What You Need to Know About Vitamin D and Fertility

 Originally published 03/18/2021. Updated for accuracy and relevancy on 10/27/2023.

Various studies have shown that vitamin D sufficiency is associated with an increase in pregnancy rates and live births. In this article, we dive into the impact of vitamin D on female and male infertility, egg quality, IVF, fibroids, and miscarriage.

By Halle Tecco, MBA, MPH

Can Low Vitamin D Cause Infertility? 

In addition to being important for bone health and immune function, emerging research shows that low vitamin D levels are associated with fertility problems, including PCOS, endometriosis, uterine fibroids, sperm health, and miscarriage. In fact, researchers have found that women with typical levels of vitamin D were 46 percent more likely to get pregnant and a third more likely to have a live birth than women with low levels of vitamin D. [1]  Women with typical levels of vitamin D were 46 percent more likely to get pregnant and a third more likely to have a live birth than women with low levels of vitamin D.

Vitamin D deficiency is associated with infertility. In fact, one study found that most infertile women (87.3%) have low levels of vitamin D. [2] 

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Vitamin D for Ovulation

Research suggests that low levels of vitamin D are associated with a longer follicular phase (the time between the first day of the period and ovulation) and an overall longer menstrual cycle. [3] However, there is not enough research to make conclusions about vitamin D supplements helping with ovulation. That being said, higher vitamin D levels may improve fertility and shorten the time it takes to get pregnant. [3] 

Vitamin D Deficiency and Miscarriage

Repeat miscarriage (aka recurrent pregnancy loss, or RPL) affects one to two percent of reproductive women. Recent studies suggest an association between vitamin D deficiency and auto- or allo-immunologic disruption in RPL. [4] In one study, women who took vitamin D supplements (0.25 mcg twice daily) saw an increase of successful pregnancies. [5] In fact, they had a continuing pregnancy rate of 70% compared to 55% in the control group. However, the study was small with just 40 women, and more research is needed. [5] 

Vitamin D for Egg Quality

It’s unknown whether vitamin D supplementation affects egg quality, but there is a clinical trial being conducted that will hopefully provide more insights on the topic. [6] Because vitamin D shows antioxidant properties, and has been shown to improve mitochondrial function of other tissues, it could become a treatment in the future. [7] However, right now more research is needed. [8] 

Vitamin D and AMH

One study looked at the impact of vitamin D supplementation on AMH levels for women with and without PCOS. [9] AMH (Anti-Müllerian hormone) is an ovarian biomarker that may be used to assess a woman’s egg count. AMH levels can be two to three times higher for women with PCOS. [10] 

The study found that vitamin D supplementation impacts AMH levels. [9] For women with PCOS, AMH was decreased after vitamin D supplementation. For women without PCOS, AMH was significantly increased. [9] 

Vitamin D and IVF

Healthy vitamin D levels are important during IVF. Multiple studies have found that vitamin D sufficient women undergoing IVF had higher implantation and pregnancy rates compared with the vitamin D deficient women. [11-13] One study suggested that “Vitamin D supplementation could provide an easy and cost-effective way of improving pregnancy rates.” [14] 

This was confirmed in a meta-analysis of 11 studies of 2,700 women undergoing IVF. [15] The researchers found that pregnancy and live birth was more likely in women with sufficient vitamin D status, compared to women who were vitamin D deficient or insufficient. 

Vitamin D and Fibroids

Uterine fibroids (also known as leiomyomas) are associated with infertility and misciarrage. Not to mention the symptoms of heavy bleeding and pelvic pain. Treatment options have traditionally been limited to surgical intervention, but that’s changing as new research is emerging that vitamin D supplementation could reduce the progression of fibroids. Read more about vitamin D and uterine fibroids. 

Vitamin D and PCOS

Vitamin D deficiency is common among women with PCOS. One meta-analysis of 13 randomized controlled trials with 824 patients found that “vitamin D oral intake alone improved insulin resistance parameters and reduced inflammation in patients with PCOS.” [16] Many doctors suggest vitamin D supplements for women with PCOS and vitamin D deficiency because it’s an inexpensive and safe treatment option. 

Vitamin D and Endometriosis

Vitamin D intake may impact the risk of endometriosis. Low levels of vitamin D appear to be correlated to the onset and severity of endometriosis. [17] And researchers have found women with the lowest levels of vitamin D also had the largest ovarian endometrioma, or ovarian cysts. Since vitamin D serves as an immunomodulator and anti-inflammatory agent, it makes sense that it can impact endometriosis from a biological standpoint. [18] However, more research is needed to draw any conclusions.

