| Sažetak | Cilj istraživanja: Cilj ovog istraživanja bio je ispitati učestalost manjka vitamina D i
pokazati njegov utjecaj na hormonske parametre plodnosti i trudnoću kod žena liječenih
postupcima MPO te utvrditi postoje li razlike u vrijednostima vitamina D između skupina
žena oboljelih od endometrioze, PCOS-a i hipotireoze kao čestih uzroka neplodnosti.
Materijali i metode: U istraživanje je uključeno 66 pacijentica koje se liječe od
neplodnosti na Zavodu za ginekološku endokrinologiju i humanu reprodukciju Klinike za
ženske bolesti i porode KBC-a Split. Retrospektivno su prikupljeni podatci o vrijednostima
spolnih hormona i vitamina D, antropometrijskim mjerama kao i podatak o ostvarenoj
trudnoći. Pacijentice su prema uzrocima neplodnosti podijeljenje u 4 skupine: skupina bez
ženskog uzroka neplodnost (kontrolna skupina) te skupine oboljenih od endometrioze,
hipotireoze i PCOS-a, te u skupine žena koje su ostale trudne i one koje nisu.
Rezultati: prosječna vrijednosti vitamina D iznosila je 57,7±22,2 nmol/L, a 78,8%
ispitanika imalo je nedostatak vitamina D. Pokazana je cikličnost vitamina D tijekom godine
(p=0,007), dok AMH nije pratio ovu cikličnost za sve ispitanice ukupno (p=0,864), a u
kontrolnoj skupini pokazuje trend ostvarenja cikličnosti (p=0,058). Povezanost vitamina D sa
svakim pojedinim hormonom nije pokazala statističku značajnost: FSH (p=0,209), LH
(p=0,700), AMH (p=0,827), estradiol (p=0,548), testosteron (p=0,965), progesteron
(p=0,239), TSH (p=0,374), prolaktin (p=310). Status vitamina D nije se razlikovao između
kontrolne skupine i skupine žena oboljeih od endometrioze (p=0,896), hipotireoze (p=1,0) i
PCOS-a (p=0,599). Također nije postojala razlika u statusu vitamina D između skupine žena
koje su ostale trudne i onih koje nisu (p=0,530) kao ni povezanost s pušenjem (p=0,066) i
indeksom tjelesna mase (p=0,618). Kao slučajne nalaze, pronašli smo da žene koje puše imaju
niži prolaktin (p=0,042) i viši AMH (p=0,027).
Zaključak: Povezanost vitamina D s niti jednim promatranim parametarom nije
dosegnula statističku značajnost, stoga u našem istraživanju možemo zaključiti da vitamin D
ne igra ulogu u liječenju neplodnosti kao ni u pogledu ostvarivanja trudnoće. Rezultati brojnih
svjetskih studija ne pokazuju jednoznačne rezultate, ali većinom govore u prilog značajnih
dobrobiti vitamina D u liječenju PCOS-a, ishodima IVF-a i ostvarenju kliničke trudnoće te u
prevenciji fetalnih anomalija i brojnih patoloških stanja u trudnoći. U tom pogledu, ima smisla
nadoknaditi manjak vitamina D jer je jeftin, jednostavan za primjenu i neškodljiv, a iako nije
pokazao utjecaj na postizanje trudnoće, zasigurnom ima utjecaj na njen povoljniji tijek kao i
na zdravlje općenito. |
| Sažetak (engleski) | Aim: The aim of this study was to investigate the incidence of vitamin D deficiency
and to demonstrate its influence on the hormonal parameters of fertility and on pregnancy in
women undergoing in vitro fertilisation. Moreover, we aimed to determine whether there are
differences in vitamin D status between women suffering from endometriosis, polycystic
ovary syndrome and hypothyroidism as frequent causes of infertility.
Materials and Methods: The study included 66 patients who were undergoing in
vitro fertilisation at the Institute for Gynecological Endocrinology and Human Reproduction
of the Clinic for Female Diseases and Birth of KBC Split. The data on the values of sex
hormones and vitamin D, anthropometric measures as well as data on pregnancy have been
collected retrospectively. Depending on the causes of infertility, the patients were divided into
4 groups: women with no female disease as the cause of infertility (control group), women
with endometriosis, hypothyroidism and PCOS, and pregnant and non-pregnant women.
Results: Average vitamin D values were 57.7±22.2 nmol/L, and 78.8% had vitamin D
deficiency. Vitamin D differed between summer and winter part of the year (p = 0.007), while
AMH did not show this diference for all subjects in total (p = 0.864), but in the control group
it has shown the trend toward it (p = 0.058). The correlation of vitamin D with each hormone
did not show any statistical significance: FSH (p = 0,209), LH (p = 0,700), AMH (p = 0,827),
estradiol (p = 0,548), testosterone (p = 0,965), progesterone = 0.239), TSH (p = 0.374),
prolactin (p = 310). The status of vitamin D did not differ between the control group and the
group of women suffering from endometriosis (p = 0.896), hypothyroidism (p = 1.0) and
PCOS (p = 0.599). There was also no difference in the status of vitamin D between the
women who were pregnant and those who were not (p = 0.530) as same as there was no
evident association with smoking (p = 0.066) and body mass index (p = 0.618). As random
findings, we found that women who smoke had lower prolactin (p = 0.042) and higher AMH
(p = 0.027).
Conclusion: Vitamin D correlation did not reach statistical significance for any
observed parameter. Therefore in our research we can conclude that vitamin D does not play a
major role in the treatment of infertility or in the pregnancy achievement. The results of many
world studies do not show unambiguous results, but most of them are in favor of significant
benefits of vitamin D in the treatment of PCOS, IVF outcomes and clinical pregnancy, but
also in the prevention of fetal anomalies and numerous pathological conditions in pregnancy.
In this respect, it makes sense to compensate for vitamin D deficiency because it is
inexpensive, easy to use and safe, and although it has not had an impact on achieving
pregnancy, it has influence of affecting its more favorable course as well as health in general. |
