances in bariatric surgery: a narrative review of weight loss procedures. Ann Med Surg (Lond). 2023;85(12):6091–104. 10.1097/MS9.0000000000001472 . Pg Baharuddin DM, Payus AO, Abdel Malek Fahmy EH, et al. Bariatric surgery and its impact on fertility, pregnancy and its outcome: a narrative review. Ann Med Surg (Lond). 2021;72:103038. 10.1016/j.amsu.2021.103038 . Pilone V, Tramontano S, Renzulli M, et al. Evaluation of anti-Müllerian hormone levels in obese women after sleeve gastrectomy. Gynecol Endocrinol. 2019;35(6):548–51. 10.1080/09513590.2018.1559285 . Merhi Z, Bazzi AA, Bonney EA, Buyuk E. Role of adiponectin in ovarian follicular development and ovarian reserve. Biomed Rep. 2019;10(6):337–42. 10.3892/br.2019.1213 . Barber TM, Hanson P, Weickert MO, Franks S. Obesity and polycystic ovary syndrome: implications for pathogenesis and novel management strategies. Clin Med Insights Reprod Health. 2019;13:1179558119874042. 10.1177/1179558119874042 . Buyukkaba M, Turgut S, Ilhan MM, et al. Anti-Müllerian hormone levels increase after bariatric surgery in obese female patients with and without polycystic ovary syndrome. Horm Metab Res. 2022;54(3):194–8. 10.1055/a-1756-4798 . Anbara T. Hormonal changes in women undergoing bariatric surgery: a comparative study with a control group. Dev Reprod. 2023;27(3):117–26. 10.12717/DR.2023.27.3.117 . Round P, Das S, Wu TS, et al. Molecular interactions between sex hormone-binding globulin and nonsteroidal ligands that enhance androgen activity. J Biol Chem. 2020;295(5):1202–11. 10.1074/jbc.RA119.011051 . Nguyen NT, Varela JE. Bariatric surgery and fertility outcomes. Surg Obes Relat Dis. 2021;17(6):1021–8. 10.1016/j.soard.2021.02.015 . Sarwer DB, Spitzer JC, Wadden TA, et al. Changes in sexual functioning and sex hormone levels in women following bariatric surgery. JAMA Surg. 2014;149(1):26–33. 10.1001/jamasurg.2013.5022 . Yin M, Wang Y, Han M, et al. Mechanisms of bariatric surgery for weight loss and diabetes remission. J Diabetes. 2023;15(9):736–52. 10.1111/1753-0407.13443 . Shabbir A, Dargan D. The success of sleeve gastrectomy in the management of metabolic syndrome and obesity. J Biomed Res. 2015;29(2):93–7. 10.7555/JBR.28.20140107 . Kjær MM, Madsbad S, Hougaard DM, et al. The impact of gastric bypass surgery on sex hormones and menstrual cycles in premenopausal women. Gynecol Endocrinol. 2017;33(2):160–3. 10.1080/09513590.2016.1236243 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 09 May, 2026 Reviewers agreed at journal 15 Apr, 2026 Reviews received at journal 23 Mar, 2026 Reviewers agreed at journal 23 Mar, 2026 Reviewers agreed at journal 21 Mar, 2026 Reviewers invited by journal 20 Mar, 2026 Editor assigned by journal 13 Mar, 2026 Submission checks completed at journal 10 Mar, 2026 First submitted to journal 06 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9050251","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":610797843,"identity":"c9cf27d3-9031-405d-8fec-939de42ea451","order_by":0,"name":"Kyriakos Bananis","email":"","orcid":"","institution":"King's College Hospital NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Kyriakos","middleName":"","lastName":"Bananis","suffix":""},{"id":610797844,"identity":"b02b1cd6-59c5-468a-ba1e-a777757e6b11","order_by":1,"name":"Charambos 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02:34:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":678201,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelations at 12 Months\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-9050251/v1/b7748e5e84bb5112544a7f12.png"},{"id":105431615,"identity":"ccb60b87-88f0-4499-9527-ef51b7cbbfb6","added_by":"auto","created_at":"2026-03-26 02:34:11","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":376411,"visible":true,"origin":"","legend":"\u003cp\u003eHormonal and metabolic shifts at 12 months\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-9050251/v1/2dcd71bad398398ef198ee4c.png"},{"id":105571015,"identity":"6ca3f7d6-190c-4f00-8862-6b2aab7486db","added_by":"auto","created_at":"2026-03-27 13:21:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2150049,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9050251/v1/3d4a2937-4ef0-454b-a504-f10178f7f865.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Sleeve Gastrectomy on Obesity Indices, Reproductive Hormones, and Follicular Quality: A 12-Month Prospective Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eObesity disrupts reproductive health by altering ovarian function through hormonal imbalances\u0026mdash;elevated androgens, reduced SHBG\u0026mdash;and metabolic disturbances like insulin resistance and chronic inflammation [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These changes impair ovulation, oocyte quality, and fertility, particularly in morbidly obese women (BMI\u0026thinsp;\u0026gt;\u0026thinsp;40 kg/m\u0026sup2;) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Sleeve gastrectomy, a cornerstone of bariatric surgery, promotes substantial weight loss and metabolic improvement, potentially restoring hormonal balance and reproductive function [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, its effects on ovarian reserve markers, such as AMH and AFC, remain debated. While AMH reductions post-surgery are documented [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], their implications\u0026mdash;diminished fertility or physiological normalization\u0026mdash;require clarification. We hypothesized that sleeve gastrectomy enhances follicular quality despite AMH and AFC declines, driven by improved hormonal and metabolic profiles. This 12-month prospective study investigates these changes in 32 morbidly obese women, exploring the interplay between weight loss, reproductive hormones, and ovarian function.