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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (1): 167-173. doi: 10.19723/j.issn.1671-167X.2023.01.026

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Correlation analysis of vitamin D level and anti-Müllerian hormone in infertile female and the role in predicting pregnancy outcome

Xi-ya SUN1,Yi-lu CHEN1,2,Lin ZENG3,Li-ying YAN1,Jie QIAO1,Rong LI1,Xu ZHI1,*()   

  1. 1. Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital; National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital); Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
    2. Women and Children's Hospital, Qingdao University, Shandong, Qingdao 266000, China
    3. Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing 100191, China
  • Received:2021-11-16 Online:2023-02-18 Published:2023-01-31
  • Contact: Xu ZHI E-mail:zhixujp@163.com
  • Supported by:
    the National Natural Science Foundation of China(81971440);the Beijing Municipal Natural Science Foundation(7212129)

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Abstract:

Objective: To investigate the relationship between serum 25(OH)D and anti-Müllerian hormone (AMH) among infertile females and their predictive impacts on in vitro fertilization and embryo transfer pregnancy outcome. Methods: Totally 756 infertile females treated with assisted reproductive technology were enrolled and divided into three groups according to their vitamin D levels (group A with serum 25(OH)D≤10 μg/L, group B with serum (10-20) μg/L, and group C with serum ≥20 μg/L). The serum AMH levels were detected. The differences among the groups were analyzed, as well as the correlation between vitamin D levels and serum AMH levels in various infertility types (fallopian tube/male factor, polycystic ovary syndrome (PCOS), ovulation disorders excluded PCOS, endometriosis, unexplained infertility, and others). Also, the predictive roles of vitamin D and AMH in pregnancy outcome in all the infertile females were discussed. Results: (1) 87.7% of the enrolled females were insufficient or deficient in vitamin D. (2) The serum AMH levels in the three groups with different vitamin D levels were 1.960 (1.155, 3.655) μg/L, 2.455 (1.370, 4.403) μg/L, 2.360 (1.430, 4.780) μg/L and there was no significant difference in serum AMH levels among the three groups (P>0.05). (3) Serum 25(OH)D and AMH levels presented seasonal variations (P < 0.05). (4) There was no prominent correlation between the serum AMH level and serum 25(OH)D level in females of various infertility types after adjusting potential confounding factors [age, body mass index (BMI), antral follicle count (AFC), vitamin D blood collection season, etc.] by multiple linear regression analysis (P>0.05). (5) After adjusting for confounding factors, such as age, BMI, number of transplanted embryos and AFC, the results of binary Logistics regression model showed that in all the infertile females, the serum AMH level was an independent predictor of biochemical pregnancy outcome (P < 0.05) while the serum 25(OH)D level might not act as a prediction factor alone (P>0.05). In the meanwhile, the serum 25(OH)D level and serum AMH level were synergistic predictors of biochemical or clinical pregnancy outcome (P < 0.05). Conclusion: Based on the current diagnostic criteria, most infertile females had vitamin D insufficiency or deficiency, but there was not significant correlation between serum 25(OH)D and ovarian reserve. While vitamin D could not be used as an independent predictor of pregnancy outcome in infertile females, the serum AMH level could predict biochemical pregnancy outcome independently or jointly with vitamin D.

Key words: Vitamin D, anti-Müllerian hormone (AMH), Infertile female, Pregnancy outcome

CLC Number: 

  • R714.8

Table 1

Clinical characteristics of the patients among three different vitamin D status"

