Department of Reproductive Medicine, The Affiliated Taizhou People's Hospital to Nanjing Medical University, Taizhou, China.
School of Medicine, Southeast University, Nanjing, China.
Front Endocrinol (Lausanne). 2023 Aug 24;14:1249445. doi: 10.3389/fendo.2023.1249445. eCollection 2023.
The debate over the impact of vitamin D in assisted reproduction continues. The purpose of our study was to assess embryo quality and pregnancy outcomes among groups with different levels of vitamin D after the first fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycle in patients with normal ovarian reserve (NOR).
Patients in this retrospective cohort study were divided into three groups: severe vitamin D deficiency group (25OH-D < 10 ng/ml), vitamin D deficiency group (10 ng/ml ≤ 25OH-D < 20 ng/ml), and non-vitamin D deficiency group (25OH-D ≥ 20 ng/ml). The primary outcome was clinical pregnancy, while the secondary outcomes were mature oocytes, oocyte fertilization, available cleavage embryos, available blastocysts, biochemical pregnancy, early abortion, and embryo implantation. A modified Poisson regression model and multiple linear regression analysis were conducted for the multivariate analysis.
264 NOR patients undergoing the first IVF/ICSI cycles were included. For the primary outcome, there was no significant difference in clinical pregnancy between the severe vitamin D deficiency group and the other two groups (vitamin D deficiency group: adjusted RR = 1.026; 0.780 - 1.350; P = 0.854; non-vitamin D deficiency group: adjusted RR = 1.092; 0.743 - 1.605; = 0.652). For all secondary outcomes, no significant differences were observed among the severe vitamin D deficiency, vitamin D deficiency, and non-vitamin D deficiency groups ( > 0.05). Exploratory subgroup analyses concerning the season of embryo transfer, phase of embryo transferred, and endometrial thickness, as well as the sensitivity analysis using logistic regression models for the primary outcome, revealed comparable clinical pregnancy rates among the groups ( > 0.05). Subgroup analysis concerning ovarian stimulation protocol indicated that in the subgroup of gonadotrophin-releasing hormone (GnRH) antagonist protocol, the clinical pregnancy rate of the non-vitamin D deficiency group was significantly higher than that of the other two groups ( < 0.05).
Serum vitamin D level was not associated with embryo quality and pregnancy outcomes for patients with NOR. Further studies with greater sample sizes and a longer follow-up period are needed to elucidate the relationships between vitamin D levels and IVF outcomes.
关于维生素 D 在辅助生殖中的作用仍存在争议。本研究的目的是评估在卵巢储备正常（NOR）患者中，首次受精（IVF）/卵胞浆内单精子注射（ICSI）周期后不同维生素 D 水平对胚胎质量和妊娠结局的影响。
本回顾性队列研究将患者分为三组：严重维生素 D 缺乏组（25OH-D < 10ng/ml）、维生素 D 缺乏组（10ng/ml ≤ 25OH-D < 20ng/ml）和非维生素 D 缺乏组（25OH-D ≥ 20ng/ml）。主要结局为临床妊娠，次要结局为成熟卵母细胞、卵母细胞受精、可利用的卵裂胚胎、可利用的囊胚、生化妊娠、早期流产和胚胎着床。采用修正泊松回归模型和多元线性回归分析进行多变量分析。
共纳入 264 例接受首次 IVF/ICSI 周期的 NOR 患者。对于主要结局，严重维生素 D 缺乏组与其他两组（维生素 D 缺乏组：调整 RR = 1.026；0.780-1.350；P = 0.854；非维生素 D 缺乏组：调整 RR = 1.092；0.743-1.605； = 0.652）的临床妊娠率无显著差异。对于所有次要结局，严重维生素 D 缺乏组、维生素 D 缺乏组和非维生素 D 缺乏组之间无显著差异（>0.05）。对胚胎移植季节、胚胎移植阶段和子宫内膜厚度的探索性亚组分析，以及对主要结局的逻辑回归模型敏感性分析，均显示各组的临床妊娠率相似（>0.05）。关于卵巢刺激方案的亚组分析表明，在 GnRH 拮抗剂方案的亚组中，非维生素 D 缺乏组的临床妊娠率显著高于其他两组（<0.05）。
血清维生素 D 水平与 NOR 患者的胚胎质量和妊娠结局无关。需要进一步开展具有更大样本量和更长随访时间的研究，以阐明维生素 D 水平与 IVF 结局之间的关系。
