3761_pdf
3761_pdf
3761_pdf
Research Article
INTERNATIONAL RESEARCH JOURNAL OF PHARMACY
www.irjponline.com
ISSN 2230-8407 [LINKING]
ABSTRACT
Background: Vitamin D receptors are found in the majority of human tissues and cells; vitamin D has historically
been regarded as a special hormone which can reduce the chance of developing chronic disease. Thyroid hormone
primarily controls metabolism, growth, and many other bodily functions.
Aim: In order to examine female infertility, the thyroid profile and blood vitamin D levels were measured in the
current investigation.
Methods: The history of the subject who was unable to conceive after a year of regular sexual activity in subjects
without accompanying systemic disorders such as diabetes, hypertension, or cardiovascular diseases was used to make
the diagnosis of infertility. Thyroid and vitamin D profiles were measured in 96 fertile controls and 48 infertile
females in the research.
Results: The values of vitamin D were shown to be 13.7±7.67, whereas the controls had considerably higher levels
(20.7±6.45) (p<0.01). Regarding vitamin D insufficiency, it was observed that 32.29% (n=31) of the controls and
20.83% (n=10) of the patients reported having a slight deficit. 22.91% (n=11) cases and 2.08% (n=2) controls had
severe instances, while 33.33% (n=16) cases and 7.29% (n=7) controls had intermediate cases. About the thyroid
profile of the fertile and infertile females, it was observed that the TSH level was significantly higher in the cases
(6.42±1.04) with p<0.01, T4 levels were significantly higher in the controls (6.41±2.06) than in the cases (5.2±3.54),
and T3 levels were significantly higher in the controls (0.93±0.26) than in the cases (0.72±0.55) with p<0.01. Among
the research participants, euthyroidism, hypothyroidism, and hyperthyroidism were seen in 41.66% (n = 20), 8.33%
(n = 4), and 50% (n = 24).
Conclusion: The current study comes to the conclusion that there is a negative link between vitamin D and TSH
levels and female infertility. But further analysis is required on this. Thyroid profile and vitamin D levels should be
routinely checked on all female women with infertility.
Keywords: Thyroid profile, TSH, vitamin D, infertility, female infertility.
INTRODUCTION
Infertility is the inability to conceive even after a year of regular sex and frequent coitus. A complex condition with
economic, psychological, and medical components is infertility. The occurrence and prevalence of infertility vary
throughout different regions of the world, as well as within cultures and societies. Infertility affects about 14% of the
population as a whole.1 According to the categorization, 15%, 20%, 35%, and 30% of the population, respectively,
had unexplained infertility, combination infertility, female infertility, and male infertility. The causes of female
infertility include anovulation, hormonal imbalances, sexually transmitted infections, old age, and disorders of the
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reproductive system. Idiopathic, radioactive, toxic lead fume, radiation exposure, alcohol use, smoking, diabetes,
and/or hypertension are medical problems thought to be linked to infertility.2
When exposed to sunshine, vitamin D is produced in the skin and serves a variety of essential bodily activities, such
as reducing inflammation, suppressing the immune system, apoptosis, and cell differentiation. Vitamin D mode of
action is facilitated by receptors produced in the uterus, placenta, and ovary, among other reproductive organs. It is
also essential for female reproduction because it increases the synthesis of progesterone, which is produced at a rate of
13% by progesterone, 9% by estradiol, and 20% by estrone in the ovaries. Vitamin D increases the generation of
steroids in the placenta, secretes and expresses human chorionic gonadotropin in syncytiotrophoblast, and modulates
HOXA10 expression in the endometrium, which is essential for uterine implantation and receptivity. AMH
(antimullerian hormone), which is involved in the long-term preservation of ovarian reserve, was significantly
impacted by vitamin D. In individuals with PCOS, vitamin D also influences insulin metabolism through gene
transcription and hormone regulation (polycystic ovarian syndrome).3
Endocrine variables, which include thyroid hormone and have a significant impact on pregnancy maintenance and
reproduction, are essential for maintaining fertility. Thyroid dysfunction is a crucial factor to examine when
evaluating infertility since it is linked to menstrual irregularities, anovulatory cycles, lower fecundity, and increased
morbidity. The increased frequency of hypothyroidism in female infertility is linked to aberrant release of luteinizing
hormone due to altered oestrogen metabolism, hyperprolactinemia, and disturbances in GnRH production. Therefore,
proper thyroid dysfunction therapy improves oocyte physiology, appropriate LH-to-LHRH response, menstrual
disturbance reduction, spontaneous fertility, and fertilisation rate.
