Lubna Pal1, Heping Zhang1, Joanne Williams1, Nanette F Santoro1, Michael P Diamond1, William D Schlaff1, Christos Coutifaris1, Sandra A Carson1, Michael P Steinkampf1, Bruce R Carr1, Peter G McGovern1, Nicholas A Cataldo1, Gabriella G Gosman1, John E Nestler1, Evan Myers1, Richard S Legro1. 1. Department of Obstetrics, Gynecology, and Reproductive Sciences (L.P., H.Z., J.W.), Yale School of Medicine, New Haven, Connecticut 06510; Department of Obstetrics and Gynecology (N.F.S., W.D.S.), University of Colorado, Denver, Colorado 80238; Department of Obstetrics and Gynecology (M.P.D.), Georgia Regents University, Augusta, Georgia 30912; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania, Philadelphia, Pennsylvania 19104; Baylor College of Medicine (S.A.C.), Houston, Texas 77030; University of Alabama (M.P.S.), Birmingham, Alabama 35233; University of Texas Southwestern Medical Center (B.R.C.), Dallas, Texas 75390; University of Medicine and Dentistry of New Jersey (P.G.M.), Newark, New Jersey 07103; Stanford University (N.A.C.), Stanford, California 94305; University of Pittsburgh (G.G.G.), Pittsburgh, Pennsylvania 15206; Department of Medicine (J.E.N.), Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298; Department of Obstetrics and Gynecology and Duke Clinical Research Institute (E.M.), Duke University Medical Center, Durham North Carolina 27710; and Department of Obstetrics and Gynecology (R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033.
Abstract
CONTEXT: Experimental evidence supports a relevance of vitamin D (VitD) for reproduction; however, data in humans are sparse and inconsistent. OBJECTIVE: To assess the relationship of VitD status with ovulation induction (OI) outcomes in women with polycystic ovary syndrome (PCOS). DESIGN: A retrospective cohort. SETTING: Secondary analysis of randomized controlled trial data. PARTICIPANTS: Participants in the Pregnancy in PCOS I (PPCOS I) randomized controlled trial (n = 540) met the National Institutes of Health diagnostic criteria for PCOS. INTERVENTIONS:Serum 25OHD levels were measured in stored sera. MAIN OUTCOME MEASURES: Primary, live birth (LB); secondary, ovulation and pregnancy loss after OI. RESULTS:Likelihood for LB was reduced by 44% for women if the 25OHD level was < 30 ng/mL (<75 nmol/L; odds ratio [OR], 0.58 [0.35-0.92]). Progressive improvement in the odds for LB was noted at thresholds of ≥38 ng/mL (≥95 nmol/L; OR, 1.42 [1.08-1.8]), ≥40 ng/mL (≥100 nmol/L; OR, 1.51 [1.05-2.17]), and ≥45 ng/mL (≥112.5 nmol/L; OR, 4.46 [1.27-15.72]). On adjusted analyses, VitD status was an independent predictor of LB and ovulation after OI. CONCLUSIONS: In women with PCOS, serum 25OHD was an independent predictor of measures of reproductive success after OI. Our data identify reproductive thresholds for serum 25OHD that are higher than recommended for the nonpregnant population.
RCT Entities:
CONTEXT: Experimental evidence supports a relevance of vitamin D (VitD) for reproduction; however, data in humans are sparse and inconsistent. OBJECTIVE: To assess the relationship of VitD status with ovulation induction (OI) outcomes in women with polycystic ovary syndrome (PCOS). DESIGN: A retrospective cohort. SETTING: Secondary analysis of randomized controlled trial data. PARTICIPANTS: Participants in the Pregnancy in PCOS I (PPCOS I) randomized controlled trial (n = 540) met the National Institutes of Health diagnostic criteria for PCOS. INTERVENTIONS: Serum 25OHD levels were measured in stored sera. MAIN OUTCOME MEASURES: Primary, live birth (LB); secondary, ovulation and pregnancy loss after OI. RESULTS: Likelihood for LB was reduced by 44% for women if the 25OHD level was < 30 ng/mL (<75 nmol/L; odds ratio [OR], 0.58 [0.35-0.92]). Progressive improvement in the odds for LB was noted at thresholds of ≥38 ng/mL (≥95 nmol/L; OR, 1.42 [1.08-1.8]), ≥40 ng/mL (≥100 nmol/L; OR, 1.51 [1.05-2.17]), and ≥45 ng/mL (≥112.5 nmol/L; OR, 4.46 [1.27-15.72]). On adjusted analyses, VitD status was an independent predictor of LB and ovulation after OI. CONCLUSIONS: In women with PCOS, serum 25OHD was an independent predictor of measures of reproductive success after OI. Our data identify reproductive thresholds for serum 25OHD that are higher than recommended for the nonpregnant population.
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