Efficacy of Vitamin D Combined with Metformin and Clomiphene in the Treatment of Patients with Polycystic Ovary Syndrome Combined with Infertility

  • Lili ZHUANG Reproductive Department, Yantai Yuhuangding Hospital, Yantai 264000, P.R. China
  • Wei CUI Obstetrics Department, Yantai Yuhuangding Hospital, Yantai 264000, P.R. China
  • Jianxiang CONG Reproductive Department, Yantai Yuhuangding Hospital, Yantai 264000, P.R. China
  • Yinghong ZHANG Obstetrics Department, Yantai Yuhuangding Hospital, Yantai 264000, P.R. China
Keywords: Vitamin D; Metformin; Clomiphene; Polycystic ovary syndrome; Infertility

Abstract

Abstract Background: We aimed to explore the clinical efficacy of vitamin D combined with metformin and clomiphene in the treatment of patients with polycystic ovary syndrome combined with infertility. Methods: Overall, 396 cases of polycystic ovarian syndrome combined with infertility in Yantai Yuhuangding Hospital, Yantai, China were prospectively analyzed. Among them, 204 cases treated with vitamin D combined with metformin and clomiphene were set as the study group; 192 cases treated with only metformin and clomiphene were set as the control group. The ovarian volume and thickness of uterine wall before and after treatment were recorded. Levels of fasting insulin (FINS), luteinizing hormone (LH), testosterone (T), follicle-stimulating hormone (FSH), and estradiol (E2) before and after treatment were recorded. Results: There was no difference in body weight, BMI, ovarian volume, thickness of ovarian wall, FINS, LH, T, FSH and E2 between the study group and the control group; there was no significant difference in FSH, E2 and the thickness of uterine wall between the two groups. After treatment, the BMI, FINS, LH, and T in the study group were significantly lower than those in the control group (P<0.05); the incidence rates of oligomenorrhea, facial acne and hairy symptoms in the study group were significantly lower than those in the control group (P<0.05); after treatment, the ovulation rate and pregnancy rate in 36 cycles in the observation group were significantly higher than those of the control group (P<0.05). Conclusion: Our challenge could significantly improve clinical symptoms and endocrine conditions, and greatly enhance the ovulation rate and pregnancy rate.    

