| 摘要: | 近十年研究人員發現Vitamin D與生殖系統有部分相關性，因此出現了Vitamin D可能會影響不孕症族群接受人工生殖治療結果的假說。由於不孕症成因很繁雜所以在這部分一直未歸納出清楚的結論，故本研究想透過系統性回顧與統合分析，來歸納探討” 血清中Vitamin D濃度與人工生殖技術治療達到臨床懷孕(Clinical Pregnancy)間的相關性”。
經由電子資料庫搜尋(包括MEDLINE、EMBASE、Cochrane Central Register of Controlled Trials)，使用的key words (MeSH term)為「Infertility」、「Vitamin D」、「ART; assisted reproductive treatment」、「pregnancy」，納入條件為(1)符合此次研究問題，(2)在標題及摘要有簡述可分析之資料；排除條件為(1)非使用Endocrine Society guidelines Vitamin D分組，(2)非使用血中Vitamin D作為研究標的(例：濾泡液)。在搜尋過程中盡可能納入所有有機會入選之文章且無限制搜索語言類別，希望與本次研究問題相關的文章都可納入本次分析當中，研究達成結果訂定為臨床懷孕(定義為7~8周有出現胎心音)的勝算比(Odds ratio)；為方便各次分組標示，本研究將Vitamin D濃度分為G1、G2及G3三組，分別代表<20 ng/mL (缺乏Deficient)、≧20 ng/mL ~ <30 ng/mL (不足Insufficient)、≧30 ng/mL (充足Replete)。
共蒐集15篇入選文章，由兩位獨立評讀人員使用Newcastle-Ottawa Quality Assessment Scales評讀後平均得分為7-9分。統合分析結果如下：G1與G2+G3 (以20ng/mL作為分組界線)：兩組之間臨床懷孕勝算比為1.12 (0.88-1.43，p=0.35)；G1+G2比G3 (以30ng/mL作為分組界線)勝算比為1.77 (1.16-2.72，p<0.05)。各研究調整後(Adjusted)數值的勝算比統合結果為Ref. G1比G2+G3是1.26 (1.04-1.52，p<0.05)；Ref. G1 比G3是1.82 (1.23-2.67，p<0.05)。各研究G3的盛行率區分G3 <23%時勝算比為1.36 (0.96~1.92，p=0.09)；G3 >23%時勝算比為2.48 (1.09~5.64，p<0.05)。
由此次研究可觀察到以下結果，推論血清中Vitamin D濃度與人工生殖治療(ART)的結果是有相關性，可能較好的範圍為血中濃度達到>30 ng/mL，其臨床懷孕勝算比會增加，並由盛行率次分析結果發現充足(G3)群集占比越多會影響其勝算比分析結果，所以推測Vitamin D可能可以增進人工生殖治療達到臨床懷孕的治療結果。根據本研究結果提供建議，若正在接受人工生殖治療的不孕症婦女可以注意血中Vitamin D數值，並補充至>30ng/mL以增加得到臨床懷孕結果的機率。
Background
There is an interest in vitamin D’s role in reproductive physiology as findings have shown that 1.2–85.4% of women at reproductive age are deficient in vitamin D. Many studies have investigated how vitamin D may affect the outcome of clinical pregnancy in assisted reproductive treatment in infertility women. I systematically reviewed and meta-analyzed cohort studies investigating vitamin D concentration in infertility women having assisted reproductive treatments and determined the odds ratios of clinical pregnancy at different vitamin D cut-off points as reported.
Method
Keywords including infertility, vitamin D, ART, assisted reproductive treatment, and pregnancy were used to search the electronic databases MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for potential cohorts. A total of 15 cohort studies were finally included in the current study.
Result
This study divided the included cohorts into G1, G2 and G3 groups, each represented their vitamin D cutoff points of , <20 ng/mL (deficient), 20-30 ng/mL (insufficient), and ≧30 ng/mL (sufficient). The integrated results showed：(1) a clinical pregnancy odds ratio of 1.12 (0.88-1.43, p=0.35) when comparing G1 with G2+G3 (cut-off = 20ng/mL); (2) a clinical pregnancy odds ratio of 1.77 (1.16-2.72, p<0.05) when comparing G1+G2 with G3 (cut-off = 30ng/mL); (3) an adjusted clinical pregnancy odds ratio of 1.26 (1.04-1.52, p<0.05) when comparing for G1 with G2+G3; (4) an adjusted clinical pregnancy odds ratio of 1.82 (1.23-2.67, p<0.05) when comparing G1 to G3; (5) with 23% of the distribution as the cutoff in G3, the clinical pregnancy odds ratio was 1.36 (0.96~1.92, p=0.09) in the <23% subgroup and 2.48 (1.09~5.64, p<0.05) in the >23% subgroup.
Conclusion
This study found that a concentration of serum vitamin D ≧30 ng/mL increases the clinical pregnancy odds ratios. Sufficient serum vitamin D concentration may increase the chance of clinical pregnancy. |
