Correlation of Vitamin D and Antimullerian Hormone Level in Infertile Women with Polycystic Ovary Syndrome and Obesity

Fatimah Usman; Irsan Saleh; Kms. Yusuf Effendi; Hadrians Kesuma Putra; Adnan Abadi; Salmon Charles Pardomuan Tua Siahaan; Cindy Kesty; Dian Permata Rizda; Bella Stevanny; Peby Maulina Lestari

doi:10.24198/obgynia.v7i3.723

Correlation of Vitamin D and Antimullerian Hormone Level in Infertile Women with Polycystic Ovary Syndrome and Obesity

Fatimah Usman, Irsan Saleh, Kms. Yusuf Effendi, Hadrians Kesuma Putra, Adnan Abadi, Salmon Charles Pardomuan Tua Siahaan, Cindy Kesty, Dian Permata Rizda, Bella Stevanny, Peby Maulina Lestari

Abstract

Introduction: Increasing amount of research indicates that women with PCOS are more likely to have a shortage in vitamin D with abnormally high anti-Müllerian hormone (AMH) levels. This study aims to assess the correlation between vitamin D and Anti-Mullerian Hormone (AMH) levels in infertile women with polycystic ovarian syndrome (PCOS) and obesity.
Method: This observational cross-sectional study examined all obese women with PCOS who sought infertility treatment at Dr. Mohammad Hoesin Hospital Palembang from August 2021 to November 2021. PCOS diagnosis was determined using the Rotterdam criteria. All research subjects underwent a physical examination and transvaginal ultrasound to evaluate body mass index (BMI) and polycystic ovary morphology. Blood samples were collected to evaluate their testosterone, AMH, and vitamin D levels. Statistical analysis was performed using the Spearman correlation test with IBM® SPSS Statistics version 24.
Results: Thirty infertile women with PCOS and obesity were included in the study, with average age of 31.17±4.48 years and average BMI of 33.45±2.67 kg/m2. The majority of the subjects had polycystic ovary morphology (86.7%) and oligomenorrhea (76.7%). No correlation between BMI and vitamin D as well as AMH levels was found in infertile women with PCOS and obesity. The Spearman test showed moderate negative correlation (p = 0.011. r = -0.458) between vitamin D and AMH levels in infertile women with PCOS and obesity.
Conclusion: There is a moderate negative correlation between vitamin D and AMH levels among infertile women with PCOS and obesity. Further research is required to comprehend the role of vitamin D in female fertility.

Korelasi Vitamin D dan Kadar Hormon Anti-Müllerian pada Wanita Infertil dengan Sindrom Ovarium Polikistik dan Obesitas

Abstrak
Pendahuluan: Semakin banyak penelitian melaporkan bahwa wanita dengan PCOS cenderung mengalami defisiensi vitamin D dengan penignkatan kadar hormon anti-Müllerian (AMH). Penelitian ini bertujuan untuk mengkaji hubungan vitamin D dan kadar AMH pada wanita infertil dengan sindrom ovarium polikistik (SOPK) dan obesitas.
Metode: Penelitian ini merupakan studi observasional potong lintang terhadap seluruh wanita infertil dengan SPOK dan obesitas yang di RSUP Dr. Mohammad Hoesin Palembang pada bulan Agustus 2021 hingga November 2021. Diagnosis SOPK ditegakkan berdasarkan kriteria Rotterdam. Seluruh subjek penelitian menjalani pemeriksaan fisik dan ultrasonografi transvaginal untuk menilai indeks massa tubuh (IMT) dan morfologi ovarium polikistik. Sampel darah dikumpulkan dari semua wanita untuk mengukur kadar testosteron, AMH, dan vitamin D. Analisis statistik dilakukan dengan menggunakan uji korelasi Spearman menggunakan IBM® SPSS Statistics versi 24.
Hasil: Tiga puluh wanita infertil dengan SOPK dan obesitas dilibatkan dalam penelitian ini dengan usia rata-rata 31,17±4,48 tahun dan rata-rata IMT 33,45±2,67 kg/m2. Mayoritas subjek memiliki morfologi ovarium polikistik (86,7%) dan oligomenore (76,7%). Tidak ada korelasi antara IMT dan vitamin D maupun kadar AMH pada wanita infertil dengan SOPK dan obesitas. Uji Spearman menunjukkan korelasi negatif sedang (p=0.011.r=-0.458) antara kadar vitamin D dan AMH pada wanita infertil dengan SOPK dan obesitas.
Kesimpulan: Kadar vitamin D berkorelasi negatif dengan kadar AMH pada wanita infertil dengan SOPK dan obesitas. Penelitian lebih lanjut diperlukan untuk memahami peran vitamin D pada kesuburan wanita.