Vitamin D Sperm Effects

The role of vitamin D in hormone production and sperm creation has been investigated in both animals and humans. Experimental studies support a beneficial effect of vitamin D on male fertility by playing a role in hormone production and by improving sperm parameters. [19-20] 

Clinical studies in humans regarding vitamin D and fertility have been controversial and more research is needed. Some studies have demonstrated a positive effect of vitamin D intake on semen quality and motility according to a literature review. [21] Conversely, a study conducted with men specifically undergoing IVF demonstrated no correlation between vitamin D status and any fertility variables (motility, count, or morphology). [22] 

Vitamin D for Erectile Dysfunction

Additionally, vitamin D may help with erectile dysfunction (ED). A significant proportion of erectile dysfunction (ED) patients have a vitamin D deficiency. [23] Research shows that vitamin D supplementation may help delay the onset of ED—and may even restore normal sexual function to some men when coupled with positive lifestyle changes. [24] 

Support Reproductive Health with Natalist

There’s no doubt vitamin D deficiency can lead to myriad fertility issues for both men and women. Determining whether there is a true vitamin D deficiency requires a blood test. It is relatively inexpensive and easily accessible, you can even test from home using our sister-company Everlywell’s vitamin D test. If  you do have low vitamin D levels, you should speak to a provider about how to ensure adequate vitamin D intake. Consuming adequate vitamin D (along with other vitamins and minerals) is important for many reasons beyond fertility. As always, it’s important to talk to a provider before making any changes to your diet or lifestyle. 

Along with vitamin D intake, you can support your health and reproductive outcomes by tracking ovulation with an ovulation testing kit, taking prenatal vitamins , and using sperm-friendly lubricant. Natalist has got you covered with evidence-backed, high-quality, and plastic-neutral offerings. 

Up next:

• Vitamin D2 vs D3: Which is Better?
• Symptoms and Treatment of Vitamin D Deficiency During Pregnancy and Breastfeeding
• Finding a Prenatal with Vegan Vitamin D

References:

