Читать книгу Assisted Reproduction Techniques - Группа авторов - Страница 113

Weight reduction and maintaining an optimum BMI, usually with the help of a dietician, helps diabetes control and ovarian response in those who are overweight or obese. Where the patient is morbidly obese and other approaches to weight reduction have failed, bariatric surgery is an option recognized to improve glycemic control in selected cases of type 2 diabetes mellitus [13,14]. In a survey of women planning bariatric surgery, future pregnancy was an important consideration for 30% [15]. A modern‐day fertility unit may therefore encounter diabetic women with a history of bariatric surgery and requesting ART treatment. Contemporaneous recommendation is to wait for at least 12 months after bariatric surgery before conception [16–18] to allow for the desired goals of surgery to be achieved. A multidisciplinary approach involving the primary surgical team is again warranted in this situation. Controlled ovarian hyperstimulation can be challenging in diabetic patients with polycystic ovary syndrome (PCOS) and would need special considerations including innovative stimulation regimens for maximum gains while avoiding complications at the same time [19].