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Design\u003c/h2\u003e \u003cp\u003eThis prospective observational study enrolled 32 morbidly obese women undergoing laparoscopic sleeve gastrectomy at Hippokration General Hospital, Athens, from January 2021 to February 2022.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Participants\u003c/h2\u003e \u003cp\u003eInclusion criteria included women aged 18\u0026ndash;50 years with BMI\u0026thinsp;\u0026gt;\u0026thinsp;40 kg/m\u0026sup2;, no menopause history, and consent to participate. Exclusion criteria comprised polycystic ovary syndrome (PCOS), recent reproductive surgery (past 6 months), or medications affecting fertility.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Assessments\u003c/h2\u003e \u003cp\u003eData were collected at baseline (pre-surgery), 6 months, and 12 months post-surgery:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eHormonal Analysis\u003c/b\u003e: Blood samples, drawn during the follicular phase (days 2\u0026ndash;5), measured AMH (ELISA, Beckman Coulter, sensitivity 0.08 ng/mL), FSH, LH, SHBG, estradiol, and free testosterone (chemiluminescent immunoassays, Roche Diagnostics). Insulin resistance was assessed via HOMA-IR: [insulin (\u0026micro;U/L) \u0026times; glucose (mg/dL)] / 405.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eOvarian Function\u003c/b\u003e: See Section \u003cspan refid=\"Sec6\" class=\"InternalRef\"\u003e2.4\u003c/span\u003e for transvaginal ultrasound details.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eBMI\u003c/b\u003e: Calculated as weight (kg) / height (m\u0026sup2;).\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Transvaginal Ultrasound Monitoring\u003c/h2\u003e \u003cp\u003eOvarian function was assessed using transvaginal ultrasound (TVUS) with a GE Voluson E8 system (6\u0026ndash;9 MHz probe). Scans were performed by a single experienced ultrasonographer during the early follicular phase (days 2\u0026ndash;5) to count antral follicles (2\u0026ndash;10 mm diameter) in both ovaries. Three scans were conducted per participant: pre-surgery (baseline), 6 months post-surgery, and 12 months post-surgery. Each session lasted approximately 15 minutes, with patients in the lithotomy position. AFC was recorded as the sum of follicles per ovary, ensuring consistency across time points. The procedure adhered to standard gynecological ultrasound protocols, with minimal discomfort reported. Ethical oversight ensured participant safety and data confidentiality, with ultrasound findings anonymized and stored securely.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Statistical Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS v.27. Descriptive statistics (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) summarized baseline and follow-up measures. Due to non-normal distributions (Shapiro-Wilk test, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), Wilcoxon signed-rank tests assessed paired differences, and Spearman correlations evaluated associations. Significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (two-sided).\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Baseline Characteristics\u003c/h2\u003e \u003cp\u003eParticipants (n\u0026thinsp;=\u0026thinsp;32) had a mean age of 33.0 (\u0026plusmn;\u0026thinsp;4.0) years and BMI of 42.12 (\u0026plusmn;\u0026thinsp;0.45) kg/m\u0026sup2;. Baseline reproductive parameters included AMH (3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0 ng/mL), AFC (11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0 right, 11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 left), FSH (6.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 mIU/mL), LH (7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 mIU/mL), SHBG (36.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0 nmol/L), estradiol (31.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0 pg/mL), free testosterone (29.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0 ng/dL), and HOMA-IR (3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics of 32 Morbidly Obese Women\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAMH (ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAFC\u0026mdash;Right Ovary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAFC\u0026mdash;Left Ovary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFSH (mIU/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLH (mIU/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSHBG (nmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEstradiol (pg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFree Testosterone (ng/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHOMA-IR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChanges in Parameters at 6 Months Post-Sleeve Gastrectomy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 Months (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDifference (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e42.