The effect of bariatric surgery on ovarian reserve function in obese women: a systematic review and meta-analysis

Abstract Background Bariatric surgery is essential for managing morbid obesity and improving fertility, however its effect on ovarian reserve remains inconclusive. Method The meta-analysis was conducted in accordance with PRISMA 2020 and MOOSE guidelines. We searched Web of Science, PubMed, and Embase for eligible studies. The outcome was the postoperative change in serum anti-Müllerian hormone (AMH) levels from baseline. The pooled results were expressed as the mean difference (MD) with a 95% confidence interval (95% CI). Influential publications were determined by performing sensitivity analysis. In addition, the potential sources of heterogeneity were examined by using subgroup analysis and meta-regression. Publication bias was assessed using funnel plots, and Begg’s and Egger’s tests. Results The 12 included cohort studies were published between 2008 and 2025, and included a total of 630 patients. The mean BMI of the obese women ranged from 40 to 50 kg/m². We found that bariatric surgery was associated with a significant decrease in serum AMH levels among obese women (ΔAMH = -0.38, 95% CI = -0.72 to -0.05, P = 0.025). Substantial heterogeneity was observed across the included studies (I 2 = 88.4%, P < 0.001). Subgroup analysis and meta-regression both revealed that the postoperative follow-up time was a potential source of heterogeneity. No influential publications or significant publication bias was detected across the studies. Conclusion Bariatric surgery is associated with a significant decrease in AMH levels in women with morbid obesity. However, further prospective longitudinal studies, including large-scale randomised controlled trials, are warranted to validate these findings. PROSPERO registration CRD420261418539 (data: 2026-06-10).