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Vitamin D and assisted reproduction: should vitamin D be routinely screened and repleted prior to ART? A systematic review

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Abstract

Purpose

To review the current literature regarding the role of vitamin D status in pregnancy outcomes in women undergoing assisted reproductive technology (ART) and to assess cost-effectiveness of routine vitamin D deficiency screening and repletion prior to initiation of ART.

Methods

A systematic literature review was conducted using PubMed. Relevant study outcomes were compared among the selected studies. A cost-benefit analysis was performed using a decision tree mathematical model with sensitivity analyses from the perspective of direct societal cost. Published data were used to estimate probabilities and costs in 2014 US dollars.

Results

Thirty-four articles were retrieved, of which eight met inclusion criteria. One study demonstrated a negative relationship between vitamin D status and ART outcomes, while two studies showed no association. The remaining five studies concluded that ART outcomes improved after vitamin D repletion.

Conclusion

The majority of reviewed studies reported a decrement in ART outcomes in patients with vitamin D deficiency. Cost-benefit analyses suggested that screening and supplementing vitamin D prior to ART might be cost effective, but further evidence is needed. Given the absence of Level I evidence regarding vitamin D status and ART outcomes, full endorsement of routine vitamin D screening and supplementation prior to ART is premature.

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Acknowledgments

The authors thank Dr. Elizabeth E. Puscheck and Dr. Alan H. DeCherney for their generous support, as well as J.C. Sanchez for graphical design assistance.

Funding

This study was funded, in part, by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, and ZIA HD-008737 to JHS.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA

    Michelle M. Pacis

  2. School of Medicine, Wayne State University, 540 East Canfield Street, Detroit, MI, 48201, USA

    Chelsea N. Fortin

  3. Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 CRC Room 1E-3140, 10 Center Drive, MSC 1109, Bethesda, MD, 20882, USA

    Shvetha M. Zarek & James H. Segars

  4. Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6100 Executive Blvd 7B03, Rockville, MD, 20852, USA

    Sunni L. Mumford

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  1. Michelle M. Pacis
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  3. Shvetha M. Zarek
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Correspondence to James H. Segars.

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Capsule

Vitamin D has been shown to play important roles in reproduction and vitamin D deficiency is a prevalent condition. A systematic review of vitamin D and ART outcomes yielded five studies that reported ART outcomes improved after vitamin D repletion, two studies found no association, and one study reported a negative association. Currently, Level I evidence is insufficient and a recommendation for routine vitamin Dscreening and supplementation prior to ART cannot be supported. There is a pressing need for additional studies of vitamin D replacement in this clinical scenario.

Michelle M. Pacis and Chelsea N. Fortin Contributed equally to the manuscript.

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Pacis, M.M., Fortin, C.N., Zarek, S.M. et al. Vitamin D and assisted reproduction: should vitamin D be routinely screened and repleted prior to ART? A systematic review. J Assist Reprod Genet 32, 323–335 (2015). https://doi.org/10.1007/s10815-014-0407-9

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