ORIGINAL ARTICLE Effectiveness of Bariatric Surgery-Induced Weight Loss on Infertility Among PCOS and Non-PCOS Women: Experience of a Maternity Hospital and In Vitro Fertilization (IVF) Center in India Rajsekhar Nayak 1 & Devika Gunasheela 1 & Vasanth Kumar 1 & Fatima Rafi 1 Received: 24 June 2019 /Accepted: 17 April 2020 # Association of Surgeons of India 2020 Abstract Obesity, mostly the abdominal deposition of fat, is prevalent with polycystic ovarian syndrome (PCOS) influencing fertility. Evidence suggests a significant surge in the number of women who became pregnant after bariatric surgery (BS). The objective of this study is to evaluate the role of bariatric surgery-induced weight loss prior to pregnancy on various parameters, with special focus on infertility among women with and without PCOS. A single-center retrospective cohort study, comprising 28 women {PCOS (n = 17) and without PCOS (n = 11)} with a history of infertility, who underwent bariatric surgery for morbid obesity. Retrospective analysis was performed for pregnancy rate, weight loss (in terms of body mass index), anti-mullerian hormone (AMH) levels, oral glucose tolerance test (OGTT) value, and serum insulin levels. The mean of total pregnancy rate was 64.28%. At 1-year follow-up, the mean BMI among all the study participants decreased from 49.11 pre-surgery to 29.33 post-surgery. Similarly, the prevalence of impaired OGTT reduced from 42.85 to 3.57% among the study groups. The AMH levels were within the normal range for both the groups after surgery, but were not statistically significant. The study showed the positive role of bariatric surgery on overall health in both groups. Also, bariatric surgery was favorable on the reproductive health of women as well as in managing other metabolic co-morbidities like impaired OGTT and serum insulin levels in PCOS as well as non-PCOS women. Keywords Bariatric surgery . Obesity . Fertility . Pregnancy . Polycystic ovarian syndrome Introduction The prevalence of obesity has reached epidemic proportions not only in developed nations but also in developing countries like India. According to WHO global estimates, about 13% of the world’ s adult population (11% of men and 15% of women) were obese in 2014 [1]. In India, the percentage of ever mar- ried women aged 15–49 years who are overweight or obese increased from 11% in National Family Health Survey (NFHS)-2 to 15% in NFHS-3 [2]. Obesity has been consid- ered as a life-threatening condition by being the forerunner of several chronic conditions like diabetes mellitus, heart dis- ease, hypertension, osteoarthritis, and cancers. Obesity in women in child-bearing age is associated with pregnancy- related complications, infertility, as well as congenital defects [3]. It is a major risk factor in obstetric practice with the mounting prevalence of overweight and obese women in the reproductive age group. The most clinically relevant defini- tion of obesity is the body mass index. Maternal obesity is defined as BMI ≥ 30 kg/m 2 at the first antenatal visit. Pre- pregnancy obesity poses significant risk for both adverse ma- ternal and perinatal outcomes. The association of obesity is not only limited to adverse maternal and fetal effects prenatal- ly, but it also exerts a negative influence on female fertility in association with PCOS. PCOS is a complex, multifaceted, endocrinological disor- der affecting 6–8% of women of reproductive age [4]. It not only affects the reproductive health but also has its impact on * Vasanth Kumar vasanthsurgeon@gmail.com Rajsekhar Nayak nayakrs@hotmail.com Devika Gunasheela gunasheelaivf@gmail.com Fatima Rafi fatimagynaec@gmail.com 1 Gunasheela Surgical and Maternity Hospital, Bengaluru, India Indian Journal of Surgery https://doi.org/10.1007/s12262-020-02228-5