| Objective:To investigate the effect of serum vitamin D in fertile women on several key indicators of IVF-ET assisted conception(number of eggs gained,number of MII eggs,number/rate of 2PN)and clinical pregnancy outcome indicators(clinical pregnancy rate,miscarriage rate,live birth rate).Methods:The literature research method was used to search online the China Knowledge Network(CNKI),Wanfang database,Cochrane Library,Pubmed,Web of science,Embase,and the search period was from the establishment of the database to September 2021.The included studies were screened according to the established inclusion and exclusion criteria,and the quality evaluation and data extraction were carried out through revman5.3 software for meta-analysis.This study was divided into two parts of analysis based on vitamin D levels and interventions;the first part was the effect of vitamin D levels in women on IVF-ET pregnancy outcomes,and the second part was the effect of vitamin D interventions in women on IVF-ET pregnancy outcomes.Results:A total of 15original papers on the effect of serum vitamin D levels in fertile women on pregnancy outcome in IVF-ET were included and divided into two groups according to serum vitamin D levels:the vitamin D non-deficient group(vitamin D≥20 ng/ml)and the vitamin D deficient group(vitamin D<20 ng/ml).Pooling the data from each study for meta-analysis showed that there was no significant difference in the number of eggs gained between the two groups(MD=0.01,95%CI=[-0.23,0.26],I2=14%,P=0.30 for Q-test,Z=0.11 for effect size,P=0.91);there was no significant difference in the number of MII eggs between the two groups(MD=0.27,95%CI[-0.02,0.57],I2=42%,P=0.11 for Q-test,effect size Z=1.80,P=0.07);There was no significant difference in the number/rate of 2PN between the two groups,and because the recording method used for the extracted data was inconsistent and data conversion was not possible,meta-analysis was done separately in three subgroups(MD/OR and95%CI for the three subgroups were-0.19[-0.76,0.38],1.09[1.00,1.19],1.88[-0.27,4.04](P-values for,effect sizes were P=0.52,P=0.05,and P=0.09,respectively,all suggesting no significant difference between the vitamin D non-deficient and vitamin D deficient groups);Clinical pregnancy rates were significantly higher in the vitamin D non-deficient group than in the vitamin D deficient group between the two groups(OR=1.61,95%CI=[1.38,1.86],I2=33%,P=0.13 for Q-test,Z=6.26 for effect size,P<0.00001);miscarriage rates were not significantly different between the two groups(OR=0.79,95%CI[0.54,1.16],I2=0%,P=0.80 for Q-test,effect size Z=1.20,P=0.23);The live birth rate between the two groups was significantly higher in the vitamin D non-deficient group than in the vitamin D deficient group(OR=1.32,95%CI=[1.08,1.61],I2=33%,P=0.21 for Q-test,effect size Z=2,68,P=0.007).A total of five original papers were included on the effect of vitamin D intervention on IVF-ET pregnancy outcome,and the studies were divided into two groups according to whether vitamin D intervention was given:vitamin D intervention group(treatment group)and control group(placebo),and the data were pooled for meta-analysis,which showed that the number of eggs gained in IVF-ET was significantly higher in the vitamin D treatment group than in the control group(MD=1.00,95%CI=[0.31,1.69],I~2=0%,P=0.83 for Q-test,effect size Z=2.86,P=0.004);There was no significant difference in the number of MII eggs between the two groups(MD=0.33,95%CI=[-0.21,0.87],I~2=44%,P=0.15 for Q-test,Z=1.21 for effect size,P=0.23);the number of 2PN was significantly higher in the vitamin D-treated group than in the control group between the two groups(MD=1.22,95%CI=[0.30,2.14],I~2=0%,P=0.56>0.1 for Q-test,effect size Z=2.61,P=0.0009).There was no significant difference in clinical pregnancy rate between the two groups(RR=1.31,95%CI=[1.00,1.72],I~2=47%,P=0.13 for Q-test,effect size Z=1.99,P=0.05).Conclusions:The clinical pregnancy rate and live birth rate of IVF-ET in the non-deficient group of women with serum vitamin D levels were significantly higher than those in the vitamin D-deficient group,and there were no significant differences in the number of eggs gained,the number of MII eggs,the number/rate of 2PN and the miscarriage rate between the two groups,suggesting that correction of vitamin D deficiency may improve the clinical pregnancy rate and live birth rate of IVF-ET.The number of eggs obtained and the number of 2PN were significantly higher in the vitamin D intervention group than in the control group;there was no significant difference in the number of MII eggs between the two groups,and there was no significant difference in the clinical pregnancy rate of IVF-ET between the two groups,but the clinical pregnancy rate in the vitamin D intervention group was 1.31 times higher than that in the control group.It is suggested that vitamin D intervention may improve the number of eggs gained and the number of 2PN in IVF-ET,especially in patients with hypoplastic ovaries and low follicle counts,which is expected to be improved by vitamin D treatment,thus indirectly increasing the probability of pregnancy.In addition,due to the insufficient number of studies on vitamin D intervention in IVF-ET,there is a relative lack of sample size,suggesting that we can conduct future research topics in this direction and constantly update the large data,which may lead to more realistic conclusions. |
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