Therapeutic effects of vitamin D and calcium in patients with polycystic ovary syndrome

Hossein Rashidi, Batool; Haghollahi, Fedyeh; Tehranian, Najmeh; Shariat, Mamak; Zayeri, Farid; Bagheri, Maryam; Masoomi, Masoomeh

Therapeutic effects of vitamin D and calcium in patients with polycystic ovary syndrome

Vol. 7, Issue 3, / October-December 2006
(pages 225-233)

Batool Hossein Rashidi: - Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University, Tehran, Iran
Fedyeh Haghollahi: - Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University, Tehran, Iran
Najmeh Tehranian: - Physiology Department Faculty of Medical Sciences, Tarbiyat Modares University, Tehran, Iran
Mamak Shariat: - Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University, Tehran, Iran
Farid Zayeri: - Biostatistics Department, Faculty of Medicine, Shahed University of Medical Sciences, Tehran, Iran
Maryam Bagheri: - Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University, Tehran, Iran
Masoomeh Masoomi: - Vali-e- Asar Reproductive Health Research Center,Tehran Medical Sciences University, Tehran, Iran

Received: 10/1/2006 Accepted: 10/1/2006 - Publisher : Avicenna Research Institute

Other Format

Abstract

Introduction: Polycystic ovary syndrome (PCOS) is the most important cause of oligoovulation and anovulation in women of reproductive age and in infertile women. Considering insulin resistance and hyperinsulinemia in this syndrome, it is believed that calcium, as well as vitamin D, will have a unique role in correcting the impairment in insulin secretion and help the deve-lopment of oocytes in mammals. Therefore, this study was carried out with the objectives of evaluating the effects of calcium on human ovulation and on the size of follicles in comparison with the current use of metformin.Materials & Methods: In this research, all PCOS patients (In accordance with the Rotterdam criteria and diagnosis confirmation by a gynecologist) who attended the infertility unit of Vali-e-Asr Reproductive Health Research Center from 2004 to 2005, after expressing their willingness to participate in the research were assigned to three 20-patient treatment groups as it follows: The cases were treated daily with: 1) Calcium/Vit. D (1000mg), 2) Calcium/Vit. D (1000mg) and metformin (1500mg) or 3) Metformin (1500mg) tablets for 3 months and were followed up for 3 more months. After this 6-month period, the size of dominant follicles, regularity of menses and pregnancy were checked for. After data collection and entry, statistical analysis (Kruskal Wallis, t-test, ANOVA and Generalized Estimating Equation (GEE) Regression) on the basis of the hypothesis, with a significance level of p=0.05 was performed by using SPSS software (Version 11).Results: Considering the response to treatment by the patients (Dominant follicle 12mm in size), GEE showed that the response was significantly higher during the 5th-6th months in the Calcium/Vit. D and metformin treatment group than the ones from the other groups (p= 0.03). Conclusion: Considering the effects of metformin in reducing and regulating insulin production, and vitamin-D in regulating and correcting serum insulin levels, simultaneous administration of these two medications is suggested for the treatment of insulin impairment and reduction of androgen levels for better oocyte maturation.

Keywords: Calcium, Vitamin D, Metformin, Insulin resistance, Hyperandrogenism, Polycystic ovary syndrome

To cite this article:

Hossein Rashidi B, Haghollahi F, Tehranian N, Shariat M, Zayeri F, Bagheri M, et al. Therapeutic effects of vitamin D and calcium in patients with polycystic ovary syndrome. J Reprod Infertil. 2006;7(3):225-233.

