The relationship between serum vitamin D levels and pregnancy in patients undergoing intrauterine insemination

Abstract

Purpose: This study aims to determine the relationship between pregnancy outcome of intrauterine insemination cycles with serum vitamin D levels. Materials and methods: Data from 212 ovulation induction cycles of 135 patients undergoing IUI after ovulation induction with gonadotropins were analyzed. Serum FSH, LH, estradiol, prolactin, anti-müllerian hormone (AMH), TSH, and vitamin 25(OH) D levels, ovarian response, and pregnancy results were analyzed. Patients were evaluated as Group A (20 ng / mL) and Group B (<20 ng / mL) according to serum vitamin D level. Results: The mean age of the patients was 29.71 ± 4.18. The mean duration of infertility was 4.31 ± 2.55 years. A total of 212 cycles were included in the study. The average gonadotropin dose used per cycle was 832.0 ± 463.8 IU. No statistically significant difference was detected between Group A (vitamin D ≥20 ng/mL) and Group B (vitamin D <20 ng/mL) regarding age, duration of infertility, BMI, AMH, antral follicle count, induction time, total gonadotropin dose, endometrial thickness (p <0.05). The pregnancy rate in Group A was 18.3% (n = 11), and 16.4% (n = 25) in Group B (p = 0.742). No correlation was found between vitamin D and BMI, duration of infertility, antral follicle number, AMH, induction time, and the number of follicles. ROC curve analysis showed that vitamin D levels are not predictive for pregnancy (AUC=0.478 p=0.684) Conclusion: Serum vitamin D levels do not affect the pregnancy rates after IUI cycles following the ovulation induction.

Keywords

• Infertility
• intrauterine insemination
• vitamin D
• pregnancy

İntrauterin inseminasyon uygulanan hastalarda serum vitamin D seviyesinin gebelik ile ilişkisi

Abstract

Amaç: İntrauterin inseminasyon, nedeni açıklanamayan infertil hastalarda ilk basamak tedavi yaklaşımıdır. Çalışmamızın amacı, intrauterin inseminasyon tedavisi uygulanan kadınların gebelik sonuçlarının, serum D vitamini seviyesi ile ilişkisini belirlemektir. Gereç ve yöntem: İntrauterin inseminasyon uygulanan 135 hastaya ait 212 ovulasyon indüksiyonu siklusuna ait veriler değerlendirilmiştir. Çalışmaya dahil edilen tüm hastalara gonadotropinler ile ovulasyon indüksiyonunu takiben intrauterin inseninasyon yapılmıştır. Hastanın ovulasyon indüksiyonu öncesi FSH, LH, estradiol, prolaktin, anti-müllerian hormon (AMH), TSH ve 25(OH) D vitamin seviyesi, overyan yanıtı ve gebelik sonucu incelenmiştir. Serum D vitamini seviyesine göre hastalar Grup A (≥20 ng/mL) ve Grup B (<20 ng/mL) olarak değerlendirilmiştir. Bulgular: Hastaların yaş ortalaması 29,71 ± 4,18 idi. Hastaların ortalama infertilite süresi 4,31± 2,55 yıldı. Toplam 212 siklus çalışmaya dahil edilmiştir. 212 siklusun ovulasyon indüksiyonunda siklus başına kullanılan ortalama gonadotropin dozu 832,0±463,8 IU, ortalama indüksiyon süresi 11,49±3,45 gündü. Grup A (vitamin D ≥20 ng/mL) ile Grup B (vitamin D <20 ng/mL) arasında yaş, infertilite süresi, vücut kitle indeksi, AMH değeri, bazal antral folikül sayısı, indüksiyon süresi, kullanılan total gonadotropin dozu, endometriyal kalınlık ölçülerinde istatistiksel olarak anlamlı fark tespit edilmedi (p<0,05). Grup A’da gebelik oranı %18,3 (n=11), Grup B’de ise %16,4 (n=25) olarak bulundu (p=0,742). D vitamini seviyesi ile vücut kitle indeksi, infertilite süresi, antral folikül sayısı, anti müllerian hormon, indüksiyon süresi, ve gelişen folikül sayısı arasında istatistiksel olarak anlamlı korelasyon tespit edilmedi. ROC eğrisi analizi, serum D vitamin seviyesinin gebelik prediksiyonunda faydalı olmadığını göstermiştir (AUC=0,478 p=0,684) Sonuç: Ovulasyon indüksiyonunu takiben yapılan intrauterin inseminasyon sikluslarında serum D vitamini seviyesi gebelik sonucu üzerinde etkili değildir.

