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Medical Journal of Babylon-Vol. 11- No. 3 -2014 ٢٠١٤ – ﺚﻟﺎﺜﻟا دﺪﻌﻟا - ﺮﺸﻋ يدﺎﺤﻟا ﺪﻠﺠﻤﻟا -ﺔﯿﺒﻄﻟا ﻞﺑﺎﺑ ﺔﻠﺠﻣ
675
Received 3 April 2014 Accepted 13 April 2014
Abstract
Back ground : Infertility is one of the most important and under appreciated reproductive health
problems in developing countries.
The causes of infertility can be found in about 90% of cases, while about 10% of patients don’t know
why they can not conceive .The causes of this case (unexplained infertility) seems to be heterogeneous,
with suggested potential causes ranging from disturbances in endocrinological, immunological , genetic
and reproductive physiological factors.
One of the main causes of unexplained infertility is the reactive oxygen species (ROS). Therefore this
study is aimed to estimate and calculate the vitamin E and C level. To carry out this aim, the vitamin E
and C level had been estimated in both sera and cervical mucus secretions among healthy fertile women
(control) and patients with unexplained infertility.
Patients and method: The study groups were attended to Babylon Maternity and Pediatric Hospital and
privet clinics. All studied patients are suffering from primary or secondary unexplained infertility types
and are diagnosed by gynecologist. The study is carried out on (30) apparently healthy fertile women as
a control group, their mean age (30.133±8.011years) and (60) infertile women as patient group , their
mean age (29.866 ±7.195 years).
Results: Vitamin C levels decrease insignificantly(p>0.05) in serum and cervical mucus secretion(9.944
± 1.549mg/l and14.233 ±3.458mg/l) in patient group comparing with(10.383±3.655mg/l and(16.447±
4.042mg/l) in control group.
Vitamin E levels decrease significantly (p<0.05) in serum and cervical mucus secretion(5.272 ±
1.228mg/l and 4.644 ± 1.343 mg/l) in patient groups comparing with (7.337±3.535 mg/l and 7.023±
0.754 mg/l) in control groups.
Conclusion: The present study shows that the vitamins level plays an important role in human fertility.
Vitamin E levels is significantly decreased in sera and cervical mucus secretion in patients with
unexplained infertility.
ﻼﺧﻟاﺔﺻ
ﺔﯾﻣﺎﻧﻟا لودﻟا ﻲﻓ ﺔﯾﺣﺻﻟا لﻛﺎﺷﻣﻟا مﻫأ نﻣ مﻘﻌﻟا رﺑﺗﻌﯾ. ﻲﻓ مﻘﻌﻟا بﺎﺑﺳأ دﯾدﺣﺗ نﻛﻣﯾ و٩٠ % ﻲﻓ بﺑﺳﻟا ﻰﻘﺑﯾ ﺎﻣﻧﯾﺑ تﻻﺎﺣﻟا نﻣ١٠
%فورﻌﻣ رﯾﻏ تﻻﺎﺣﻟا نﻣ.ﻔﻟا تﺎﺑارطﺿﻻا ﻲﻓ ﻪﺑﺎﺑﺳأ نﻣﻛﺗ ﺎﻣﺑر رﺳﻔﻣﻟا رﯾﻏ مﻘﻌﻟا اذﻫو ﺔﯾﺟﻠﺳ:ﺔﯾﺛارو وأ ﺔﯾﻋﺎﻧﻣ وأ ﺔﯾﻧوﻣرﻫ.
ودﺑﯾو رﺿﺎﺣﻟا تﻗوﻟا ﻲﻓنإ رﺳﻔﻣ رﯾﻐﻟا مﻘﻌﻠﻟ ﺔﯾﺳﯾﺋرﻟا بﺎﺑﺳﻷا نﻣ ةدﺣاو ﺔﻟﺎﻌﻔﻟا نﯾﺟﺳﻛوﻷا عاوﻧأ. ﺔﺳاردﻟا ﻩذﻫ تﻣﻣﺻ كﻟذﻟ
دﻟا لﺻﻣ ﻲﻓ ةدﺳﻛﻷا تادﺎﺿﻣ سﺎﯾﻗ كﻟذﻛو ةرﺣﻟا روذﺟﻟﺎﺑ ﻰﻣﺳﺗ ﻲﺗﻟاو ﺔﻟﺎﻌﻔﻟا نﯾﺟﺳﻛوﻷا عاوﻧأ سﺎﯾﻗو دﯾدﺣﺗﻟ ﺔﯾطﺎﺧﻣﻟا تازارﻓﻹا و م
رﺳﻔﻣﻟا رﯾﻏ مﻘﻌﻟﺎﺑ ﺎﻬﺗﻗﻼﻋ ىدﻣ ﺔﻓرﻌﻣﻟ مﺣرﻟا قﻧﻌﻟ.
