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

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.