Poor ovarian response (poor IVF) associated with low vitamin D – Sept 2019

Poor ovarian response is associated with serum vitamin D levels and pro-inflammatory immune responses in women undergoing in-vitro fertilization

Journal of Reproductive Immunology, https://doi.org/10.1016/j.jri.2019.102617
LiWuacJean AlyxaVendiolabMaria DinorahSalazar GarciaaNayoungSungaAnnieSkariahaAliceGilman-SachsbSvetlanaDambaevabJoanneKwak-Kimab

Highlights

• Poor ovarian response is associated with inflammatory and autoimmune conditions.
• Proinflammatory condition and vitamin D independently affect poor ovarian response.
• In women with poor ovarian response, low vitamin D had 4.71 higher risk of APA.
• Th1/Th2 ratios were higher in women with poor ovarian response and low vitamin D.
• Poor ovarian response and low vitamin D is associated with increased homocysteine.

Poor ovarian response (POR1) limits the success of infertility treatment modality. In this study, we aim to investigate if POR is associated with serum 25(OH) vitamin D (VD2) levels and pro-inflammatory immune responses in infertile women with a history of in-vitro fertilization and embryo transfer failures. A retrospective cross-sectional study included 157 women with IVF failures.
Study patients were divided into four groups based on serum 25(OH)VD level and ovarian responses during the most recent IVF cycle;

• low VD (LVD3) with POR,
• LVD with normal ovarian response (NOR4),
• normal VD (NVD5) with POR, and
• NVD with NOR.

Serum 25(OH)VD level, cellular- and auto-immunity, and metabolic parameters, including homocysteine and plasminogen activator inhibitor-1 were investigated. Peripheral blood CD56+ NK cell levels (%) and NK cytotoxicity were significantly higher in POR-LVD when compared to the other groups (P < 0.05, respectively). CD19 + B and CD19+/5+ B-1 cell levels were significantly higher in women with POR-LVD as compared with those of NOR-LVD and POR-NVD (P < 0.05, respectively). TNF-α/IL-10 producing Th1/Th2 cell ratio of POR-LVD was significantly higher than those of POR-NVD and NOR-NVD (P < 0.05 respectively). Peripheral blood homocysteine level of POR-LVD was significantly higher than those of NOR-LVD and POR-NVD (P < 0.05 respectively).
We conclude that assessment of cellular and autoimmune abnormalities and metabolic factors, such as homocysteine should be considered in women with POR and LVD. VD and folic acid supplementation may be explored further as a possible therapeutic option for POR with immune and metabolic etiologies.