Thyroid dysfunction and vitamin D deficiency both contribute significantly to infertility by altering the anti-
inflammatory and immunological regulatory functions of the receptor binding site RXR, also known as the steroid
receptor. Serum vitamin D and thyroid hormone levels can be measured to aid in the early detection of infertility
linked to these deficiencies, which increases the conception rate in infertile individuals.5. Therefore, in order to
analyse female infertility, compare the thyroid profile and vitamin D in infertile females, and detect vitamin D
insufficiency in infertile females, the current study was carried out to measure the thyroid profile and vitamin D blood
levels.
MATERIALS AND MATERIALS
The goal of the current prospective clinical study is to analyse female infertility by measuring serum levels of vitamin
D and thyroid profile, comparing these parameters in infertile females, and determine if these females are deficient in
vitamin D. The study was carried out at...from.. to.. after approval from the relevant ethics committee. The patients
who visited the Institute's outpatient department of obstetrics and gynaecology made up the study population.
Based on the patient's history of not being able to conceive after 12 months of frequent coitus and sexual activity and
the absence of any systemic disorders such as diabetes, hypertension, or cardiovascular diseases, infertility was
diagnosed. All subjects gave their verbal and written informed permission after being fully told about the study's
design. In sterile and aseptic settings, 5 millilitres of fasting intravenous blood were drawn to evaluate the research
parameters, which included TSH, T4, T3, and vitamin D levels. An analyzer in the lab was used to evaluate the
parameters.
There were 96 fertile controls in the research and 48 infertile females between the ages of 18 and 40 who were
infertile, free of concomitant conditions such as diabetes, hypertension, or cardiovascular disorders, and willing
research participants were the inclusion criteria. The criteria for exclusion included females who were infertile and
had structural abnormalities in their reproductive organs, such as polyps, septate uterus, fibroids in the uterus or
fallopian tube, females older than 18 or older than 40, and participants who refused to take part in the study. The
serum was isolated from the blood samples by centrifuging them for 10 minutes at 3000 rpm in order to evaluate the
study's parameters. Chemiluminescence Competitive Immunoassay was used to measure vitamin D, TSH, T4, and T3.
Chemiluminescence Two-site Sandwich Immunoassay was used to measure TSH, T4 levels, and T3 levels.
RESULTS
The goal of the current prospective clinical study is to analyse female infertility by measuring serum levels of vitamin
D and thyroid profile, comparing these parameters in infertile females, and determine if these females are deficient in
vitamin D. Table 1 contains a list of the research individuals' demographic details. There were 96 fertile controls in
the research and 48 infertile females. Females in the 18–40 age groups met the inclusion criteria. The research
subjects' mean age for the cases and controls was 30.1±6.5 years and 28.4±6.5 years, respectively. These differences
were not statistically significant.
The majority of the subjects in cases and controls were within the age range of 31-40 years with 45.83% (n=22)
subjects and 35.4% (n=34) subjects respectively. According to Table 1, patients from cases and controls had serum
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Paviaya RS et al. International Research Journal Of Pharmacy, 2023,14:10:1-4
vitamin D levels of <20 in 72.91% (n=-35) and 41.66% (n=40) respectively, and of >30 in 6.25% (n=3) and 10.41%
(n=10).