Keywords

• İnfertilite
• intrauterin inseminasyon
• vitamin D
• gebelik

References

1. Ayeleke RO, Asseler JD, Cohlen BJ, Veltman-Verhulst SM. Intra-uterine insemination for unexplained subfertility. Cochrane Database Syst Rev 2020;3:CD001838. https://doi.org/10.1002/14651858.CD001838.pub6
2. Chen Y, Zhi X. Roles of Vitamin D in reproductive systems and assisted reproductive technology. Endocrinology 2020;161. https://doi.org/10.1210/endocr/bqaa023
3. Luk J, Torrealday S, Neal Perry G, Pal L. Relevance of vitamin D in reproduction. Hum Reprod 2012;27:3015-3027. https://doi.org/10.1093/humrep/des248
4. Irani M, Merhi Z. Role of vitamin D in ovarian physiology and its implication in reproduction: a systematic review. Fertil Steril 2014;102:460-468.e3. https://doi.org/10.1016/j.fertnstert.2014.04.046
5. Kinuta K, Tanaka H, Moriwake T, Aya K, Kato S, Seino Y. Vitamin D is an important factor in estrogen biosynthesis of both female and male gonads. Endocrinology 2000;141:1317-1324. https://doi.org/10.1210/endo.141.4.7403
6. Lerchbaum E, Rabe T. Vitamin D and female fertility. Curr Opin Obstet Gynecol 2014;26:145-150. https://doi.org/10.1097/GCO.0000000000000065
7. Rudick B, Ingles S, Chung K, Stanczyk F, Paulson R, Bendikson K. Characterizing the influence of vitamin D levels on IVF outcomes. Hum Reprod 2012;27:3321-3327. https://doi.org/10.1093/humrep/des280
8. Rudick BJ, Ingles SA, Chung K, Stanczyk FZ, Paulson RJ, Bendikson KA. Influence of vitamin D levels on in vitro fertilization outcomes in donor-recipient cycles. Fertil Steril 2014;101:447-52. https://doi.org/10.1016/j.fertnstert.2013.10.008

9. Ozkan S, Jindal S, Greenseid K, et al. Replete vitamin D stores predict reproductive success following in vitro fertilization. Fertil Steril 2010;94:1314-1319. https://doi.org/10.1016/j.fertnstert.2009.05.019
10. Zhao J, Huang X, Xu B, Yan Y, Zhang Q, Li Y. Whether vitamin D was associated with clinical outcome after IVF/ICSI: a systematic review and meta-analysis. Reprod Biol Endocrinol 2018;16:13. https://doi.org/10.1186/s12958-018-0324-3
11. Anifandis GM, Dafopoulos K, Messini CI, et al. Prognostic value of follicular fluid 25-OH vitamin D and glucose levels in the IVF outcome. Reprod Biol Endocrinol 2010;8:91. https://doi.org/10.1186/1477-7827-8-91
12. Firouzabadi RD, Rahmani E, Rahsepar M, Firouzabadi MM. Value of follicular fluid vitamin D in predicting the pregnancy rate in an IVF program. Arch Gynecol Obstet 2014;289:201-206. https://doi.org/10.1007/s00404-013-2959-9
13. Franasiak JM, Molinaro TA, Dubell EK, et al. Vitamin D levels do not affect IVF outcomes following the transfer of euploid blastocysts. Am J Obstet Gynecol 2015;212:315.e1-6. https://doi.org/10.1016/j.ajog.2014.09.029
14. Neville G, Martyn F, Kilbane M, et al. Vitamin D status and fertility outcomes during winter among couples undergoing in vitro fertilization/intracytoplasmic sperm injection. Int J Gynaecol Obstet 2016;135:172-176. https://doi.org/10.1016/j.ijgo.2016.04.018
15. World health organization. WHO laboratory manual for the examination and processing of human semen. 5th ed. Geneva: World Health Organization; 2010.
16. Türkiye endokrinoloji ve metabolizma derneği. Vitamin D eksikliği. In: Osteoporoz ve metabolik kemik hastalıkları tanı ve tedavi kılavuzu. 14. ed., Ankara: 2019; 119-127.
17. Lerchbaum E, Obermayer-Pietsch B. Vitamin D and fertility: a systematic review. Eur J Endocrinol 2012;166:765-778. https://doi.org/10.1530/EJE-11-0984
18. Lv SS, Wang JY, Wang XQ, Wang Y, Xu Y. Serum vitamin D status and in vitro fertilization outcomes: a systematic review and meta-analysis. Arch Gynecol Obstet 2016;293:1339-1345. https://doi.org/10.1007/s00404-016-4058-1
19. Parikh G, Varadinova M, Suwandhi P, et al. Vitamin D regulates steroidogenesis and insulin-like growth factor binding protein-1 (IGFBP-1) production in human ovarian cells. Horm Metab Res 2010;42:754-757. https://doi.org/10.1055/s-0030-1262837
20. Yoshizawa T, Handa Y, Uematsu Y, et al. Mice lacking the vitamin D receptor exhibit impaired bone formation, uterine hypoplasia and growth retardation after weaning. Nat Genet 1997;16:391-396. https://doi.org/10.1038/ng0897-391
21. Liu X, Zhang W, Xu Y, et al. Effect of vitamin D status on normal fertilization rate following in vitro fertilization. Reprod Biol Endocrinol 2019;17:59. https://doi.org/10.1186/s12958-019-0500-0
22. Yilmaz N, Ersoy E, Tokmak A, et al. Do serum vitamin D levels have any effect on intrauterine insemination success? Int J Fertil Steril 2018;12:164-168. https://doi.org/10.22074/ijfs.2018.5256
23. Asadi M, Matin N, Frootan M, Mohamadpour J, Qorbani M, Tanha FD. Vitamin D improves endometrial thickness in PCOS women who need intrauterine insemination: a randomized double-blind placebo-controlled trial. Arch Gynecol Obstet 2014;289:865-870. https://doi.org/10.1007/s00404-013-3055-x