Sivalingarajah Raguraman, Kesavan Vithegi, Coonghe Pethirupillai A, Vethanayagam Sheron A, Jeyaluxmy Sivalingam, Dhushyanthy Kaviranjan, Paramanathan Shathana
Obstetrics and Gynaecology, University of Jaffna, Jaffna, LKA.
Chemical Pathology, Jaffna Teaching Hospital, Jaffna, LKA.
Cureus. 2024 Oct 22;16(10):e72094. doi: 10.7759/cureus.72094. eCollection 2024 Oct.
Subfertility is a global burden. Low vitamin D status has been associated with an increased risk for subfertility. Even though the prevalence of vitamin D deficiency is very high among women in Sri Lanka, not much importance is given to addressing the issue, especially among subfertile women. Moreover, no studies have been reported on the prevalence of vitamin D in subfertile women in Sri Lanka. Thus, the current study aimed to assess the prevalence and associated risk factors among subfertile women in the northern part of Sri Lanka. Methodology: This was a cross-sectional study comprising an interviewer-administered questionnaire and a laboratory analysis of vitamin D conducted on 371 subfertile women above 18 years of age who attended the subfertility clinic at the Professorial Unit in the Jaffna Teaching Hospital, Jaffna, Sri Lanka, between January 2023 to October 2023. Considering the time limitation and sample size, subfertile women attending during the study period were included without any sampling technique. Competitive chemiluminescence immunoassay for 25 hydroxy vitamin D (25(OH)D) was used to estimate the vitamin D level, and an external quality assessment (EQA) standard was used to categorize the level into deficient, insufficient, and sufficient. Chi-squared and ANOVA tests were used to assess the factors associated with vitamin D levels using IBM SPSS Statistics for Windows, Version 21.0 (Released 2012; IBM Corp., Armonk, New York, United States). Results: The mean age of subfertile women was 33.7 years (SD=6.7), and nearly half of them (n=173, 46.6%) were in the age group of 30-40 years. All the participants (n=371, 100%) were Sri Lankan Tamil, the majority (n=289, 77.9%) of them were Hindus, and nearly three-quarters of the participants (n=269, 72.5%) were unemployed. Moreover, almost 90% (n=334) of the subfertile women never estimated their vitamin D level prior to the study. The study revealed that only 36.4% (n=135) of subfertile women had adequate vitamin D levels, whereas 63.4% (n=235) had inadequate and low BMI levels, and intake of fish and eggs was statistically associated with adequate vitamin D levels. Conclusion: The study recommends a routine assessment of vitamin D levels, periodical monitoring of vitamin D levels for all subfertile women with particular attention towards the obese and overweight category, and a combination of pharmacological and dietary interventions to improve vitamin D levels, which might benefit the fertility outcome.
生育力低下是一项全球性负担。维生素D水平低与生育力低下风险增加有关。尽管斯里兰卡女性中维生素D缺乏的患病率很高，但解决该问题并未得到太多重视，尤其是在生育力低下的女性中。此外，尚无关于斯里兰卡生育力低下女性中维生素D患病率的研究报告。因此，本研究旨在评估斯里兰卡北部生育力低下女性中维生素D的患病率及相关风险因素。方法：这是一项横断面研究，包括一份由访谈员实施的问卷，以及对2023年1月至2023年10月期间在斯里兰卡贾夫纳教学医院教授单元的不孕不育诊所就诊的371名18岁以上生育力低下女性进行维生素D的实验室分析。考虑到时间限制和样本量，研究期间就诊的生育力低下女性被纳入研究，未采用任何抽样技术。采用竞争性化学发光免疫分析法检测25羟维生素D（25(OH)D）以估计维生素D水平，并使用外部质量评估（EQA）标准将维生素D水平分为缺乏、不足和充足三类。使用IBM SPSS Statistics for Windows 21.0版（2012年发布；IBM公司，美国纽约州阿蒙克）进行卡方检验和方差分析，以评估与维生素D水平相关的因素。结果：生育力低下女性的平均年龄为33.7岁（标准差=6.7），其中近一半（n=173，46.6%）年龄在30-40岁之间。所有参与者（n=371，100%）均为斯里兰卡泰米尔人，其中大多数（n=289，77.9%）为印度教徒，近四分之三的参与者（n=269，72.5%）失业。此外，几乎90%（n=334）的生育力低下女性在研究前从未检测过自己的维生素D水平。研究显示，只有36.4%（n=135）的生育力低下女性维生素D水平充足，而63.4%（n=235）的女性维生素D水平不足且体重指数较低，鱼类和蛋类的摄入与充足的维生素D水平在统计学上相关。结论：该研究建议对维生素D水平进行常规评估，对所有生育力低下女性定期监测维生素D水平，尤其关注肥胖和超重人群，并采用药物和饮食干预相结合的方式来提高维生素D水平，这可能有利于生育结局。
