Mauro Cozzolino1, Andrea Busnelli2, Livia Pellegrini3, Emma Riviello4, Amerigo Vitagliano4. 1. 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. Electronic address: mauro.cozzolino@ivirma.com. 2. 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. 3. IVIRMA, IVI Foundation, Valencia, Spain. 4. Unit of Gynecology and Obstetrics, Department of Women and Children's Health, University of Padua, Padua, Italy.
Abstract
OBJECTIVE: To investigate the impact of serum vitamin D level on in vitro fertilization (IVF) outcomes. DESIGN: Systematic review and meta-analysis. SETTING: Not applicable. PATIENTS: Infertile women undergoing conventional IVF or intracytoplasmic sperm injection (ICSI). INTERVENTIONS: 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). MAIN OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSION: 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. PROSPERO NUMBER: CRD42019134258.
OBJECTIVE: To investigate the impact of serum vitamin D level on in vitro fertilization (IVF) outcomes. DESIGN: Systematic review and meta-analysis. SETTING: Not applicable. PATIENTS: Infertilewomen undergoing conventional IVF or intracytoplasmic sperm injection (ICSI). INTERVENTIONS: 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). MAIN OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSION: 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. PROSPERO NUMBER: CRD42019134258.
Authors: Nicole Banks; Fangbai Sun; Stephen A Krawetz; R Matthew Coward; Puneet Masson; James F Smith; J C Trussell; Nanette Santoro; Heping Zhang; Anne Z Steiner Journal: Fertil Steril Date: 2021-07-18 Impact factor: 7.490