Is the ovarian reserve influenced by vitamin D deficiency and the dress code in an infertile Iranian population?

Abstract

BackgroundIn the recent years, vitamin D has become a topical subject and a focus of research not only in reproductive medicine but across many medical disciplines. In reproductive medicine, studies have identified an association between vitamin D status in women and ovarian reserve. In humans, exposure of the skin to sunlight is the main important source of vitamin D. A dress code of wearing concealing clothing is a risk factor for vitamin D deficiency. The objective of this prospective observational study was to evaluate the correlation between vitamin D deficiency and ovarian reserve in a population of infertile women in Iran. As part of the basic fertility assessment of study participants, blood tests were taken to measure vitamin D concentration and transvaginal ultrasound scans were performed on day 2–5 of the cycle to determine antral follicle count (AFC). All study participants were assessed by a reproductive medicine specialist and consultant dermatologist to classify their skin types according to the Fitzpatrick classification. In addition, the dress code of each study participant was recorded noting the percentage of exposed skin not covered by concealing clothing.Results189 infertility patients were included in this study. The mean concentration of vitamin D in this study population was 15.46 ng/ml, indicating severe vitamin D deficiency. A statistically significant negative correlation between age and vitamin D (p = 0.008) and age and AFC (p = 0.001) was identified. This study revealed a highly significant correlation between vitamin D concentrations and AFC (p < 0.001).ConclusionsA concealing dress code is an independent risk factor for vitamin D deficiency due to a lack of skin exposure to sunlight. Our study suggests that the so caused severe vitamin D deficiency may play a crucial role in reduced ovarian reserve in the herein described group of an infertile female Iranian population.

Relation between vit D level and low antral follicle count in infertile female below 35 years

“…The current study results are in the line with those of other studies, who could not find a definite correlation between vit D level and AFC [5]- [7]. On the contrary, our results contrast with the literature reports that have found a negative correlation between vit D and AFC [8].…”

“…In comparison with the study of Arefi et al, [8] which aimed to evaluate the vitamin D status in an infertile population in Iran and to correlate vitamin D concentrations with parameters such as female age, skin type, degree of skin concealment and antral follicle count (AFC) as parameter of the ovarian reserve, and reported that total of 189 patients have been included in this prospective observational study, the mean age of the study group was 32.21 years, and the mean BMI of the patients was 26.70 kg/m 2 with a range of 17.9-35.5 kg/m 2 .The mean vit D was for study group was 15.46 ng/ml and while the mean AFC in all patients was 10.84 follicle . There was negative correlation between vit D level and AFC in the study group .…”

“…The contradictory finding between the studies may be attributed to the different ethnicities of the [5] evaluated women with Caucasian ethnicity, which have been treated in an infertility center due to primary / secondary infertility in Belgium .the study of Nazanin Alavi et al [6] was studying three hundred and five infertile Iranian women referred to the IVF Unit who had different ethnicity , different sociocultural habits and different study population .The study of Fabris et al, [7] studied Spanish patients who had Caucasian ethnicity in contrast to those mentioned in our study the described study population presents completely different ethnicity and secondly majority of the study population is dressed in dress-codes, which leaves less than 10%of the skin uncovered, thereby limiting the skin exposure to the sun dramatically . The study of Arefi et al, [8] was studying a larger study population of Iranian women with different sociocultural habits and different dess-codes.…”

The Role of Oxidative Stress and Natural Antioxidants in Ovarian Aging

“…For example, kiwifruit, nuts, tomatoes are rich in vitamins C, D, and E; walnuts, peanuts, cherries, corn are high in melatonin. A prospective study showed that there is a highly significant correlation between vitamin D deficiency and DOR ( Arefi et al, 2018 ). The combined use of vitamin E and C can prevent apoptosis of ovarian tissue following mancozeb exposure in the first generation of mouse pups ( Mahdi et al, 2019 ).…”

Ethnical and sociocultural differences causing infertility are poorly understood—insights from the Arabian perspective

“…However, it can be assumed that most patients in those studies were not expected to be subjected to concealing dress due to their sociocultural backgrounds. In contrast to these study findings, the study of Arefi et al [31] was conducted in a society in which women wear concealing clothing and this dress-code is imposed from an early age. In this study, women diagnosed as severely vitamin D-deficient demonstrated a clear correlation between vitamin D deficiency and a reduced ovarian reserve.…”