Characteristic Group A Group B Group C P valuea
Total, n 85 578 93
Age/years, $\bar x \pm s$ 32.2±4.4 31.8±4.2 33.5±4.1 0.001
BMI/(kg/m2), $\bar x \pm s$ 22.70±3.60 22.73±3.21 22.09±3.26 0.211
Serum 25(OH)D/(μg/L), $\bar x \pm s$ 8.384±1.038 14.395±2.645 22.96±2.89 < 0.001
Duration of infertility/years, M(P25, P75) 3.0 (1.0, 4.0) 3.0 (2.0, 5.0) 3.0 (1.0, 6.0) 0.123
AFC, $\bar x \pm s$ 10.4±5.8 11.3±6.2 11.9±5.9 0.267
AMH/(μg/L), M(P25, P75) 1.960 (1.155, 3.655) 2.455 (1.370, 4.403) 2.360 (1.430, 4.780) 0.242
Basal FSH levels/(IU/L), $\bar x \pm s$ 6.845±2.202 6.801±2.753 7.282±2.065 0.321
Infertility factor, n(%) 0.069
  Fallopian tube/Male factor 36 (42.4) 231 (40.0) 37(39.8)
  PCOS 8 (9.4) 107 (18.5) 18(19.4)
  Ovulation disorders excluded PCOS 18 (21.2) 90 (15.6) 19(21.3)
  Endometriosis 5 (5.9) 19 (3.3) -
  Unexplained infertility 5 (5.9) 67 (11.6) 13(14.0)
  Others 13 (15.3) 64 (11.1) 6(6.5)
Season of blood draw, n(%) < 0.001
  Spring 60 (70.6%) 312 (54.0%) 44 (47.3%)
  Summer 9 (10.6%) 183 (31.7%) 33 (35.5%)
  Autumn - 4 (0.7%) 4 (4.3%)
  Winter 16 (18.8%) 79 (13.7%) 12 (12.9%)
Duration of treatment/d, $\bar x \pm s$ 11.0±2.2 10.9±2.5 10.2±2.9 0.015
Total dose of Gn used/IU，M(P25, P75) 2 700.0 (2 012.5, 3 375.0) 2 475.0 (1 743.8, 3 375.0) 2 400.0 (1 828.1, 3 150.0) 0.258
Number of oocytes retrieved, M(P25, P75) 10.0 (7.5, 16.5) 12.0 (8.0, 18.0) 12.0 (7.0, 17.5) 0.343

Table 2

Effect of blood sampling season on serum 25(OH)D and AMH"

Items Season of blood draw P valuea
Spring Summer Autumn Winter
Serum 25(OH)D/(μg/L), $\bar x \pm s$ 14.317±4.167 15.711±4.008 20.320±5.474 14.153±5.400 < 0.001
AMH/(μg/L), M(P25, P75) 2.245 (1.360, 3.958) 2.540 (1.315, 4.805) 3.430 (2.900, 5.060) 2.590 (1.310, 5.230) 0.046

Table 3

Correlation analysis of AMH in different types of infertility"

Infertility factor Items B SE P value
Fallopian tube/Male factor (n=304) Serum 25(OH)D －0.039 0.029 0.186
Age －0.079 0.035 0.024
BMI －0.013 0.042 0.767
AFC 0.144 0.027 < 0.001
Constant 5.326 1.580 0.001
PCOS (n=133) Serum 25(OH)D 0.122 0.095 0.201
Age －0.008 0.120 0.947
BMI －0.389 0.111 0.001
AFC 0.357 0.057 < 0.001
Constant 9.012 4.771 0.061
Ovulation disorders excluded PCOS (n=127) Serum 25(OH)D －0.005 0.014 0.734
Age 0.025 0.014 0.088
BMI －0.010 0.021 0.621
AFC 0.159 0.022 < 0.001
Constant －0.100 0.778 0.898
Endometriosis (n=24) Serum 25(OH)D 0.106 0.107 0.336
Age －0.050 0.101 0.624
BMI －0.122 0.106 0.263
AFC 0.081 0.074 0.289
Constant 5.249 4.111 0.218
Unexplained infertility (n=85) Serum 25(OH)D 0.049 0.056 0.391
Age 0.017 0.068 0.799
BMI －0.172 0.089 0.057
AFC 0.105 0.057 0.071
Constant 4.608 2.886 0.114
Others (n=83) Serum 25(OH)D －0.007 0.046 0.885
Age 0.006 0.048 0.904
BMI －0.031 0.061 0.619
AFC 0.168 0.038 < 0.001
Constant 2.009 2.241 0.373

Table 4

The role of serum 25(OH)D and AMH in predicting pregnancy outcome in the infertility female"

Items Biochemical pregnancy Clinical pregnancy
OR 95%CI P value OR 95%CI P value
AMH 1.503 1.083-2.086 0.015 1.310 0.957-1.791 0.092
Serum 25(OH)D 1.044 0.974-1.119 0.223 1.039 0.970-1.114 0.276
25(OH)D*AMH 0.978 0.958-0.997 0.027 0.982 0.962-1.002 0.071
Age 0.948 0.905-0.992 0.022 0.949 0.907-0.993 0.024
BMI 1.018 0.962-1.078 0.531 1.019 0.963-1.079 0.515
AFC 1.024 0.979-1.070 0.302 1.019 0.975-1.064 0.403
Number of embryos transferred 1.052 0.670-1.652 0.827 1.051 0.674-1.641 0.826
Constant 1.122 - 0.924 1.242 - 0.857
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