References

Speroff L, Marc AF. Clinical gynecology endocrinology and infertility. 7th Edition. Lippincott Williams & Wil-kins. 2005;Chapter 12,pp:465
نیرومنش شیرین، رضایی زهرا، افتخار زهرا و همکاران، اصول بیماریهای زنان و زایمان، هکرـ مور، ویرایش سوم، موسسه فرهنگی، انتشاراتی سیمیا، 1378، صفحات:491-489
Jonathan S, Berek. Novak’s Gynecology. Lippincot Williams & Wilkins. 13th Edition. 2002;Chapter27,pp: 996
The Rotterdam ESHRE/ Asrm-sponsored PCOs consen-sus workshop group- revised 2003 consensus on diag-nostic criteria and long term health risks related to polycystic ovary syndrome (PCOs). Human reproduce-tion. 2004;19(1)pp:41-47
Conway GS, Agarwal R, Betteridge DJ, Jacobs HS. Risk factors for coronay syndrome, clininical endocri-nol. 1992;37(2):119-125 [PubMed]
Wild RA. Long-term health consequences of PCOs. Hum reprod update.2002;8(3):231-241 [PubMed]
Tallbot EO, Guzick DS, Sutton-tyrrell K, McHugh-Pemu KP, Zborowski JV, Remsberg KE, Kuller LH. Evidence for association between polycystic ovary syndrome and premature carotid atherosclerosis in middle-aged women. Arterioscler Thromb Vasc Biol. 2000;20(11):2414-21 [PubMed]
Zborowski JV, Talbtt EO, Cauley JA. Polycystic ovary syndrome, androgen excess, and the impact on bone. Obstet Gynecol Clininical North Am. 2001; 28(1):135-51 [PubMed]
دکتر ملتي. کلسيم و ديابت، مجموعه مقالات پيرامون اختلالات ويتامين D، معاونت پژوهشي دانشگاه علوم پزشکي تهران، مرکز تحقيقات غدد درون ريز متابوليسم دانشگاه علوم پزشکي تهران،مرداد 1381. صفحه:40
Jorde R, Sundsfyord J, Haug E, Bonaa KH. Relation between low calcium intake, parathyroid hormone, and blood pressure. Hypertention 2000;35: 1154-9 [PubMed]
Bostick RM, Kushi LH, Wu Y, Meyer KA, Sellers TA, Folsom AR. Relation of calcium, vitamin D, and dairy food intake to ischemic heart disease mortality among postmenopausal women. Am J Epidemiol 1999; 149:151-61 [PubMed]
Homa ST, Carroll J, Swann K. The role of calcium in mammalian oocyte maturation and egg activation. Hum Reprod 1993;8:1274-81 [PubMed]
Kaufman M, Homa ST. Defining a role for calcium in the resumption and progression of meiosis in the pig oocyte. J Exp Zool. 1993;265:69-76 [PubMed]
Thys- Yacobs S, Donovan D, Papadopoulos A, Sarrel P,Bilezikian J.P. Vitamin D and Calcium dysregulation in the polycystic ovarian syndrome. Steroids 1999; 64: 430-5 [PubMed]
Toth S, Huneau D, Banrezes B, Ozil JP. Egg activation is the result of calcium signal summation in the Mouse. Reproduction. 2006;131(1):27-34 [PubMed]
Lee JH, Joon SY, Bae IH. Studies on ca+2- channel distribution in maturation arrested mouse oocyte. Mol Reprod Dev. 2004;69(2):174-85 [PubMed]
Zhang HS, Xiao JH, Cao EH, Qin JF. Homocysteine inhibits store- mediated calcium entry in human endothelial cells: evidence for involvement of mem-brance potential and actin cytoskeleton. Mol Cell Biochem. 2005;269(1-2):37-47 [PubMed]
Schachter M, Raziel A, Friedler S, Strassburger D, Bern O, Ron-El R. Insulin resistance in patients with polycystic ovary syndrome is associated with elevated plasma homocysteine. Hum Reprod. 2003;18(4):721-7 [PubMed]
Chen JC, Wangy L, Liu CP ,Liu Cp , Cheng JS, Chang HT,Yuk-Keung L, et all. Clomiphene, an ovula-tion inducing agent, causes [ca+2] increases in human osteoblast like cells. Chin J Physiol. 2001;44(2):67-72 [PubMed]
Velazquez E, Acosta A, Mendoza SG. Menstural cyc-licity after Metformin therapy in polycystic ovary syndrome. Obstet Gynecol. 1997;90(3):395-5 [PubMed]
Kiatal H, Santuli R, Wright KH, Wallach EE. Exami-nation of the role of calcium in the in vitro perfused ovary with use of ethyleneglycol-bis (beta-amino-ethylether)-n, n'- tetraacetic acid and verapamil. Am J Obstet Gynecol. 1985;152(6 pt 1):705-8 [PubMed]
Kobayashi K, Kiatai H, Santulli R, Wright KH and Wallach EE. Influence of calcium and magnesium deprivation on ovulation and ovum maturation in the perfused rabbit ovary. Biol Reprod 1984;31(2):287-95 [PubMed]
Racowasky C. The releasing action of calcium upon cyclic AMP dependent meiotic arrest in hamster oocytes. J EXP Zool. 1986;239:263-75