References

1. Xu J, Bao X, Peng Z, Wang L, Du L, Niu W, Sun Y (2016). Comprehensive analysis of genome-wide DNA methylation across human polycystic ovary syndrome ovary granulosa cell. Oncotarget, 7: 27899-27909.
2. Laven JSE (2019). Follicle Stimulating Hor-mone Receptor (FSHR) Polymorphisms and Polycystic Ovary Syndrome (PCOS). Front Endocrinol (Lausanne), 10: 23.
3. American Society for Reproductive Medi-cine, Birmingham, Alabama (2017). Role of metformin for ovulation induction in infertile patients with polycystic ovary syndrome (PCOS): a guideline. Fertil Steril, 108: 426-441.
4. Hruschka DJ, Sear R, Hackman J, Drake A (2018). Worldwide fertility declines do not rely on stopping at ideal parities. Popul Stud (Camb), 73: 1-17.
5. Goodman NF, Cobin RH, Futterweit W, et al (2018). American association of clinical endocrinologists, American college of endocrinology, and androgen excess and PCOS society disease state clinical review: guide to the best practices in the evalua-tion and treatment of polycystic ovary syndrome--part 1. Endocr Pract, 21: 1291-1300.
6. Wang L, Qi H, Baker PN, Zhen Q, Zeng Q, Shi R, Tong C, Ge Q (2017). Altered Cir-culating Inflammatory Cytokines Are As-sociated with Anovulatory Polycystic Ovary Syndrome (PCOS) Women Re-sistant to Clomiphene Citrate Treatment. Med Sci Monit, 23: 1083-1089.
7. Facchinetti F, Orrù B, Grandi G, Unfer V (2019). Short-term effects of metformin and myo-inositol in women with polycys-tic ovarian syndrome (PCOS): a meta-analysis of randomized clinical trials. Gy-necol Endocrinol, 35: 198-206.
8. Johnson NP (2014). Metformin use in women with polycystic ovary syndrome. Ann Transl Med, 2: 56.
9. Irani M, Merhi Z (2014). Role of vitamin D in ovarian physiology and its implication in reproduction: a systematic review. Fertil Steril, 102: 460-468.
10. Shahrokhi SZ, Ghaffari F, Kazerouni F (2015). Role of vitamin D in female re-production. Clin Chim Acta, 455: 33-38.
11. Lerchbaum E, Rabe T (2014). Vitamin D and female fertility. Curr Opin Obstet Gyne-col, 26: 145-150.
12. Thomson RL, Spedding S, Buckley JD (2012). Vitamin D in the aetiology and management of polycystic ovary syn-drome. Clin Endocrinol (Oxf), 77: 343-350.
13. Alalami H, Sathyapalan T, Atkin SL (2018). Cardiovascular profile of pharmacological agents used for the management of poly-cystic ovary syndrome. Ther Adv Endocrinol Metab, 10: 2042018818805674.
14. Greenwood EA, Yaffe K, Wellons MF, Ce-dars MI, Huddleston HG (2019). De-pression over the lifespan in a popula-tion-based cohort of women with poly-cystic ovary syndrome: longitudinal analy-sis. J Clin Endocrinol Metab, 104: 2809-2819.
15. Amiri M, Bidhendi Yarandi R, Nahidi F, Tohidi M, Ramezani Tehrani F (2018). The relationship between clinical and bio-chemical characteristics and quality of life in patients with polycystic ovary syn-drome. Clin Endocrinol (Oxf), 90: 129-137.
16. Kar S, Sanchita S (2015). Clomiphene citrate, metformin or a combination of both as the first line ovulation induction drug for Asian Indian women with polycystic ovarian syndrome: A randomized con-trolled trial. J Hum Reprod Sci, 8: 197-201.
17. Trummer C, Pilz S, Schwetz V, Obermayer-Pietsch B, Lerchbaum E (2018). Vitamin D, PCOS and androgens in men: a sys-tematic review. Endocr Connect, 7: R95-R113.
18. Firouzabadi RD, Aflatoonian A, Modarresi S, Sekhavat L, MohammadTaheri S (2012). Therapeutic effects of calcium & vitamin D supplementation in women with PCOS. Complement Ther Clin Pract, 18: 85-88.
19. Irani M, Minkoff H, Seifer DB, Merhi Z (2014). Vitamin D increases serum levels of the soluble receptor for advanced gly-cation end products in women with PCOS. J Clin Endocrinol Metab, 99: E886-E890.
20. Sahin FK, Sahin SB, Ural UM, et al (2015). Nesfatin-1 and Vitamin D levels may be associated with systolic and diastolic blood pressure values and hearth rate in polycystic ovary syndrome. Bosn J Basic Med Sci, 15: 57-63.
21. Irani M, Seifer DB, Grazi RV, et al (2015). Vitamin D Supplementation Decreases TGF-β1 Bioavailability in PCOS: A Ran-domized Placebo-Controlled Trial. J Clin Endocrinol Metab, 100: 4307-4314.
22. Zhao J, Liu S, Wang Y, Wang P, Qu D, Liu M, Ma W, Li Y (2019). Vitamin D im-proves the outcome of in vitro fertiliza-tion (IVF) in infertile women with poly-cystic ovary syndrome and insulin re-sistance. Minerva Med, 110: 199-208.
23. Polyzos NP, Anckaert E, Guzman L, et al (2014). Vitamin D deficiency and preg-nancy rates in women undergoing single embryo, blastocyst stage, transfer (SET) for IVF/ICSI. Hum Reprod, 29: 2032-2040.
24. Abedi S, Taebi M, Nasr-Esfahani MH (2019). Effect of vitamin D supplementa-tion on intracytoplasmic sperm injection outcomes: a randomized double-blind placebo-controlled trial. Int J Fertil Steril, 13: 18-23.
25. Dastorani M, Aghadavod E, Mirhosseini N, et al (2018). 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 fertiliza-tion. Reprod Biol Endocrinol, 16: 94.
Published
2019-10-05
How to Cite
1.
ZHUANG L, CUI W, CONG J, ZHANG Y. Efficacy of Vitamin D Combined with Metformin and Clomiphene in the Treatment of Patients with Polycystic Ovary Syndrome Combined with Infertility. Iran J Public Health. 48(10):1802-1809.
Section
Original Article(s)