لﻣﻌﻟا قرطو ﻰﺿرﻣﻟا : ﺔﺳاردﻟا تﻠﻣﺷ)٦٠ ( نﻫرﺎﻣﻋأ طﺳوﺗﻣ رﺳﻔﻣﻟا رﯾﻏ مﻘﻌﻟﺎﺑ ﺔﺑﺎﺻﻣ ةأرﻣا(7.195±29.866) ﻲﺗﻼﻟاو ﺎﻣﺎﻋ
ﺎﯾرﺑﺗﺧﻣ و ﺎﯾررﺳ نﺻﺧﺷ .لﺑﺎﺑ ﻰﻔﺷﺗﺳﻣ ﻲﻓ ﺔﯾﺋﺎﺳﻧ ﺔﯾﺋﺎﺻﺧأ لﺑﻗ نﻣ ءﺎﺳﻧﻟا صﺣﻓ مﺗ لﺑﺎﺑ ﻲﻓ ﺔﺻﺎﺧﻟا تادﺎﯾﻌﻟا ﻲﻓو لﺎﻔطﻷاو ةدﻻوﻠﻟ
Vitamin E and C Status In The Sera and Cervical Mucus
Secretion of Infertile Female With Unexplained Infertility
Naseer J.H. Al.Mukhtar1 Sahib Y.H.Al.Morshidy2 Ban J.Edan3
1,3 College of Medicine, University of Babylon, Hilla, Iraq
2 College of Medicine, University of kufa, Al Najaf,Iraq
676
لوﻠﯾأ نﻣ ةرﺗﻔﻠﻟ و٢٠٠٨ رﺎﯾأ ﺔﯾﺎﻐﻟو٢٠٠٩ . ﺔﺳاردﻟا تﻧﻣﺿﺗ ﺎﻣﻛ)٣٠ ( طﺳوﺗﻣ تﺎﺑﺟﻧﻣﻟا ءﺎﺳﻧﻟا نﻣ ﺔﯾﺳﺎﯾﻗ ﺔﻧﯾﻋ
نﻫرﺎﻣﻋأ(8.011±30.133) ﺔﺑﺳﻧ ﺔﺳارد مﺗ ثﯾﺣ ، ﺎﻣﺎﻋ يأ نﯾﻣﺎﺗﯾﻓ)E (ﻲﺳ نﯾﻣﺎﺗﯾﻓ ﺔﺑﺳﻧ و)C ( تازارﻓﻹا ﻲﻓو مدﻟا لﺻﻣ ﻲﻓ
و مﺣرﻟا قﻧﻌﻟ ﺔﯾطﺎﺧﻣﻟا نﯾﺗﻋوﻣﺟﻣﻟا ﻼﻛﻟ.
ﺞﺋﺎﺗﻧﻟا : مﺣرﻟا قﻧﻌﻟ ﺔﯾطﺎﺧﻣﻟا تازارﻓﻹا و مدﻟا لﺻﻣ ﻲﻓ يوﻧﻌﻣ ضﺎﻔﺧﻧا ضﻔﺧﻧا دﻗ يإ نﯾﻣﺎﺗﯾﻓ ﺔﺑﺳﻧ نإ ﺞﺋﺎﺗﻧﻟا تﻧﯾﺑ 1.228
±5.272 )و 1.343 ±4.644 مﻐﻠﻣ/رﺗﻟ (تﺎﺑﺟﻧﻣﻟا ءﺎﺳﻧﻟﺎﺑ مﻬﺗﻧرﺎﻘﻣ دﻧﻋ تﺎﻣﯾﻘﻌﻟا ءﺎﺳﻧﻠﻟ)٧.٣٣٧ ±٣.٥٣٥ و٠.٧٥٤ ±٧.٠٢٣
مﻐﻠﻣ/رﺗﻟ.
مﺣرﻟا قﻧﻌﻟ ﺔﯾطﺎﺧﻣﻟا تازارﻓﻹا و مدﻟا لﺻﻣ ﻲﻓ يوﻧﻌﻣ رﯾﻏ ضﺎﻔﺧﻧا دﺟو دﻘﻓ ﻲﺳ نﯾﻣﺎﺗﯾﻓ ﺔﺑﺳﻧ ﺎﻣإ 1.549±9.944) و3.458
±14.233 مﻐﻠﻣ/رﺗﻟ( تﺎﺑﺟﻧﻣﻟا ءﺎﺳﻧﻟﺎﺑ مﻬﺗﻧرﺎﻘﻣ دﻧﻋ تﺎﻣﯾﻘﻌﻟا ءﺎﺳﻧﻠﻟ)١٠.٣٨٣±٣.٦٥٥ و١٦.٤٤٧ ±٤.٠٤٢ مﻐﻠﻣ/رﺗﻟ .(
جﺎﺗﻧﺗﺳﻻا : نارﯾﻏ مﻘﻌﻟا تﻻﺎﺣ ﻲﻓ ﺔﺿﻔﺧﻧﻣ ﻪﺗﺑﺳﻧ ناو مﻘﻌﻟﺎﺑ ﺔﻘﯾﺛو ﺔﻗﻼﻋ ﻪﻟ يا نﯾﻣﺎﺗﯾﻓ ﺔﺑﺳﻧ رﺳﻔﻣﻟا.
