IVIRMA, IVI Foundation, Valencia, Spain; Department of Obstetrics, Gynaecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut; Rey Juan Carlos University, Madrid, Spain.
Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Clinical and Research Center - IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Fertil Steril. 2020 Nov;114(5):1014-1025. doi: 10.1016/j.fertnstert.2020.05.040. Epub 2020 Oct 1.
To investigate the impact of serum vitamin D level on in vitro fertilization (IVF) outcomes.
Systematic review and meta-analysis.
Not applicable.
Infertile women undergoing conventional IVF or intracytoplasmic sperm injection (ICSI).
Systematic search of PubMed, MEDLINE, EMBASE, Global Health, The Cochrane Library, Health Technology Assessment Database, and Web of Science from inception until July 2019 with cross-checking of references from relevant articles in English. Vitamin D levels were categorized into three groups: deficient (<20 ng/mL), insufficient (20-30 ng/mL), and replete (>30 ng/mL). Before starting the data extraction, we registered the review protocol in PROSPERO (CRD42019134258).
We consider clinical pregnancy rate (CPR), live birth rate (LBR), and/or ongoing pregnancy rate (OPR) as primary outcomes. Likewise, the miscarriage rate was considered as a secondary outcome.
Primary analysis showed that women with a replete level of vitamin D had higher CPR and LBR/OPR compared to those with a deficient of insufficient level of vitamin D. However, sensitivity analysis led to non-significant differences between the comparators for CPR (odds ratio 0.71, 95% confidence interval 0.47-1.08, I2 = 61%) and OPR/LBR (odds ratio 0.78, 95% confidence interval 0.56-1.08], I2 = 61%). Also, for miscarriage a statistically different rate was not reached.
Serum vitamin D levels do not influence IVF outcomes in terms of CPR, LBR/OPR, and miscarriage rate. Future large cohort studies are warranted to determine whether the threshold of vitamin D affects reproductive outcomes. Currently, there is a lack of consensus between the appropriate vitamin D threshold to predict reproductive outcomes compared to the one established for bone health.
CRD42019134258.
探讨血清维生素 D 水平对体外受精（IVF）结局的影响。
系统评价和荟萃分析。
不适用。
接受常规体外受精或胞浆内精子注射（ICSI）的不孕妇女。
从开始到 2019 年 7 月，系统检索 PubMed、MEDLINE、EMBASE、全球健康、Cochrane 图书馆、卫生技术评估数据库和 Web of Science，并从相关文章中交叉核对英文参考文献。维生素 D 水平分为三组：缺乏（<20ng/ml）、不足（20-30ng/ml）和充足（>30ng/ml）。在开始提取数据之前，我们在 PROSPERO（CRD42019134258）中注册了该综述方案。
我们将临床妊娠率（CPR）、活产率（LBR）和/或持续妊娠率（OPR）视为主要结局。同样，流产率也被视为次要结局。
初步分析显示，维生素 D 充足水平的女性与维生素 D 缺乏或不足水平的女性相比，CPR 和 LBR/OPR 更高。然而，敏感性分析导致比较组之间的 CPR（优势比 0.71，95%置信区间 0.47-1.08，I2=61%）和 OPR/LBR（优势比 0.78，95%置信区间 0.56-1.08]，I2=61%）无显著差异。此外，流产率也未达到统计学差异。
血清维生素 D 水平对 CPR、LBR/OPR 和流产率等 IVF 结局没有影响。需要进一步开展大型队列研究，以确定维生素 D 水平的阈值是否会影响生殖结局。目前，与用于骨健康的阈值相比，预测生殖结局的适当维生素 D 阈值缺乏共识。
PROSPERO 编号：CRD42019134258。