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-9.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAMH (ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-0.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAFC\u0026mdash;Right Ovary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-2.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAFC\u0026mdash;Left Ovary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e8.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-3.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChanges in Parameters at 12 Months Post-Sleeve Gastrectomy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 Months (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDifference (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e42.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e25.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-16.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAMH (ng/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-0.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAFC\u0026mdash;Right Ovary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-4.31\u0026thinsp;\u0026plusmn;\u0026thinsp;2.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAFC\u0026mdash;Left Ovary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-4.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFSH (mIU/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e+\u0026thinsp;2.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLH (mIU/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e+\u0026thinsp;2.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSHBG (nmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e36.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e64.0\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e+\u0026thinsp;27.51\u0026thinsp;\u0026plusmn;\u0026thinsp;8.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEstradiol (pg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e31.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e49.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e+\u0026thinsp;18.16\u0026thinsp;\u0026plusmn;\u0026thinsp;4.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFree Testosterone (ng/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e29.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-19.35\u0026thinsp;\u0026plusmn;\u0026thinsp;8.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHOMA-IR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-2.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Post-Surgery Changes\u003c/h2\u003e \u003cp\u003eAt 6 months, BMI decreased to 32.87 (\u0026plusmn;\u0026thinsp;1.01) kg/m\u0026sup2;, AMH to 2.5 (\u0026plusmn;\u0026thinsp;0.3) ng/mL, and AFC to 9.0 (\u0026plusmn;\u0026thinsp;1.0) and 8.0 (\u0026plusmn;\u0026thinsp;1.0) for right and left ovaries, respectively (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). By 12 months, BMI fell to 25.65 (\u0026plusmn;\u0026thinsp;0.34) kg/m\u0026sup2;, AMH to 2.0 (\u0026plusmn;\u0026thinsp;0.2) ng/mL, and AFC to 7.0 (\u0026plusmn;\u0026thinsp;1.0) and 6.0 (\u0026plusmn;\u0026thinsp;1.0) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Hormonal shifts included FSH rising to 9.0 (\u0026plusmn;\u0026thinsp;1.0) mIU/mL, LH to 9.0 (\u0026plusmn;\u0026thinsp;1.0) mIU/mL, SHBG to 64.0 (\u0026plusmn;\u0026thinsp;12.0) nmol/L, estradiol to 49.0 (\u0026plusmn;\u0026thinsp;4.0) pg/mL, free testosterone dropping to 9.0 (\u0026plusmn;\u0026thinsp;2.0) ng/dL, and HOMA-IR improving to 1.2 (\u0026plusmn;\u0026thinsp;0.3) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Trends are visualized in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Correlations\u003c/h2\u003e \u003cp\u003eHOMA-IR negatively correlated with SHBG (r=-0.45, p\u0026thinsp;=\u0026thinsp;0.01) and positively with free testosterone (r\u0026thinsp;=\u0026thinsp;0.55, p\u0026thinsp;=\u0026thinsp;0.004), while AMH and AFC showed a strong positive association (r\u0026thinsp;=\u0026thinsp;0.65, p\u0026thinsp;=\u0026thinsp;0.001) at 12 months (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Hormonal and metabolic improvements are summarized in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe reductions in AMH and AFC post-sleeve gastrectomy, alongside hormonal restoration, suggest a normalization of ovarian function rather than diminished fertility. Our study revealed an apparent paradox: while hormonal profiles improved, AMH and AFC decreased. However, a closer analysis of the data and existing literature indicates that these changes are not necessarily linked to negative reproductive outcomes.