Kata kunci: Anti-Müllerian Hormone, Indeks Massa Tubuh, Obesitas, Sindrom Ovarium Polikistik, Vitamin D

Keywords

Anti-Mullerian Hormone; Body mass index; Obesity; Polycystic ovarian syndrome; Vitamin D

Full Text:

PDF

References

el Hayek S, Bitar L, Hamdar LH, Mirza FG, Daoud G. Poly Cystic Ovarian Syndrome: An Updated Overview. Front Physiol. 2016;7.

Kamangar F, Okhovat JP, Schmidt T, Beshay A, Pasch L, Cedars MI, et al. Polycystic Ovary Syndrome: Special Diagnostic and Therapeutic Considerations for Children. Pediatr Dermatol. 2015;32(5):571-8.

Halloran BP, Deluca HF. Effect of vitamin D deficiency on fertility and reproductive capacity in the female rat. Journal of Nutrition. 1980;110(8):1573-80.

Li HWR, Brereton RE, Anderson RA, Wallace AM, Ho CKM. Vitamin D deficiency is common and associated with metabolic risk factors in patients with polycystic ovary syndrome. Metabolism. 2011;60(10):1475-81.

Xue Y, Xu P, Xue K, Duan X, Cao J, Luan T, et al. Effect of vitamin D on biochemical parameters in polycystic ovary syndrome women: a meta-analysis. Arch Gynecol Obstet. 2017;295(2):487-96.

Tal R, Seifer DB. Ovarian reserve testing: a user's guide. Am J Obstet Gynecol. 2017;217(2):129-40.

Dennis NA, Houghton LA, Pankhurst MW, Harper MJ, McLennan IS. Acute supplementation with high dose vitamin D3 increases serum anti-müllerian hormone in young women. Nutrients. 2017;9(7).

Drakopoulos P, Van De Vijver A, Schutyser V, Milatovic S, Anckaert E, Schiettecatte J, et al. The effect of serum Vitamin D levels on ovarian reserve markers: A prospective cross-sectional study. Human Reproduction. 2017;32(1):208-14.

Pearce K, Gleeson K, Tremellen K. Serum anti-Mullerian hormone production is not correlated with seasonal fluctuations of Vitamin D status in ovulatory or PCOS women. Human Reproduction. 2015;30(9):2171-7.

Shapiro AJ, Darmon SK, Barad DH, Gleicher N, Kushnir VA. Vitamin D levels are not associated with ovarian reserve in a group of infertile women with a high prevalence of diminished ovarian reserve. Fertil Steril. 2018;110(4):761-766.e1.

Smet M, McLennan A. Rotterdam criteria, the end. Australas J Ultrasound Med. 2018;21(2):59.

Hilger J, Friedel A, Herr R, Rausch T, Roos F, Wahl DA, et al. A systematic review of vitamin D status in populations worldwide. Br J Nutr. 2014;111(1):23-45.

Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, et al. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int. 2009;20(11):1807-20.

He Y, Zheng D, Shang W, Wang X, Zhao S, Wei Z, et al. Prevalence of oligomenorrhea among women of childbearing age in China: A large community-based study. Women's Health. 2020;16:174550652092861.

Rojas J, Chávez M, Olivar L, Rojas M, Morillo J, Mejías J, et al. Polycystic Ovary Syndrome, Insulin Resistance, and Obesity: Navigating the Pathophysiologic Labyrinth. Int J Reprod Med. 2014;2014:1-17.

Harris HR, Babic A, Webb PM, Nagle CM, Jordan SJ, Risch HA, et al. Polycystic Ovary Syndrome, Oligomenorrhea, and Risk of Ovarian Cancer Histotypes: Evidence from the Ovarian Cancer Association Consortium. Cancer Epidemiology Biomarkers & Prevention. 2018;27(2):174-82.

Harris HR, Babic A, Webb PM, Nagle CM, Jordan SJ, Risch HA, et al. Polycystic ovary syndrome, oligomenorrhea, and risk of ovarian cancer histotypes: Evidence from the Ovarian Cancer Association Consortium. Cancer Epidemiol Biomarkers Prev. 2018;27(2):174.

Oriji VK, Onwuegbulam C. Prevalence of Polycystic Ovary Syndrome (PCOS) Among Infertile Women Attending Fertility Clinic at a University Teaching Hospital in Nigeria. Journal of Gynecology and Women's Health. 2019;15(5):1-6.

Lagunova Z, Porojnicu A carmen, Lindberg FHS, Moan J. The Dependency of Vitamin D Status on Body Mass Index, Gender, Age and Season. Anticancer Res. 2009;29(9):3713-20.

