The Exploration Of The Correlation Of Vitamin D Level And The Early Pregnancy Outcome Of Ivf/Icsi-ET In Women With Polycystic Ovary Syndrome

Objective To make an exploration on the correlation between 25-hydroxyvitamin D(25OHD)level and early pregnancy outcome of in-vitro fertilization/intracytoplasmic sperm injection-embryo transplantation(IVF/ICSI-ET)in women with polycystic ovary syndrome(PCOS).Methods(1)(1)A total of 764 infertility women for the first cycle of IVF/ICSI-ET from November 2016 to November 2018 were selected.According to their serous 25 OHD,the patients were divided into vitamin D deficiency group(serous 25 OHD < 10 ng/ml),insufficiency group(serous 25 OHD 10~30 ng/ml)and sufficiency group(serous 25 OHD ?30 ng/ml).The effect of 25-hydroxyvitamin D levels on the initial dose and total dose of gonadotropin,the number of retrieved oocytes,fertilization rate,embryo quality,the number of embryos transplanted,implantation rate,clinical pregnancy rate of IVF/ICSIET were analyzed.Logistic regression analysis on serous vitamin D level and cycle outcome of IVF/ICSI-ET was performed.(2)The data of 136 patients with PCOS included in the 764 patients were analyzed further.Logistic regression analysis on serous vitamin D level and cycle outcome of IVF/ICSI-ET in women with POCS was performed.(2)To explore the relationship between follicular fluid 25 OHD levels and early pregnancy outcome of women under IVF / ICSI-ET,63 infertile patients from January to April 2018 were enrolled.The patients were classified as having low or high levels of follicular fluid 25 OHD according to the cut off value of bisection(13.8 ng/ml).The relationship of follicular fluid and serum 25 OHD were analyzed.The effect of different follicular fluid 25 OHD levels on cycle characteristics and clinical pregnancy rate of IVF/ICSI were analyzed.Results(1)The relationship between serous 25 OHD levels and early pregnancy outcome in 764 patients(1)The composition ratio of serous basic vitamin D deficiency group,insufficient group and sufficient group was 18.19%,78.80% and 3.01%,respectively.There was not a significant difference in participants' baseline characteristics among three groups(P>0.05).(2)There were significant differences in the fertilization rate and embryo quality rate among the three groups,the group with serous 25 OHD level ?30ng/ml was significantly higher than the group with serous 25 OHD level <30ng/ml(P < 0.05).(3)Compared with the non-pregnant group,body mass index and basal luteinizing hormone in the clinical pregnancy group were significantly lower than those in the non-pregnant group(P < 0.05),and the number of retrieved oocytes,the rate of high-quality embryos and the thickness of endometrium on the day of transplantation were significantly different between the two groups(P < 0.05).(4)Adjustment the confounding factors may affect the clinical pregnancy rate,logistic regression analysis showed that different serous vitamin D was not a protective factor for the clinical pregnancy of infertility women underwent IVF/ICSIET.(2)The relationship between serous 25 OHD levels and early pregnancy outcome of 136 patients with PCOS(1)The composition ratio of serous basic vitamin D deficiency group,insufficient group and sufficient group in PCOS patients was 15.44%,75.74% and 8.82%.There were statistically significant differences in body mass index among the three groups.Among which the body mass index of the group with serous 25 OHD level <10ng/ml was higher than that of the insufficient group significantly(P < 0.05).There were no significant differences on the other baseline characteristics(P>0.05).(2)There were also statistically significant differences in the fertilization rate and embryo implantation rate among the three groups,among which the fertilization rate of the group with serum 25 OHD level 10~30ng/ml was significantly higher than that of the group with serum 25 OHD level among<10ng/ml(P < 0.05).The embryo implantation rate of the group with serum 25 OHD level among ?30ng/ml was significantly higher than that of the groups with serum 25 OHD level among <30ng/ml(P < 0.05).(3)Compared with the non-pregnant group,the levels of basal luteinizing hormone,basal testosterone and basal luteinizing hormone/basal follicle stimulating hormone in the clinical pregnancy group were significantly lower than those in the non-pregnant group(P < 0.05).The intrauterine membrane thickness and fertilization rate of the clinical pregnancy group were higher than those of the nonpregnancy group(P < 0.05).(4)Adjustment for confounding factors,logistic regression analysis showed that serum vitamin D>10ng/ml was a protective factor for the clinical pregnancy of PCOS women underwent IVF/ICSI-ET(insufficient group:a OR=4.236,95%CI: 1.241~14.455,P=0.021;sufficient group:a OR=8.138,95%CI: 1.186~55.853,P=0.033).(3)The effect of follicular fluid vitamin D on the pregnancy outcome: There was a significant linear correlation between the levels of 25 OHD in serum and follicular fluid on the day of ovum pick up(r=0.845,P<0.001).In women with PCOS,the rates of MII,embryo implantation and clinical pregnancy in the 25 OHD high level group were significantly higher than low level group(P<0.05).In women without PCOS,the cycle characteristics and IVF/ICSI outcome were of no significant differences between two 25 OHD level groups(P>0.05).Conclusion The variation tendency of serum 25 OHD was similarly among the women with or without PCOS,however the serum 25 OHD level of the women with PCOS was lower than the women without PCOS on the the fifth day after transplantation.The pregnancy rate increased when the level of serum 25 OHD ?10ng/ml and follicular fluid 25 OHD ? 13.8ng/ml in the women with PCOS.