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Controversial Findings on AMH and Weight Loss\u003c/h2\u003e \u003cp\u003eAMH serves as a marker of ovarian reserve, produced by granulosa cells of developing follicles. In most studies, AMH correlates directly with antral follicle count (AFC) and typically reflects the number of available follicles in the ovaries [26]. In patients with polycystic ovary syndrome (PCOS), AMH levels are often elevated due to an increased number of small follicles [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Regarding weight loss following bariatric surgery, the data are conflicting. Some studies report a decrease in AMH post-surgery, potentially due to a reduction in overall ovarian mass and the number of small follicles, particularly in women with PCOS who initially exhibit elevated AMH levels [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This reduction may result from the gradual normalization of ovarian function and the elimination of excessive folliculogenesis commonly observed in PCOS [26]. Conversely, other studies suggest AMH may increase post-bariatric surgery, reflecting individual variability or different surgical impacts [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Our findings align with the former, showing a consistent AMH decline (3.0 to 2.0 ng/mL) alongside AFC reductions, suggesting a quantitative shift in ovarian dynamics.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Follicular Quality\u003c/h2\u003e \u003cp\u003eDespite the decline in AMH levels and follicle count, hormonal changes\u0026mdash;such as the restoration of FSH (6.0 to 9.0 mIU/mL), LH (7.0 to 9.0 mIU/mL), and SHBG (36.0 to 64.0 nmol/L)\u0026mdash;may indicate a qualitative improvement in follicles [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Enhanced hormonal profiles likely contribute to better overall ovarian function and the development of higher-quality follicles, as weight loss is often accompanied by improvements in metabolic health and insulin sensitivity [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The higher quality of remaining follicles could imply improved oocyte maturation and enhanced reproductive prospects, even with a reduced follicle count. Specifically, the observed increase in SHBG and decrease in free testosterone (29.0 to 9.0 ng/dL) post-surgery suggest significantly improved hormonal conditions, creating a more favorable environment for the development of better follicles and potentially superior reproductive outcomes [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. These findings are consistent with reports that weight loss mitigates hyperandrogenism, a key barrier to ovulation [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Metabolic Health and Fertility\u003c/h2\u003e \u003cp\u003eAnother key finding is the direct link between metabolic health and reproductive function. Bariatric surgery markedly improves metabolic function, reducing insulin resistance (HOMA-IR from 3.8 to 1.2) and associated endocrine disturbances tied to obesity [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These metabolic improvements are well-documented to support the restoration of ovulation and enhance fertility, even in women without PCOS [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. As noted elsewhere, despite AMH reductions post-weight loss, women undergoing bariatric surgery often exhibit overall improvements in reproductive health, reinforcing the idea that follicle and oocyte quality improve [27]. The strong negative correlation between HOMA-IR and SHBG (r=-0.45, p\u0026thinsp;=\u0026thinsp;0.01) and positive correlation with free testosterone (r\u0026thinsp;=\u0026thinsp;0.55, p\u0026thinsp;=\u0026thinsp;0.004) underscore how metabolic correction drives hormonal normalization.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Quality as a Critical Factor\u003c/h2\u003e \u003cp\u003eThe enhancement of the hormonal profile post-surgery is a pivotal finding. Increased FSH, LH, and SHBG, alongside reduced free testosterone, contribute to better follicular quality [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Studies demonstrate that follicles remaining after surgery are often of superior quality, despite their reduced number, due to more favorable hormonal conditions for normal oocyte development and maturation [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Furthermore, the reduction in free testosterone and rise in SHBG alleviate hyperandrogenism, which frequently hinders ovulation, resulting in follicles with improved maturation and fertilization potential [28]. The rise in estradiol (31.0 to 49.0 pg/mL) further supports enhanced follicular development, aligning with improved ovarian steroidogenesis post-weight loss [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cem\u003e4.5 Clinical Implications\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAMH and AFC reductions post-surgery should be interpreted as physiological normalization, not infertility markers.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eClinicians should prioritize follicular quality over quantity when assessing reproductive potential post-bariatric surgery, using hormonal profiles as key indicators.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e4.6 Limitations and Future Directions\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eLimitations\u003c/b\u003e: Small sample size (n\u0026thinsp;=\u0026thinsp;32), 12-month follow-up, and focus on sleeve gastrectomy limit generalizability.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eFuture Directions\u003c/b\u003e: Larger cohorts, longer follow-ups (e.g., 18 months), and fertility outcome assessments (e.g., pregnancy rates) are needed. Comparative studies with other bariatric procedures could further elucidate effects.