Role of Vitamin D Deficiency in Female Infertility and ART Outcomes
Munazzah Rafique, king fahad medical city
Ayesha Nuzhat. Faculty of Medicine, King Fahad Medical City, Saudi Arabia
Dania Al-Jaroudi, Reproductive Endocrine and Infertility and Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia
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Healthy pregnancies need lots of vitamin D has the following summaryProblem
Reduces Evidence 0. Chance of not conceiving 3.4 times Observe 1. Miscarriage 2.5 times Observe 2. Pre-eclampsia 3.6 times RCT 3. Gestational Diabetes 3 times RCT 4. Good 2nd trimester sleep quality 3.5 times Observe 5. Premature birth 2 times RCT 6. C-section - unplanned 1.6 times Observe Stillbirth - OMEGA-3 4 times RCT - Omega-3 7. Depression AFTER pregnancy 1.4 times RCT 8. Small for Gestational Age 1.6 times meta-analysis 9. Infant height, weight, head size
within normal limits
RCT 10. Childhood Wheezing 1.3 times RCT 11. Additional child is Autistic 4 times Intervention 12.Young adult Multiple Sclerosis 1.9 times Observe 13. Preeclampsia in young adult 3.5 times RCT 14. Good motor skills @ age 3 1.4 times Observe 15. Childhood Mite allergy 5 times RCT 16. Childhood Respiratory Tract visits 2.5 times RCT
RCT = Randomized Controlled Trial
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Objective: To assess the role of vitamin D deficiency and perceive the outcomes of ART among vitamin D deficient females in infertile females attending infertility clinic in Riyadh Saudi Arabia.
Place and Duration: A retrospective cohort study of all vitamin D deficient infertile women who presented to Reproductive endocrinology and infertility department (REIMD), King Fahd Medical City infertility center from January 2012 and January 2016 for a period of 4 years was performed.
Methodology: Random sampling was done to take around 192 infertile females who fulfill the inclusion criteria for the study. The association of vitamin D deficiency in infertile females between deficient and insufficient groups was distinguished followed by analysis of the outcome (aborted, ectopic pregnancy, molar pregnancy, no pregnancy, successful pregnancy and unknown) after the intervention done in the form of different ART options (OI, IUI, IVF, ICSI).
Results: Among 192 patients in total, 56.2% had primary infertility,36.5% had an irregular menstrual cycle,33.3% had PCOS, 78.1% underwent IVF, and successful pregnancy was observed in only 15.1%. Of the included women, 88.5% were vitamin D deficient, (less than 50nmol/l) and 5.2% were vitamin D insufficient(50-75nmol/l).
In infertile women with low vitamin D, there was also decrease in the level of FSH and LH. When vitamin D deficient (<50nmol/l) and vitamin D insufficient groups(50-75nmol/l) were compared the maximum duration of infertility among vitamin D deficient (29.4%), and vitamin D insufficient (40%) was six years.
Though vitamin D deficient patients had primary infertility (57.6%), Vitamin D insufficient patients had secondary infertility (50%).
Almost 37.6% of vitamin D deficient and 30% of vitamin D insufficient groups had an irregular menstrual cycle.
Most common ultrasound manifestation in vitamin D deficient (33.5%) and vitamin D insufficient cases (40%) was PCOS. 80.6% of vitamin D deficient patients underwent IVF compared to 40% of vitamin D insufficient patients with statistical significance less than 0.05(p value=0.008).
Pregnancy with IVF was observed in 21.8% of vitamin D deficient and 10% of vitamin D insufficient patients with statistical significance less than 0.05(p value=0.009). As for the outcome, no pregnancy was observed in 62.3% vitamin D deficient and 40% of vitamin D insufficient patients. Successful pregnancy was confirmed in 15.3% of vitamin D deficient and 20% in vitamin D insufficient cases.
Conclusion: Both vitamin D deficiency, as well as insufficiency, adversely affect the outcome of ART contributing to lower pregnancy rates among Arabian women in the reproductive age group. Vitamin D supplementation might bring on treatment success in infertile patients undergoing IVF and is recommended for infertile women in our region.Many fertilization and pregnancy problems associated with low vitamin D in Saudi Arabia – April 2018
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