1. Justin Chu, Ioannis Gallos, Aurelio Tobias, Bee Tan, Abey Eapen, Arri Coomarasamy, Vitamin D and assisted reproductive treatment outcome: a systematic review and meta-analysis, Human Reproduction, Volume 33, Issue 1, January 2018, Pages 65–80, https://doi.org/10.1093/humrep/dex326
2. Ikemoto Y, Kuroda K, Nakagawa K, et al. Vitamin D Regulates Maternal T-Helper Cytokine Production in Infertile Women. Nutrients. 2018;10(7):902. Published 2018 Jul 13. doi:10.3390/nu10070902
3. Jukic AMZ, Wilcox AJ, McConnaughey DR, Weinberg CR, Steiner AZ. 25-Hydroxyvitamin D and Long Menstrual Cycles in a Prospective Cohort Study. Epidemiology. 2018;29(3):388-396. doi:10.1097/EDE.0000000000000804
4. Schröder-Heurich B, Springer CJP, von Versen-Höynck F. Vitamin D Effects on the Immune System from Periconception through Pregnancy. Nutrients. 2020;12(5):1432. Published 2020 May 15. doi:10.3390/nu12051432
5. Zakia Mahdy Ibrahim, Elham H. madany, Radwa M. Abdel Aal, Magda M. El Biely, Role of 1,25-dihydroxyvitamin D (vitamin D3) as immunomodulator in recurrent missed miscarriage, Middle East Fertility Society Journal, Volume 18, Issue 3, 2013. Pages 171-176, ISSN 1110-5690, https://doi.org/10.1016/j.mefs.2013.04.002.
6. Paffoni A, Somigliana E, Sarais V, et al. Effect of vitamin D supplementation on assisted reproduction technology (ART) outcomes and underlying biological mechanisms: protocol of a randomized clinical controlled trial. The "supplementation of vitamin D and reproductive outcome" (SUNDRO) study. BMC Pregnancy Childbirth. 2019;19(1):395. Published 2019 Nov 1. doi:10.1186/s12884-019-2538-6
7. Gong Q, Li X, Sun J, et al. The effects of calcipotriol on the dendritic morphology of human melanocytes under oxidative stress and a possible mechanism: is it a mitochondrial protector?. J Dermatol Sci. 2015;77(2):117-124. doi:10.1016/j.jdermsci.2014.12.006
8. Rodríguez-Varela C, Labarta E. Clinical Application of Antioxidants to Improve Human Oocyte Mitochondrial Function: A Review. Antioxidants (Basel). 2020;9(12):1197. Published 2020 Nov 28. doi:10.3390/antiox9121197
9. Moridi I, Chen A, Tal O, Tal R. The Association between Vitamin D and Anti-Müllerian Hormone: A Systematic Review and Meta-Analysis. Nutrients. 2020;12(6):1567. Published 2020 May 28. doi:10.3390/nu12061567
10. Yue CY, Lu LK, Li M, Zhang QL, Ying CM. Threshold value of anti-Mullerian hormone for the diagnosis of polycystic ovary syndrome in Chinese women. PLoS One. 2018;13(8):e0203129. Published 2018 Aug 28. doi:10.1371/journal.pone.0203129
11. Paffoni A, Ferrari S, Viganò P, et al. Vitamin D deficiency and infertility: insights from in vitro fertilization cycles. J Clin Endocrinol Metab. 2014;99(11):E2372-E2376. doi:10.1210/jc.2014-1802
12. Ozkan S, Jindal S, Greenseid K, et al. Replete vitamin D stores predict reproductive success following in vitro fertilization. Fertil Steril. 2010;94(4):1314-1319. doi:10.1016/j.fertnstert.2009.05.019
13. Farzadi L, Khayatzadeh Bidgoli H, Ghojazadeh M, et al. Correlation between follicular fluid 25-OH vitamin D and assisted reproductive outcomes. Iran J Reprod Med. 2015;13(6):361-366.
14. 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(2):E77-E82. Published 2013 Jun 28. doi:10.9778/cmajo.20120032
15. Chu J, Gallos I, Tobias A, Tan B, Eapen A, Coomarasamy A. Vitamin D and assisted reproductive treatment outcome: a systematic review and meta-analysis. Hum Reprod. 2018;33(1):65-80. doi:10.1093/humrep/dex326
16. Guo S, Tal R, Jiang H, Yuan T, Liu Y. Vitamin D Supplementation Ameliorates Metabolic Dysfunction in Patients with PCOS: A SystematicReview of RCTs and Insight into the Underlying Mechanism. Int J Endocrinol. 2020;2020:7850816. Published 2020 Dec 19. doi:10.1155/2020/7850816
17. Michele Fichera, Péter Török, Jan Tesarik, Luigi Della Corte, Gianluca Rizzo, Simone Garzon, Annunziata Carlea, Silvia Di Angelo Antonio, Gabriella Zito & Marco Marzio Panella. (2020) Vitamin D, reproductive disorders and assisted reproduction: evidences and perspectives. International Journal of Food Sciences and Nutrition 71:3, pages 276-285.
18. Sayegh L, Fuleihan Gel-H, Nassar AH. Vitamin D in endometriosis: a causative or confounding factor?. Metabolism. 2014;63(1):32-41. doi:10.1016/j.metabol.2013.09.012
19. Silva T, Jesus M, Cagigal C, Silva C. Food with Influence in the Sexual and Reproductive Health. Curr Pharm Biotechnol. 2019;20(2):114-122. doi:10.2174/1389201019666180925140400
20. Salas-Huetos A, Bulló M, Salas-Salvadó J. Dietary patterns, foods and nutrients in male fertility parameters and fecundability: a systematic review of observational studies. Hum Reprod Update. 2017;23(4):371-389. doi:10.1093/humupd/dmx006
21. de Angelis C, Galdiero M, Pivonello C, et al. The role of vitamin D in male fertility: A focus on the testis. Rev Endocr Metab Disord. 2017;18(3):285-305. doi:10.1007/s11154-017-9425-0
22. Neville G, Martyn F, Kilbane M, et al. Vitamin D status and fertility outcomes during winter among couples undergoing in vitro fertilization/intracytoplasmic sperm injection. Int J Gynaecol Obstet. 2016;135(2):172-176. doi:10.1016/j.ijgo.2016.04.018
23. Farag YMK, Guallar E, Zhao D, et al. Vitamin D deficiency is independently associated with greater prevalence of erectile dysfunction: The National Health and Nutrition Examination Survey (NHANES) 2001-2004. Atherosclerosis. 2016;252:61-67. doi:10.1016/j.atherosclerosis.2016.07.921
24. Sorenson M, Grant WB. Does vitamin D deficiency contribute to erectile dysfunction?. Dermatoendocrinol. 2012;4(2):128-136. doi:10.4161/derm.20361