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eBariatric surgery markedly improves metabolic and reproductive health in morbidly obese women. Over 12 months, BMI, AMH, and AFC decreased, while SHBG, FSH, LH, and insulin sensitivity (HOMA-IR: 3.8 to 1.2) improved, alongside reduced free testosterone (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These changes suggest enhanced follicular quality despite lower ovarian reserve markers, reflecting normalized ovarian function and potential fertility gains. By prioritizing quality over quantity, sleeve gastrectomy offers a dual benefit\u0026mdash;metabolic correction and reproductive optimization\u0026mdash;highlighting its value in obesity management. Long-term studies are needed to confirm these reproductive outcomes.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eK.B. conceived and designed the study, performed the statistical analysis, interpreted the data, and wrote the main manuscript text. C.V. was responsible for patient sample collection and contributed to data analysis, along with G.D.E.M. contributed to patient recruitment and provided clinical guidance throughout the study. G.Z. and D.T. supervised the research project and provided critical revisions of the manuscript. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to patient privacy and institutional ethical restrictions but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLin X, Li H, Obesity. Epidemiology, pathophysiology, and therapeutics. Front Endocrinol (Lausanne). 2021;12:706978. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fendo.2021.706978\u003c/span\u003e\u003cspan address=\"10.3389/fendo.2021.706978\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYlli D, Sidhu S, Parikh T, Burman KD. Endocrine changes in obesity. 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Gynecol Endocrinol. 2017;33(2):160\u0026ndash;3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/09513590.2016.1236243\u003c/span\u003e\u003cspan address=\"10.1080/09513590.2016.1236243\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Bariatric surgery, sleeve gastrectomy, reproductive hormones, ovarian reserve, follicular quality, insulin resistance","lastPublishedDoi":"10.21203/rs.3.rs-9050251/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9050251/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObesity impairs reproductive health through hormonal imbalances and insulin resistance. This prospective study evaluated the effects of laparoscopic sleeve gastrectomy on obesity indices, reproductive hormones, and ovarian reserve in 32 morbidly obese women over 12 months. Assessments at baseline, 6, and 12 months measured BMI, anti-M\u0026uuml;llerian hormone (AMH), antral follicle count (AFC), follicle-stimulating hormone (FSH), luteinizing hormone (LH), sex hormone-binding globulin (SHBG), estradiol, free testosterone, and HOMA-IR. BMI decreased from 42.12 (\u0026plusmn;\u0026thinsp;0.45) to 25.65 (\u0026plusmn;\u0026thinsp;0.34), AMH from 3.0 to 2.0 ng/mL, and AFC from 11 to 6\u0026ndash;7 per ovary (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Concurrently, SHBG increased (36 to 64 nmol/L), free testosterone decreased (29 to 9 ng/dL), and HOMA-IR improved from 3.8 (\u0026plusmn;\u0026thinsp;0.9) to 1.2 (\u0026plusmn;\u0026thinsp;0.3) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Despite reduced AMH and AFC, enhanced hormonal profiles and insulin sensitivity suggest improved follicular quality, indicating normalized ovarian function and reproductive potential post-surgery. Sleeve gastrectomy thus offers metabolic and reproductive benefits, prioritizing follicle quality over quantity, with implications for fertility management in obese women.\u003c/p\u003e","manuscriptTitle":"Impact of Sleeve Gastrectomy on Obesity Indices, Reproductive Hormones, and Follicular Quality: A 12-Month Prospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-26 02:34:02","doi":"10.21203/rs.3.rs-9050251/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-09T19:27:46+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"140297630722579653835006807846935762476","date":"2026-04-15T14:24:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-23T14:55:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"7016379168721741077801796533652113482","date":"2026-03-23T13:16:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"153006874837670523653894517263969110228","date":"2026-03-21T10:11:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-20T09:26:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-13T13:49:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-10T11:50:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"Obesity Surgery","date":"2026-03-06T11:44:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"9f674aa4-6c49-42e4-831c-1dfb6e3527dd","owner":[],"postedDate":"March 26th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-09T19:27:46+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T18:23:24+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-26 02:34:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9050251","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9050251","identity":"rs-9050251","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}