When the vitamin D profile of the research participants was evaluated, the mean levels of vitamin D were found to be
13.7±7.67, but the values of 20.7±6.45 (p<0.01) were substantially higher in the controls. Table 2 shows that with
regards to vitamin D insufficiency, there were reports of mild deficiency in 20.83% (n=10) patients and 32.29%
(n=31) controls, moderate deficiency in 33.33% (n=16) cases and 7.29% (n=7) controls, and severe shortage in
22.91% (n=11) cases and 2.08% (n=2) controls.
About the thyroid profile of the fertile and infertile females, it was observed that the TSH level was significantly
higher in the cases (6.42±1.04) with p<0.01, T4 levels were significantly higher in the controls (6.41±2.06) than in the
cases (5.2±3.54), and T3 levels were significantly higher in the controls (0.93±0.26) than in the cases (0.72±0.55) with
p<0.01. Table 3 shows that among the study individuals, euthyroidism, hypothyroidism, and hyperthyroidism were
seen in 41.66% (n = 20), 8.33% (n = 4), and 50% (n = 24).
DISCUSSION
The goal of the current prospective clinical study is to analyse female infertility by measuring serum levels of vitamin
D and thyroid profile, comparing these parameters in infertile females, and determine if these females are deficient in
vitamin D. There were 96 fertile controls in the research and 48 infertile females. Females in the 18–40 age groups
met the inclusion criteria. The research patients mean age for the cases and controls was 30.1±6.5 years and 28.4±6.5
years, respectively. These differences were not statistically significant. The age group of 31 to 40 years old included
the majority of individuals in both the cases and controls, with 45.83% (n = 22) and 35.4% (n = 34) participants,
respectively.
Serum vitamin D levels of <20 were seen in 72.91% (n=-35) and 41.66% (n=40) of the participants in the case and
control groups, respectively, and of >30 in 6.25% (n=3) and 10.41% (n=10) of the subjects. The findings aligned with
the research conducted by Gabedian K et al.6 (2013) and Pagliardani L et al.7 (2015), which evaluated participants
with comparable demographics and Vitamin D levels to those in the current investigation.
When the vitamin D profile of the research subjects was evaluated, the mean levels were found to be 13.7±7.67,
whereas the values of 20.7±6.45 (p<0.01) were substantially higher in the controls. Regarding vitamin D
insufficiency, it was observed that 22.83% (n=10) patients and 32.29% (n=31) controls had mild deficit, 33.33%
(n=16) cases and 7.29% (n=7) controls had moderate deficiency, and 22.91% (n=11) cases and 2.08% (n=2) controls
had severe deficiency. These findings corroborated those of research by Lata I et al. 8 in 2017 and Mansournia N et al.9
in 2014, in which the authors observed similar vitamin D levels in infertile females.
TSH was significantly higher in cases, while T3 levels were significantly higher in controls (0.93±0.26) compared to
cases (0.72±0.55) with p<0.01, and T4 levels were significantly higher in controls (6.41±2.06) than in cases
(5.2±3.54) with p<0.01, according to an assessment of the thyroid profiles in infertile and fertile females. Among the
research participants, euthyroidism, hypothyroidism, and hyperthyroidism were seen in 41.66% (n = 20), 8.33% (n =
4), and 50% (n = 24). These findings were in line with those of studies conducted in 2006 by Trokoudes KM et al. 10
and in 2016 by Nasir S et al.11 which also found a similar thyroid profile in female infertiles.
Within its limitations, the current study indicates that there may be a connection between female infertility and a
variety of challenging circumstances, such as stress, sexual dysfunction, depression, psychological effects, personal
suffering, and social repercussions.
CONCLUSION
Hormonal assessment and relevant research are therefore necessary for the efficient management of infertility. When
females require early medication for infertility, there is a negative correlation between their levels of TSH and vitamin
D. Nevertheless, the current study included several drawbacks, such as biases related to geographic location, a limited
sample size, and a brief monitoring time. Therefore, further long-term research with bigger sample sizes and longer
observation periods will aid in coming to a conclusive result.
