A new review article published in Journal of Assisted Reproduction and Genetics looked at the published research on vitamin D and assisted reproduction technology and came to the conclusion that treating vitamin D deficiency may be a cost effective way to improve chances of pregnancy.
Assisted reproductive technology (ART) consists of a number of technological processes used to help women achieve pregnancy. Common ART’s include fertility medication, artificial insemination, in vitro fertilization and surrogacy. ART is primarily used in situations where a woman is infertile and cannot get pregnant on her own.
Studies have illustrated the need for maintaining healthy vitamin D levels during pregnancy and birth for both the mother and child. Researchers have found that vitamin D is important for healthy embryonic development, the health of the pregnant mother, and aiding in an uncomplicated and healthy birth.
Is there also evidence that supports vitamin D’s role in helping a woman to get pregnant, particularly if she is infertile and requires ART?
Preliminary research suggests that vitamin D deficiency may increase the chance of complications in specific types of ART, such as success rates during in-vitro fertilization. Yet, only a handful of studies have been conducted, and they have yielded mixed results.
ART is an expensive and risky procedure, and complications can increase both health risks and costs.
If treating vitamin D deficiency could help prevent complications during an ART procedure, it could be an easily administered therapy to aid in a healthy birth and potentially reduce costs of ARTs.
In a recent study, researchers from the eastern United States reviewed all published research on vitamin D and ART to determine its cost-effectiveness.
Using the search engine PubMed, the researchers found eight studies in which vitamin D levels were measured before ART and data was provided on outcomes of interest, including fertilization rates, clinical pregnancy rates, and live birth rates. Of these eight observational cohort studies, three were retrospective and five were prospective.
The research team, led by Dr. Michelle Pacis from the Dartmouth-Hitchcock Medical Center in New Hampshire, then created a model to conduct a cost-benefit analysis of vitamin D repletion during ART. They were interested in comparing the cost of a single ART when the patient was either vitamin D deficient and not treated for that deficiency or vitamin D deficient and treated.
They looked at various costs associated with ART and vitamin D deficiency to complete their model:
- The cost of one vitamin D test was estimated to be $52.53 and it was estimated that a person would undergo three tests during the ART cycle, equaling a total of $158.
- The cost of vitamin D supplementation was estimated to be $0.029 per 1,000 IU.
- It was assumed that an ART cycle lasts 6 weeks on average, meaning the cost of a vitamin D repletion strategy (50,000 IU/week for 8 weeks followed by 2,000 IU/day) would cost $2.44.
- The cost of one ART cycle was calculated to be $14,847 without vitamin D treatment and $14,967 with vitamin D treatment.
The researchers looked at the eight studies that met their criteria to determine, overall, whether vitamin D could improve ART outcomes. They then used their model to estimate the benefits and cost-effectiveness of vitamin D repletion in vitamin D deficient women undergoing ART.
For their systematic review, the researchers found:
- Of the six studies that categorized vitamin D levels, 27.7% were vitamin D deficient (less than 20 ng/ml), 38.4% were insufficient (20-30 ng/ml), and 33.8% were vitamin D sufficient (greater than 30 ng/ml).
- Five of the eight studies found that vitamin D repletion improved ART outcomes.
- One study found a negative relationship, meaning that vitamin D repletion was associated with worse ART outcomes.
- The remaining two studies found no association between vitamin D and ART outcomes.
For their cost-benefit analysis, the researchers found:
- The cost for each ongoing pregnancy in those not treated for vitamin D deficiency was $42,734, compared to $31,410 for each ongoing pregnancy in those treated for vitamin D deficiency.
- After examining the national average of successful ongoing pregnancies and determining the cost of the ART for those not treated to be $14,847, treating patients for vitamin D deficiency was cost-effective when the ART cycle was less than $20,500.
The researchers concluded,
“These data suggest that since a sizeable proportion of ART clinics in the US offer services at less than $20,500 per cycle with an ongoing pregnancy rate of approximately 38%, in the majority of cases there might be substantially decreased costs for patients with vitamin D assessment and treatment.”
Because all of the studies that were reviewed were designed differently, it cannot be said with certainty that vitamin D repletion causes improved ART outcomes.
The cost-benefit analysis was based on estimated costs of factors associated with ART and vitamin D deficiency, meaning that we cannot know for certain that treating for vitamin D deficiency would be truly cost-effective.
Nonetheless, this further supports the notion that treating for vitamin D deficiency is cheap, easy to administer, and may reduce the overall burden of both clinical and financial factors associated with many health-related issues today.
Clinical trials are needed to confirm that vitamin D supplementation improves ART outcomes, while firm economic analyses of vitamin D’s relationship to ART costs will be needed to validate the model presented in this study.