Damayanti AY, Indarto D, Wasita B, Ardyanto TD. Indeks massa tubuh, asupan vitamin D, dan serum 25-hydroxyvitamin D pada pasien kanker payudara Related papers. Jurnal Gizi Klinik Indonesia. 2017;14(2):56-63.

Bindayel IA. Effect of age and body mass index on vitamin D level in children with asthma in Riyadh. Sci Rep. 2021;11(1):11522.

Bernardi LA, Carnethon MR, de Chavez PJ, Ikhena DE, Neff LM, Baird DD, et al. Relationship between obesity and anti-Müllerian hormone in reproductive-aged African American women. Obesity (Silver Spring). 2017;25(1):229-35.

Jaswa EG, Rios JS, Cedars MI, Santoro NF, Pavone MEG, Legro RS, et al. Increased Body Mass Index Is Associated With A Nondilutional Reduction in Antimüllerian Hormone. J Clin Endocrinol Metab. 2020;105(10):3234.

Arita Y, Kihara S, Ouchi N, Takahashi M, Maeda K, Miyagawa J, et al. Paradoxical decrease of an adipose-specific protein, adiponectin, in obesity. 1999. Biochem Biophys Res Commun. 2012;425(3):560-4.

Nouri M, Aghadavod E, Khani S, Jamilian M, Amiri Siavashani M, Ahmadi S, et al. Association between BMI and gene expression of anti-Müllerian hormone and androgen receptor in human granulosa cells in women with and without polycystic ovary syndrome. Clin Endocrinol (Oxf). 2016;85(4):590-5.

Shorakae S, Teede H, De Courten B, Lambert G, Boyle J, Moran LJ. The Emerging Role of Chronic Low-Grade Inflammation in the Pathophysiology of Polycystic Ovary Syndrome. Semin Reprod Med. 2015;33(4):257-69.

Wong HYQ, Li HWR, Lam KSL, Tam S, Shek CC, Lee CYV, et al. Independent association of serum vitamin D with anti-Mullerian hormone levels in women with polycystic ovary syndrome. Clin Endocrinol (Oxf). 2018;89(5):634-41.

Bakeer E, Radwan R, El Mandoury A, El Rahman AA, Gad M, El Maksoud SA. Anti-Müllerian Hormone as a Diagnostic Marker in Egyptian Infertile Polycystic Ovary Syndrome Females: Correlations with Vitamin D, Total Testosterone, Dyslipidemia and Anthropometric Parameters. J Med Biochem. 2018;37(4):448-55.

Szafarowska M, Dziech E, Kaleta B, Kniotek M, Rogowski A, Segiet - Święcicka A, et al. Anti-Müllerian hormone level is associated with vitamin D receptor polymorphisms in women with polycystic ovary syndrome. J Assist Reprod Genet. 2019;36(6):1281-9.

Arslan E, Gorkem U, Togrul C. Is There a Relationship between Vitamin D Deficiency Status and PCOS in Infertile Women? Geburtshilfe Frauenheilkd. 2019;79(7):723-30.

Bednarska-Czerwińska A, Olszak-Wąsik K, Olejek A, Czerwiński M, Tukiendorf A. Vitamin D and anti-müllerian hormone levels in infertility treatment: The change-point problem. Nutrients. 2019;11(5).

Moridi I, Chen A, Tal O, Tal R. The association between vitamin D and anti-müllerian hormone: A systematic review and meta-analysis. Nutrients. 2020;12(6).

Arefi S, Khalili G, Iranmanesh H, Farifteh F, Hosseini A, Fatemi HM, et al. Is the ovarian reserve influenced by Vitamin D deficiency and the dress code in an infertile Iranian population? J Ovarian Res. 2018;11(1).

Dastorani M, Aghadavod E, Mirhosseini N, Foroozanfard F, Zadeh Modarres S, Amiri Siavashani M, et al. The effects of vitamin D supplementation on metabolic profiles and gene expression of insulin and lipid metabolism in infertile polycystic ovary syndrome candidates for in vitro fertilization. Reproductive Biology and Endocrinology. 2018;16(1).

Kokanall D, Karaca M, Ozakśit G, Elmas B, Üstün YE. Serum Vitamin D Levels in Fertile and Infertile Women with Polycystic Ovary Syndrome. Geburtshilfe Frauenheilkd. 2019;79(5):510-6.

Johansson J, Stener-Victorin E. Polycystic ovary syndrome: Effect and mechanisms of acupuncture for ovulation induction. Evidence-based Complementary and Alternative Medicine. 2013;2013.

Łagowska K, Bajerska J, Jamka M. The role of vitamin D oral supplementation in insulin resistance in women with polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials. Nutrients. 2018;10(11).

DOI: http://dx.doi.org/10.24198/obgynia.v7i3.723