REFERENCES
1. Lerchbaum E, Obermayer-Pietsch B. Mechanisms in endocrinology: Vitamin D and fertility: a systematic
review. European Journal of Endocrinology. 2012;166:765-78.
2. Thomson RL, Spedding S, Buckley JD. Vitamin D in the aetiology and management of polycystic ovary
syndrome. Clinical endocrinology. 2012;77:343-50.
3
Paviaya RS et al. International Research Journal Of Pharmacy, 2023,14:10:1-4
3. Strauss JF, Barbieri RL. Yen & Jaffe's reproductive endocrinology chapter 22 female infertility, 8th edition.
E-book: physiology, pathophysiology, and clinical management (Expert Consult-Online and Print). Elsevier
Health Sciences; 2013;28:556.
4. Poppe K, Velkeniers B. Female infertility and the thyroid. Best practice & research Clinical endocrinology&
metabolism. 2004;18:153-65.
5. Mackawy AM, Al-Ayed BM, Al-Rashidi BM. Vitamin D deficiency and its association with thyroiddisease.
International journal of health sciences. 2013;7:267.
6. Garbedian K, Boggild M, Moody J, Liu KE. Effect of vitamin D status on clinical pregnancy rates following
in vitro fertilization. CMAJ open. 2013;1:77.
7. Pagliardini L, Vigano P, Molgora M, Persico P, Salonia A, Vailati S, Paffoni A, Somigliana E, Papaleo E,
Candiani M. High prevalence of vitamin D deficiency in infertile women referring for assisted reproduction.
Nutrients. 2015;7:9972-84.
8. Lata I, Tiwari S, Gupta A, Yadav S, Yadav S. To study the vitamin D levels in infertile females and
correlation of Vitamin D deficiency with AMH levels in comparison to fertile females. Journal of human
reproductive sciences. 2017;10:86.
9. Mansournia N, Mansournia MA, Saeedi S, Dehghan J. The association between serum 25OHD levels and
hypothyroid Hashimoto’s thyroiditis. Journal of endocrinological investigation. 2014;37:473-6.
10. Trokoudes KM, Skordis N, Picolos MK. Infertility and thyroid disorders. Current Opinion in Obstetrics and
Gynecology. 2006;18:446-51.
11. Nasir S, Khan MM, Ahmad S, Alam S, Ziaullah S. Role of Thyroid Dysfunction in Infertile Women with
Menstrual Disturbances. Gomal Journal of Medical Sciences. 2016;14:31.
TABLES
Characteristics Cases % (n=48) Controls % (n=96) Total/p-
value
Mean Age (years) 30.1±6.5 28.4±6.5 >0.05
Age range (years)
18-24 20.83 (10) 31.25 (30)
25-31 33.33 (16) 33.33 (32)
31-40 45.83 (22) 35.41 (34)
Serum Vitamin D
<20 72.91 (35) 41.66 (40)
21-39 20.83 (10) 47.91 (46)
>30 6.25 (3) 10.41 (10)
Table 1: Demographic characteristics of the study subjects
Vitamin D status Cases % (n=48) Controls % (n=96)
Mean Vitamin D level 13.7±7.67 20.7±6.45
p-value <0.01
Deficiency
Mild (10-20) 20.83 (10) 32.29 (31)
Moderate (5-10) 33.33 (16) 7.29 (7)
Severe <5 22.91 (11) 2.08 (2)
Table 2: Vitamin D profile in the study subjects
Thyroid status Cases % (n=48) Controls % (n=96) p-value
Laboratory assessment
T3 0.72±0.55 0.93±0.26 <0.01
T4 5.2±3.54 6.41±2.06 <0.01
TSH 6.42±4.02 3.66±1.04 <0.01
Thyroid profile
Euthyroidism 41 -
Hypothyroidism 9 -
Hyperthyroidism 50 -
Table 3: Thyroid profile in the study subjects