Abstract
ObjectiveRecent studies revealed intriguing associations between cholecalciferol (D3) and reproductive functions. Seasonal changes of D3 concentrations are well known; however, they are not always considered in the context of reproductive functions. In this study, we analyzed D3 serum concentration in IVF/ICSI patients with respect to seasonal 3-month quartiles and anti-Muellerian hormone (AMH) referring to the impact on Assisted Reproductive Technologies (ART) outcome.Materials and research methodsWe studied 469 female patients, presenting between 2012 and 2018 for ART treatment in our fertility center. D3 as well as the AMH serum concentrations were measured at the beginning of the follicle stimulation (days 3–5 of menstrual cycles). Results were evaluated with respect to seasonal quartiles and outcome of the ART cycles.ResultsD3 concentrations showed significant fluctuations within annual quartiles with a pronounced peak in August–October and a minimum in February–April (26.0 vs. 20.5 mg/dl; p < 0.0001). Similar seasonal dynamics were found for AMH (2.98 vs. 1.78 ng/ml; p = 0.010) and these were associated with significantly shorter stimulation periods during August–October (11.29 vs. 12.12 days; p = 0.042), higher number of fertilized oocytes between August and October (6.23 vs. 4.97; p = 0.05) along with a trend towards higher numbers of cumulus–oocyte complexes. However, no such differences were found for the numbers of MII oocytes or pregnancy rates.ConclusionOur data indicate seasonal 3-month quartile variations of AMH concentrations and characteristics of ART, such as days of ovarian stimulation and number of fertilized oocytes. Highest AMH concentrations were found between August and October and this quartile was associated with highest D3 concentrations.
Highlights
Vitamin D is a steroid hormone, mainly produced by the skin upon exposure to sunlight, with less than 20% provided by alimentary sources [1]
Just since we reported in our pilot study 3-month fluctuations of D3 serum concentrations with delayed peak in autumn (August to end of October) postulating a prolonged tissue storage with a following slow release of D3 resulting in a delay of the D3 deficiency [36]
There are discordances if there is an association between seasonal D3 concentrations and anti-Muellerian hormone (AMH) and if there is an influence on the outcome of an in vitro fertilization (IVF)/intracytoplasmatic sperm injection (ICSI) treatment
Summary
Vitamin D is a steroid hormone, mainly produced by the skin upon exposure to sunlight, with less than 20% provided by alimentary sources [1]. AMH is a member of the transforming growth factor-beta superfamily produced by the granulosa cells [16]. Current data point to the D3 status as one additional factor affecting AMH concentrations, since early in vitro studies detected a vitamin D response element in the promotor of the AMH gene, providing a direct molecular link for vitamin D effects on AMH gene expression [19]. Data demonstrated that D3 could increase AMH production via activating the vitamin D response element in the AMH gene [19, 20]. Resulting data suggested that D3 affects ovarian reserve along with the ability to modify AMH production [2, 21]. Based on accumulating evidence that D3 supplementation may be beneficial for fertility and pregnancy, it was approved that seasonal changes in AMH concentrations can be annihilated by appropriate supplementation of D3 in vitamin D-depleted women [2, 18, 22]
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