Vitamin D Deficiency Is Associated with Poor Ovarian Stimulation Outcome in PCOS but Not Unexplained Infertility

Samantha F. Butts, David B. Seifer, Nathanael Koelper, Suneeta Senapati, Mary D. Sammel, Andrew N. Hoofnagle, Andrea Kelly, Steven A. Krawetz, Nanette Santoro, Heping Zhang, Michael Peter Diamond, Richard S. Legro

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Context The impact of vitamin D deficiency on the success of ovarian stimulation according to underlying infertility diagnosis has not been investigated. Objective To evaluate the relationship between vitamin D deficiency and reproductive outcomes after ovarian stimulation in women with either polycystic ovary syndrome (PCOS) or unexplained infertility. Design Retrospective cohort study. Setting Analysis of randomized controlled trial (RCT) data. Participants Participants from the Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) RCT (n = 607); participants from the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) RCT of unexplained infertility (n = 647). Interventions Serum 25(OH)D levels measured in banked sera. Main Outcome Measures Primary: live birth; secondary: ovulation (PPCOS II), pregnancy, and early pregnancy loss. Results In PPCOS II, subjects with vitamin D deficiency [25(OH)D < 20 ng/mL or 50 nmol/L] were less likely to ovulate (adjusted OR, 0.82; 95% CI, 0.68 to 0.99; P = 0.04) and experienced a 40% lower chance of live birth (adjusted OR, 0.63; 95% CI, 0.41 to 0.98; P = 0.04) than those not deficient. In AMIGOS, no significant association between vitamin D deficiency and live birth was noted. In pregnant subjects from both studies, vitamin D deficiency was associated with elevated risk of early pregnancy loss (OR, 1.6; 95% CI, 1.0 to 2.6; P = 0.05). Conclusions In this investigation of women pursuing ovarian stimulation, the association between vitamin D deficiency and diminished live birth relied on carrying the diagnosis of PCOS and was not observed in unexplained infertility. Given the generally modest success of ovarian stimulation, addressing vitamin D deficiency may prove an important treatment adjunct for many infertile women.

Original languageEnglish (US)
Pages (from-to)369-378
Number of pages10
JournalJournal of Clinical Endocrinology and Metabolism
Volume104
Issue number2
DOIs
StatePublished - Nov 9 2018

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Vitamin D Deficiency
Ovulation Induction
Polycystic Ovary Syndrome
Vitamin D
Infertility
Pregnancy
Live Birth
Randomized Controlled Trials
Ovulation
Serum
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Butts, S. F., Seifer, D. B., Koelper, N., Senapati, S., Sammel, M. D., Hoofnagle, A. N., ... Legro, R. S. (2018). Vitamin D Deficiency Is Associated with Poor Ovarian Stimulation Outcome in PCOS but Not Unexplained Infertility. Journal of Clinical Endocrinology and Metabolism, 104(2), 369-378. https://doi.org/10.1210/jc.2018-00750

Vitamin D Deficiency Is Associated with Poor Ovarian Stimulation Outcome in PCOS but Not Unexplained Infertility. / Butts, Samantha F.; Seifer, David B.; Koelper, Nathanael; Senapati, Suneeta; Sammel, Mary D.; Hoofnagle, Andrew N.; Kelly, Andrea; Krawetz, Steven A.; Santoro, Nanette; Zhang, Heping; Diamond, Michael Peter; Legro, Richard S.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 104, No. 2, 09.11.2018, p. 369-378.

Research output: Contribution to journalArticle

Butts, SF, Seifer, DB, Koelper, N, Senapati, S, Sammel, MD, Hoofnagle, AN, Kelly, A, Krawetz, SA, Santoro, N, Zhang, H, Diamond, MP & Legro, RS 2018, 'Vitamin D Deficiency Is Associated with Poor Ovarian Stimulation Outcome in PCOS but Not Unexplained Infertility', Journal of Clinical Endocrinology and Metabolism, vol. 104, no. 2, pp. 369-378. https://doi.org/10.1210/jc.2018-00750
Butts, Samantha F. ; Seifer, David B. ; Koelper, Nathanael ; Senapati, Suneeta ; Sammel, Mary D. ; Hoofnagle, Andrew N. ; Kelly, Andrea ; Krawetz, Steven A. ; Santoro, Nanette ; Zhang, Heping ; Diamond, Michael Peter ; Legro, Richard S. / Vitamin D Deficiency Is Associated with Poor Ovarian Stimulation Outcome in PCOS but Not Unexplained Infertility. In: Journal of Clinical Endocrinology and Metabolism. 2018 ; Vol. 104, No. 2. pp. 369-378.
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title = "Vitamin D Deficiency Is Associated with Poor Ovarian Stimulation Outcome in PCOS but Not Unexplained Infertility",
abstract = "Context The impact of vitamin D deficiency on the success of ovarian stimulation according to underlying infertility diagnosis has not been investigated. Objective To evaluate the relationship between vitamin D deficiency and reproductive outcomes after ovarian stimulation in women with either polycystic ovary syndrome (PCOS) or unexplained infertility. Design Retrospective cohort study. Setting Analysis of randomized controlled trial (RCT) data. Participants Participants from the Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) RCT (n = 607); participants from the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) RCT of unexplained infertility (n = 647). Interventions Serum 25(OH)D levels measured in banked sera. Main Outcome Measures Primary: live birth; secondary: ovulation (PPCOS II), pregnancy, and early pregnancy loss. Results In PPCOS II, subjects with vitamin D deficiency [25(OH)D < 20 ng/mL or 50 nmol/L] were less likely to ovulate (adjusted OR, 0.82; 95{\%} CI, 0.68 to 0.99; P = 0.04) and experienced a 40{\%} lower chance of live birth (adjusted OR, 0.63; 95{\%} CI, 0.41 to 0.98; P = 0.04) than those not deficient. In AMIGOS, no significant association between vitamin D deficiency and live birth was noted. In pregnant subjects from both studies, vitamin D deficiency was associated with elevated risk of early pregnancy loss (OR, 1.6; 95{\%} CI, 1.0 to 2.6; P = 0.05). Conclusions In this investigation of women pursuing ovarian stimulation, the association between vitamin D deficiency and diminished live birth relied on carrying the diagnosis of PCOS and was not observed in unexplained infertility. Given the generally modest success of ovarian stimulation, addressing vitamin D deficiency may prove an important treatment adjunct for many infertile women.",
author = "Butts, {Samantha F.} and Seifer, {David B.} and Nathanael Koelper and Suneeta Senapati and Sammel, {Mary D.} and Hoofnagle, {Andrew N.} and Andrea Kelly and Krawetz, {Steven A.} and Nanette Santoro and Heping Zhang and Diamond, {Michael Peter} and Legro, {Richard S.}",
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T1 - Vitamin D Deficiency Is Associated with Poor Ovarian Stimulation Outcome in PCOS but Not Unexplained Infertility

