Vitamin D and Anti-Müllerian Hormone Levels in Infertility Treatment: The Change-Point Problem

Abstract

Background: Anti-Müllerian hormone (AMH) is considered to be one of the most significant indicators of women’s fertility. Many studies have shown that vitamin D may modify human reproductive functions; however, the results are conflicting. The composition of follicular fluid (FF) creates the biochemical environment of the oocyte and affects its quality, which later determines the embryo quality. In this study, we aimed to revise with advanced statistical techniques the relationship between AMH and vitamin D in FF. Methods: The study was designed as a prospective single-center study in infertile patients with AMH ≥ 0.7 ng/mL who underwent controlled ovarian hyperstimulation for in vitro fertilization. AMH and vitamin D levels in FF were measured. Next, the standard and advanced statistical (including segmented regression) techniques were applied. Results: We observed a negative linear correlation between levels of AMH in serum and FF and total vitamin D concentrations up to approximately 30 ng/mL; with a statistically significant relationship in FF. Beyond that concentration, the trend was positive but statistically insignificant. Conclusions: As an existing “change-point problem” was noticed, we suggest segmentation in the relationship between vitamin D and AMH during infertility treatment.

The Association between Vitamin D and Anti-Müllerian Hormone: A Systematic Review and Meta-Analysis

“…This may be a particularly important source of variation in reported findings between studies, since the relationship between vitamin D and AMH has been suggested to be nonlinear. In fact, Bednarska-Czerwińska et al [58] reported a negative correlation between AMH and vitamin D concentrations of up to approximately 30 ng/mL, while beyond that concentration, the trend became positive but statistically insignificant. In addition, differences in the population size may also account for negative findings, as some of the studies had small numbers of patients [43,49,[51][52][53][54]56,58] and were not adequately powered to detect small but significant associations between vitamin D and AMH.…”

“…The current systematic review included eighteen cross-sectional studies and six interventional studies assessing the relationship between serum vitamin D levels and serum AMH levels. The cross-sectional studies demonstrated conflicting results, with several studies finding a positive correlation between serum AMH and vitamin D levels [42,46,50,61], while most studies reported largely negative findings [43][44][45]47,49,[51][52][53][54][55][56][57][58][59]. The systematic review and meta-analysis of the interventional studies revealed that vitamin D supplementations affect serum AMH levels but have opposite effects depending on the ovulatory statuses of the women.…”

“…Vitamin D levels were not significantly correlated with AMH (p = 0.629) [54]. Another study conducted by Bednarska-Czerwińska et al [58] comprised 53 women diagnosed with tubal factor infertility. Using Pearson's linear correlations, they found overall a nonsignificant negative correlation between serum AMH and total vitamin D (r = −0.19, CI 95%: (−0.46, 0.12), p= 0.22).…”

“…The authors also found a significant, negative correlation between follicular fluid AMH and total vitamin D (r = −0.28, CI 95%: (−0.51, 0.02), p = 0.0391). In addition, they investigated seasonal differences in various biomarkers and found fluctuations between winter/spring and summer/autumn in serum vitamin D and serum AMH levels (p = 0.0363 and p = 0.0165, respectively) [58]. Another study conducted by Liu et al [59] involved a large cohort of women (n = 848) that had indications for IVF.…”

Vitamin D status and features of the immune status in women with autoimmune thyroiditis in the postmenopausal period

“…1 Харківська медична академія післядипломної освіти 2 Вивчено імунофенотип лімфоцитів з використанням стабільних діагностикумів на основі моноклональних антитіл до CD3+ (зрілі Т-лімфоцити), CD4+ (Т-лімфоцити хелпери/індуктори), CD8+ (Т-лімфоцити кілери-супресори), CD22+ (антитілопродукувальні В-лімфоцити) і CD16+ (натуральні кілери). Як інтегральний критерій регуляторної та ефекторної ланок імунітету розраховували імунорегуляторний індекс (ІРІ) супресії (CD4+/CD8+) -один з ключових показників імунного статусу.…”