Vitamin D Deficiency and PCOS
Many women dealing with infertility have a disease known as PCOS (Polycystic Ovary Syndrome). Studies now suggest that women with PCOS can also have low levels of vitamin D, a critical factor needed to conceive. Dr. Jessica McLaughlin addresses these findings in this month’s blog, along with the correlation between vitamin D and pregnancy.
A correlation between female reproduction and vitamin D is of increasing importance. There is a widespread deficiency of vitamin D in women of reproductive age. Throughout the female reproductive tract, both the site of action and development are present and we know vitamin D controls various endometrial and ovarian functions.
Polycystic ovarian syndrome (PCOS), an anovulation-related common cause of infertility, bears many of the metabolic symptoms of vitamin D deficiency, including insulin resistance and obesity. PCOS fertility therapies normally begin with ovarian stimulation to stimulate ovulation, but up to 25% may not respond. Because of this, a new report looked at vitamin D and the effectiveness of PCOS therapy. The study analyzed stored vitamin D evidence from one of the Reproductive Medicine Network’s biggest randomized control studies: Pregnancy in Polycystic Ovary Syndrome II (PPCOS II).
Is there any association between vitamin D levels and polycystic ovary syndrome (PCOS) phenotypes?
750 women with PCOS who were randomized to either receive letrozole or clomiphene citrate to determine ovulation rates and live birth rate were included in the PPCOS II experiment. Of the 750 women, 607 had levels of vitamin D (25 (OH) D) available at the bank. Forty-one percent of PCOS patients meet the vitamin D deficiency criterion. Subjects with vitamin D deficiency were slightly more likely than those who were not deficient to have higher degrees of hyperandrogenism (elevated testosterone) and insulin resistance. PCOS patients with vitamin D deficiency were also less likely to ovulate with treatment and had a 40% lower risk of live birth relative to non-deficient patients. Interestingly, this review even looked at evidence from unexplained infertility patients (in the large AMIGOS trial).
Improves Fertility For PCOS Patients
Vitamin D has been shown to play a role in egg quality, development, and overall fertility. A study published in the Journal of Obstetrics & Gynecology showed that infertile PCOS women had improvements in menstrual regularity after 3 months of supplementation with 1000 milligrams of calcium and 400 international units (IU) per day of vitamin D.2
Vitamin D status has been shown to improve fertility and pregnancy rates during assisted reproduction therapy. In a study published in the European Journal of Endocrinology, infertile women with PCOS who underwent Clomid stimulation had more mature follicles and were more likely to get pregnant when they had had higher vitamin D levels.3 Conversely, those who were deficient in vitamin D had less mature follicles and lower pregnancy rates.
The results show that vitamin D status determines how patients with PCOS respond to care and contributes to the evidence that vitamin D deficiency has adverse reproductive effects for women with PCOS. To truly make a point about future screening and care for deficiency in this patient group, we need an intervention review of vitamin D in PCOS. It will involve finding women with PCOS that are deficient in vitamin D and looking at treatment results after the deficiency has been corrected or not corrected. This is coming, I’m positive. In the meantime, for all of our patients prior to birth, we prescribe regular vitamin D supplementation. For all females of reproductive age, including maternity and lactation, the Institute of Medicine suggests 600 IU. Routine prenatal vitamin supplementation can range from 400-2000 IU.
Can Vitamin D Cure PCOS?
Evidence from the current results suggested that the use of vitamin D, as a treatment for patients with PCOS, could improve insulin resistance, hyperandrogenism and a number of the lipid metabolic parameters in PCOS patients in the short-term follow-up intervention