Grzechocinska Barbara, Dabrowski Filip A, Cyganek Anna, Wielgos Miroslaw
1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland.
Neuro Endocrinol Lett. 2013;34(8):756-62.
Vitamin D is currently in the scope of research in many fields of medicine. Despite that its influence on health remains uncertain. This paper presents the review of the publications concerning the role of calciferol in reproduction processes and its significance in infertility therapy covering topics of polycystic ovary syndrome, endometriosis infertility, myoma infertility, male infertility, premature ovary failure and in vitro fertilization techniques. The results of latest research articles in those fields has been discussed and summarized. The deficiency of vitamin defined as the concentration of 25-hydroxycalciferol <20 ng/ml is frequently noted in patients of fertility clinics. Serum vitamin D concentration in healthy women is higher comparing to PCOS patients. The supplementation with vitamin D should be applied in the schemes of PCOS treatment both due to an improved insulin resistance and the results of infertility treatment. The explanation of vitamin D activity mechanism in patients with PCOS requires further research. Vitamin D have direct effect on AMH production, and thus increase longer maintenance of ovarian reserve in the patients with its higher concentration. The occurrence of uterine myomas in the group with vitamin D deficiency was evaluated as much higher comparing to controls. On the other hand it is supposed that high concentration of calciferol may be related to an impaired elimination of endometrial cells passing to peritoneal cavity via ovarian reflux causing endometriosis. In male infertility both low (<20 ng/ml) and high (>50 ng/ml) concentration of vitamin D in serum negatively affects spermatozoa number per ml of semen, their progressive movement and morphology. Significant differences as a response on ovulation stimulation, number and quality of embryos depending on vitamin D concentration were not observed in none of the analyzed papers concerning the role of vitamin D in in vitro fertilization (IVF). Better results in patients without calciferol insufficiency are explained by reports about high concentration of vitamin D and its metabolites in human in decidua collected in the 1st trimester of pregnancy which suggests its contribution in proper implantation and local immunological preference of the embryo. It is accepted that the treatment requires vitamin D concentration below 20 ng/ml (up to 50 nmol/l), especially in obese women, these with insulin resistance and small ovarian reserve and in men with oligo- and asthenozoospermia.
维生素D目前处于许多医学领域的研究范围内。尽管其对健康的影响仍不确定。本文对有关骨化醇在生殖过程中的作用及其在不孕症治疗中的意义的出版物进行了综述，涵盖多囊卵巢综合征、子宫内膜异位症不孕症、肌瘤不孕症、男性不育症、卵巢早衰和体外受精技术等主题。讨论并总结了这些领域最新研究文章的结果。生育诊所的患者中经常发现维生素缺乏，定义为25-羟基维生素D浓度<20 ng/ml。与多囊卵巢综合征患者相比，健康女性的血清维生素D浓度更高。由于改善胰岛素抵抗和不孕症治疗结果，维生素D补充剂应应用于多囊卵巢综合征治疗方案中。多囊卵巢综合征患者中维生素D活性机制的解释需要进一步研究。维生素D对抗苗勒管激素（AMH）的产生有直接影响，因此在浓度较高的患者中可延长卵巢储备的维持时间。与对照组相比，维生素D缺乏组子宫肌瘤的发生率评估要高得多。另一方面，有人认为高浓度的骨化醇可能与通过卵巢反流进入腹腔的子宫内膜细胞清除受损有关，从而导致子宫内膜异位症。在男性不育症中，血清中低（<20 ng/ml）和高（>50 ng/ml）浓度的维生素D均会对每毫升精液中的精子数量、其向前运动和形态产生负面影响。在关于维生素D在体外受精（IVF）中的作用的任何分析论文中，均未观察到根据维生素D浓度对排卵刺激、胚胎数量和质量的反应有显著差异。关于妊娠早期收集的人蜕膜中高浓度的维生素D及其代谢产物的报道解释了维生素D充足的患者有更好的结果，这表明其对胚胎的正确着床和局部免疫偏好有贡献。人们公认治疗需要维生素D浓度低于20 ng/ml（高达50 nmol/l），特别是在肥胖女性、有胰岛素抵抗和卵巢储备小的女性以及少弱精子症的男性中。
