Effect of calcium and vitamin D supplementation on follicular fluid tumor necrosis-alpha and interleukin-6 and IVF/ICSI outcomes in infertile patients with polycystic ovary syndrome

To evaluate the effect of calcium and vitamin D supplementation on follicular fluid (FF) tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) concentrations and IVF/ICSI outcomes in infertile patients with polycystic ovary syndrome (PCOS). A total of one hundred infertile patients with PCOS were randomized to receive calcium and vitamin D (treatment group, n=50) or placebo (control group, n=50) on the starting day of oral contraceptive (OC) pretreatment, followed by controlled ovarian stimulation (COS) using GnRH antagonist for IVF/ICSI. Calcium 400 mg/d with vitamin D 1000 IU/d or placebo was administered once daily from the starting day of OC to the day of human chorionic gonadotropin (hCG) injection. There were no significant differences in patient´s characteristics between the treatment and control groups. There were also no differences in total dose and days of recombinant human FSH (rhFSH) administered and the numbers of retrieved, mature and fertilized oocytes between the two groups. However, number of grade 1 or 2 embryos was significantly higher in the treatment group than in the control group (p< .001). FF TNF-α and IL-6 concentrations at oocyte retrieval were significantly lower in the treatment group (p=.001, p< .001, respectively). Embryo implantation rate was higher in the treatment group with borderline significance (p=0.075). Clinical pregnancy rate and miscarriage rate were similar in the two groups. Calcium and vitamin D treatment can reduce FF TNF-α and IL-6 levels in COS cycles, and therefore may be beneficial in improving pregnancy outcome in patients with PCOS undergoing IVF/ICSI.