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

  • Xi-ya SUN ,
  • Yi-lu CHEN ,
  • Lin ZENG ,
  • Li-ying YAN ,
  • Jie QIAO ,
  • Rong LI ,
  • Xu ZHI
Expand
  • 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 date: 2021-11-16

  Online published: 2023-01-31

Supported by

the National Natural Science Foundation of China(81971440);the Beijing Municipal Natural Science Foundation(7212129)

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.

Cite this article

Xi-ya SUN , Yi-lu CHEN , Lin ZENG , Li-ying YAN , Jie QIAO , Rong LI , Xu ZHI . Correlation analysis of vitamin D level and anti-Müllerian hormone in infertile female and the role in predicting pregnancy outcome[J]. Journal of Peking University(Health Sciences), 2023 , 55(1) : 167 -173 . DOI: 10.19723/j.issn.1671-167X.2023.01.026

References

1 Rizzo G , Garzon S , Fichera M , et al. Vitamin D and gestational diabetes mellitus: Is there a link[J]. Antioxidants (Basel), 2019, 8 (11): 511.
2 Malloy PJ , Peng L , Wang J , et al. Interaction of the vitamin D receptor with a vitamin D response element in the mullerian-inhibiting substance (mis) promoter: Regulation of mis expression by calcitriol in prostate cancer cells[J]. Endocrinology, 2009, 150 (4): 1580- 1587.
3 Rosen CJ , Abrams SA , Aloia JF , et al. Iom committee members respond to endocrine society vitamin D guideline[J]. J Clin Endocrinol Metab, 2012, 97 (4): 1146- 1152.
4 Bouillon R , Carmeliet G , Verlinden L , et al. Vitamin D and human health: Lessons from vitamin D receptor null mice[J]. Endocr Rev, 2008, 29 (6): 726- 776.
5 Moolhuijsen LME , Visser JA . Anti-Müllerian hormone and ovarian reserve: Update on assessing ovarian function[J]. J Clin Endocrinol Metab, 2020, 105 (11): 3361- 3373.
6 Dewailly D , Andersen CY , Balen A , et al. The physiology and clinical utility of anti-Müllerian hormone in women[J]. Hum Reprod Update, 2014, 20 (3): 370- 385.
7 Dixon KM , Mason RS . Vitamin D[J]. Int J Biochem Cell Biol, 2009, 41 (5): 982- 985.
8 Dennis NA , Houghton LA , Jones GT , et al. The level of serum anti-Müllerian hormone correlates with vitamin D status in men and women but not in boys[J]. J Clin Endocrinol Metab, 2012, 97 (7): 2450- 2455.
9 Krishnan AV , Moreno J , Nonn L , et al. Novel pathways that contribute to the anti-proliferative and chemopreventive activities of calcitriol in prostate cancer[J]. J Steroid Biochem Mol Biol, 2007, 103 (3/4/5): 694- 702.
10 Xu J , Hennebold JD , Seifer DB . Direct vitamin D3 actions on rhesus macaque follicles in three-dimensional culture: Assessment of follicle survival, growth, steroid, and anti-Müllerian hormone production[J]. Fertil Steril, 2016, 106 (7): 1815e1811- 1820e1811.
11 Xu J, Lawson MS, Xu F, et al. Vitamin D3 regulates follicular development and intrafollicular vitamin D biosynthesis and signaling in the primate ovary[J/OL]. Front Physiol, 2018, 9: 1600(2018-11-14)[2021-11-01]. https://www.frontiersin.org/articles/10.3389/fphys.2018.01600/full.
12 Merhi Z , Doswell A , Krebs K , et al. Vitamin D alters genes involved in follicular development and steroidogenesis in human cumulus granulosa cells[J]. J Clin Endocrinol Metab, 2014, 99 (6): E1137- E1145.
13 Drakopoulos P , van de Vijver A , Schutyser V , et al. The effect of serum vitamin D levels on ovarian reserve markers: A prospective cross-sectional study[J]. Hum Reprod, 2017, 32 (1): 208- 214.
14 Fabris AM , Cruz M , Iglesias C , et al. Impact of vitamin D levels on ovarian reserve and ovarian response to ovarian stimulation in oocyte donors[J]. Reprod Biomed Online, 2017, 35 (2): 139- 144.
15 Merhi ZO , Seifer DB , Weedon J , et al. Circulating vitamin D correlates with serum antimüllerian hormone levels in late-reproductive-aged women: Women's interagency HIV study[J]. Fertil Steril, 2012, 98 (1): 228- 234.
16 Bednarska-Czerwińska A , Olszak-W?sik K , Olejek A , et al. Vitamin D and anti-müllerian hormone levels in infertility treatment: The change-point problem[J]. Nutrients, 2019, 11 (5): 1053.
17 胡贻椿, 陈竞, 王睿, 等. 我国育龄女性维生素D营养状况分析[J]. 营养学报, 2020, 42 (6): 537- 541.
18 孙丽君, 冯营营, 胡继君, 等. 维生素D与不孕女性卵巢储备标志物的相关性分析[J]. 中华生殖与避孕杂志, 2017, 37 (9): 706- 710.
19 Visser JA , Themmen APN . Anti-müllerian hormone and folliculogenesis[J]. Mol Cell Endocrinol, 2005, 234 (1/2): 81- 86.
20 Moslehi N , Shab-Bidar S , Ramezani Tehrani F , et al. Is ovarian reserve associated with body mass index and obesity in reproductive aged women? A meta-analysis[J]. Menopause, 2018, 25 (9): 1046- 1055.
21 Merhi Z , Buyuk E , Berger DS , et al. Leptin suppresses anti-mullerian hormone gene expression through the JAK2/STAT3 pathway in luteinized granulosa cells of women undergoing IVF[J]. Hum Reprod, 2013, 28 (6): 1661- 1669.
22 Ligon S , Lustik M , Levy G , et al. Low antimüllerian hormone (AMH) is associated with decreased live birth after in vitro fertilization when follicle-stimulating hormone and AMH are discordant[J]. Fertil Steril, 2019, 112 (1): 73e71- 81e71.
23 Ciepiela P , Dul?ba AJ , Kario A , et al. Oocyte matched follicular fluid anti-müllerian hormone is an excellent predictor of live birth after fresh single embryo transfer[J]. Hum Reprod, 2019, 34 (11): 2244- 2253.
24 Wu CH , Yang SF , Tsao HM , et al. anti-Müllerian hormone gene polymorphism is associated with clinical pregnancy of fresh IVF cycles[J]. Int J Environ Res Public Health, 2019, 16 (5): 841.
25 Chen Y, Zhi X. Roles of vitamin D in reproductive systems and assisted reproductive technology[J/OL]. Endocrinology, 2020, 161(4): bqaa023(2020-02-18)[2021-11-01]. https://academic.oup.com/endo/article/161/4/bqaa023/5739616?login=true.
Outlines

/