Correlation Analysis Of The Relationship Between Vitamin D And Ovarian Reserve And The Outcome Of Assisted Reproductive Technologies In Infertile Women

ObjectiveTo explore the relationship and the effect of serum vitamin D levels and antral follicle count?AFC?or anti-mullerian hormone?AMH?that are ovarian reserve markers as well as serum vitamin D levels and the outcomes of assisted reproductive technology in infertile women.Materials and MethodsTo retrospectively analyse 6770 infertility patients who received assisted reproductive technology for the first time from January 2016 to December 2017 in our reproductive center.Inclusion criteria:age 20⁴1 years:cause of infertility:Tubal,Diminished ovarian reserve?POR?,Endometriosis,Ovulatory?PCOS,Hyperprolactinemia and Luteinized unruptured follicle syndrome?,Male?severe oligo-astheno-teratospermia and azoospermia?,Unexplained.Exclusion criteria:contraindications of assisted reproductive technology,Endocrine and metabolic diseases,vitamin D supplements within recent half a year,history of hormone treatment or ovulation in hospital within recent half a year.The diagnostic criteria and group:Adult vitamin D deficiency was serum vitamin D level<50nmol/L,in accordance with the Institute of Medicine?IOM?and the Endocrine Society clinical practice guidelines.According to the serum 25?OH?D level,it can be divided into group A?<50nmol/L?and group B??50nmol/L?,which included 1146 cases and 5624 cases respectively.According to assisted reproduction methods of patients divided into IVF/ICSI group?4543 cases,including vitamin D deficiency group 3776 examples,not a lack of vitamin D group,767 cases?and artificial insemination assisted group?2227 cases,including vitamin D deficiency group 1848 examples,not a lack of vitamin D group,379 cases?.Subgroups according to difference seasons:Spring:March–June;summer:June–September;autumn:September–December;winter:December–March.Outcome Measures:the baseline characteristics of patients:Age,Body mass index?BMI?,cause of infertility.Basal hormone levels,levels of serum vitamin D and AMH levels were measured by chemiluminescence.AFC:2⁹mmantral follicle was recorded in bilateral ovarian at 2⁴ days of menstruation by Vaginal ultrasound.The laboratory and clinical indicators of in vitro fertilization and artificial insemination are recorded in detail.SPSS21.0 was used to analyze the data P<0.05 was considered to be statistically significant.ResultsThe baseline characteristics between the two groups:There was no significant difference in age,BMI and infertility duration?P>0.05?.The basic endocrine of the two groups:bE₂,bLH and bFSH were not statistically significant?P>0.05?.There was no statistical difference in the composition of the causes of infertility between the two groups?P>0.05?.AFC?14.32±6.68 vs 13.91±6.54,P=0.646?and AMH?4.45±3.42 vs 4.35±3.44 ng/mL,P=0.129?were not statistically significant?P>0.05?.Serum vitamin D levels of infertile women is not related to the season in the two groups?P>0.05?.Regression analysis of AFC and the related factors:There was no correlation between AFC?B:0.004,Std.Error:0.006,P=0.539?and serum vitamin D levels?P>0.05?.There was a statistically significant correlation between AFC and age?B:-0.351,Std.Error:0.022,P=0.000?andbFSH?B:-0.591,Std.Error:0.030,P=0.000??P<0.05?.Regression analysis of AMH levels and the related factors:There was no correlation between AMH levels?B:0.035,Std.Error:0.023,P=0.136?and serum vitamin D levels?P>0.05?.There was a significant correlation between AMH levels and age?B:-0.205,Std.Error:0.011,P=0.000?and bFSH?B:-0.152,Std.Error:0.009,P=0.000??P<0.05?.No correlations were observed between vitamin D and AMHC.Comparison of laboratory and clinical observation indexes between the two groups with IVF/ICSI:The level of E₂ on hCG day of the group A?3507.92±2222.51vs 3615.03±2409.20 ng/L,P=0.030?was significantly lower than group B?P<0.05?.The levels of LH?1.75±3.48 vs 1.84±3.77 IU/L,P=0.494?,P?1.22±0.81 vs1.26±0.74 ug/L,P=0.297?and endometrial thickness on hCG day?10.67±2.72 vs10.74±2.75 mm,P=0.238?were no statistical difference between the two groups?P>0.05?.No statistical difference in the number of retrieved oocytes?12.56±7.06 vs12.60±7.08,P=0.646?and embryos transferred?1.76±0.43 vs 1.74±0.44,P=0.524?was observed between the two groups?P>0.05?;?3?2PN rate?62.9%vs 63.0%,P=0.912?,top-quality embryo rate?42.1%vs 42.5%,P=0.511?,clinical pregnancy rate?49.9%vs 51.0%,P=0.616?and early abortion rate?8.4%vs 7.5%,P=0.579?had no significant differences between the two groups?P>0.05?.Comparison of clinical observation indicators of patients with artificial insemination:No statistical difference was found in the clinical pregnancy rate?21.9%vs 22.2%,P=0.897?and the early abortion rate?6.2%vs 5.0%,P=0.682?.ConclusionsThere was no correlation between serum vitamin D and ovarian reserve marker AFC or AMH for infertile women.For infertile women lacking of vitamin D,it may have no effects on improving ovarian reserve function by supplementing vitamin D.Vitamin D deficiency in infertile women may affect E₂ anabolism,lowering E₂level in controlled ovarian hyperstimulation.The deficiency of vitamin D in infertile women does not significantly affect the outcomes.