AU - Butts, Samantha F.

AU - Seifer, David B.

AU - Koelper, Nathanael

AU - Senapati, Suneeta

AU - Sammel, Mary D.

AU - Hoofnagle, Andrew N.

AU - Kelly, Andrea

AU - Krawetz, Steven A.

AU - Santoro, Nanette

AU - Zhang, Heping

AU - Diamond, Michael Peter

AU - Legro, Richard S.

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N2 - Context The impact of vitamin D deficiency on the success of ovarian stimulation according to underlying infertility diagnosis has not been investigated. Objective To evaluate the relationship between vitamin D deficiency and reproductive outcomes after ovarian stimulation in women with either polycystic ovary syndrome (PCOS) or unexplained infertility. Design Retrospective cohort study. Setting Analysis of randomized controlled trial (RCT) data. Participants Participants from the Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) RCT (n = 607); participants from the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) RCT of unexplained infertility (n = 647). Interventions Serum 25(OH)D levels measured in banked sera. Main Outcome Measures Primary: live birth; secondary: ovulation (PPCOS II), pregnancy, and early pregnancy loss. Results In PPCOS II, subjects with vitamin D deficiency [25(OH)D < 20 ng/mL or 50 nmol/L] were less likely to ovulate (adjusted OR, 0.82; 95% CI, 0.68 to 0.99; P = 0.04) and experienced a 40% lower chance of live birth (adjusted OR, 0.63; 95% CI, 0.41 to 0.98; P = 0.04) than those not deficient. In AMIGOS, no significant association between vitamin D deficiency and live birth was noted. In pregnant subjects from both studies, vitamin D deficiency was associated with elevated risk of early pregnancy loss (OR, 1.6; 95% CI, 1.0 to 2.6; P = 0.05). Conclusions In this investigation of women pursuing ovarian stimulation, the association between vitamin D deficiency and diminished live birth relied on carrying the diagnosis of PCOS and was not observed in unexplained infertility. Given the generally modest success of ovarian stimulation, addressing vitamin D deficiency may prove an important treatment adjunct for many infertile women.

AB - Context The impact of vitamin D deficiency on the success of ovarian stimulation according to underlying infertility diagnosis has not been investigated. Objective To evaluate the relationship between vitamin D deficiency and reproductive outcomes after ovarian stimulation in women with either polycystic ovary syndrome (PCOS) or unexplained infertility. Design Retrospective cohort study. Setting Analysis of randomized controlled trial (RCT) data. Participants Participants from the Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) RCT (n = 607); participants from the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) RCT of unexplained infertility (n = 647). Interventions Serum 25(OH)D levels measured in banked sera. Main Outcome Measures Primary: live birth; secondary: ovulation (PPCOS II), pregnancy, and early pregnancy loss. Results In PPCOS II, subjects with vitamin D deficiency [25(OH)D < 20 ng/mL or 50 nmol/L] were less likely to ovulate (adjusted OR, 0.82; 95% CI, 0.68 to 0.99; P = 0.04) and experienced a 40% lower chance of live birth (adjusted OR, 0.63; 95% CI, 0.41 to 0.98; P = 0.04) than those not deficient. In AMIGOS, no significant association between vitamin D deficiency and live birth was noted. In pregnant subjects from both studies, vitamin D deficiency was associated with elevated risk of early pregnancy loss (OR, 1.6; 95% CI, 1.0 to 2.6; P = 0.05). Conclusions In this investigation of women pursuing ovarian stimulation, the association between vitamin D deficiency and diminished live birth relied on carrying the diagnosis of PCOS and was not observed in unexplained infertility. Given the generally modest success of ovarian stimulation, addressing vitamin D deficiency may prove an important treatment adjunct for many infertile women.

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