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Introduction
Infertility is defined as ‘the
inability to conceive following 12
months of unprotected sexual
intercourse, before an investigation is
undertaken unless medical history and
physical findings dictate earlier
evaluation and treatment (1).
Unexplained infertility is a diagnosis of
exclusion, when the standard
investigation of both the female and
male partner has ruled out other
infertility diagnoses (2).A couple is
considered to have unexplained
infertility if the woman ovulated and
had a normal and hysterosalpingogram,
and the man a normal semen analysis
.Critical factors to be considered in
evaluating and managing unexplained
infertility are the duration of infertility
and female age (3).
Vitamin C is a water soluble vitamin
found in many fruit and vegetable(4).
It is required for optimal functions of
number of enzymes ;deficiency cause
scurvy and poor wound repair. It is also
considered a chain breaking antioxidant
that stops the propagation of the
peroxidative process.
Ascorbic acid has three main biological
functions, each dependent on its role as
a reducing agent:
It is required for biosynthesis of
collagen.
For biosynthesis of steroids and
peptide hormones (5) and
Protects the body from the
harmful effects of free radicals
and pollutants (6).
Vitamin E is fat - soluble vitamin. The
primary role of vitamin E within the
body is to function as an antioxidant
(7).Within cells and organelles (e.g.
mitochondria) vitamin E is the first line
of defense against lipid peroxidation.
Moreover, it plays a very important
function in lending red blood cells
flexibility as they make their way
through the arterial network and helps
prolong the life of erythrocytes,
immune function, and has positive
effects in the fertility (8).
Aims of The Study
The aims of the present work is to
explore some vitamins level in
unexplained infertility among women
and relationship between these vitamins
and some factors (age, body mass index
,smoking ,infertility duration and type
of infertility).
Materials and Methods
Patients and control groups:
Control group: This group consists of
thirty apparently healthy fertile women,
with a mean age (30.133±8.011years),
and range from 18 to 44 years were
investigated to serve as a controlling
group. None of them had clinical or
laboratory evidence of diseases that
would affect the parameters to be
measured.
Patients group: Couples resident in
Babylon with unexplained infertility of
677
more than 12 months duration were
identified from the Fertility Clinic
database in Babylon maternity hospital
and private clinic. The patients were
seen between August 2008 and May
2009.
The following criteria have been used to
establish the diagnosis of unexplained
infertility: mid-luteal serum
progesterone concentration >20 nmol/l,
bilateral tubal patency demonstrated by
laparoscopy or hysterosalpingogram
and normal semen parameters
(WHO,1999).
Sixty women had been studied,
with a mean of age (29.866 ±7.195
years), and from 18 to 44 years ; 26
with primary unexplained infertility and
34 have secondary unexplained
infertility. Those having male factor of
infertility or female factors or any other
an associated condition which could
alter the level of free radicals like,
hypertension, diabetes mellitus, heart
disease, malignancy, and antioxidant
therapy, had been excluded from the
study. Each subject was involved to
detailed clinical history and physical
examination. The infertile group had
undergone baseline investigations of
infertility.
Method
Collection of blood and serum
preparation
About 5 ml of venous blood for
specific test of markers was collected
by vein puncture using 5ml disposable
syringes. Some blood drops are put on
slide for blood group typing(9) . The
obtained sera was put then in another
disposable tubes and labeled. The
samples were transferred to the
biochemical laboratory for analysis of
vitamin C and vitamin E.
Collection of cervical secretion
About 0.5 ml of cervical
secretion was taken by syringe from
high cervix using cusco speculum,
labeled and storage at – 20 C◦.
For biochemical tests, the mucus must
be liquefied by mucolytic agent of N-
acetyl L- cycteine at concentration 0.2
mg/ml which prepared by weight 0.2
mg of N-acetyl L- cycteine and
complete to one milliliter with DW
(10,11).
Biochemical tests
Determination of total vitamin C in
sera and cervical
secretions: vitamin C was determined
according to 2,4-dinitrophenylhydrazine
(DNPH) methods (12)
Determination of Vitamin E in sera
and cervical secretions: The α - α
dipynidyl was added to an aliquot of the
upper layer to estimate the principal
interfering substance, B-carotene, at
460 nm. At this time, the ferric chloride
(FeCl3) reagent was added to the
system to produce the colour which was
measured at 510 nm (13).
Statistical Analysis
SPSS program was used in this
study.All values were expressed as
mean ± standard deviation (SD).
Independent t-test was used to estimate
differences between groups. The
differences were considered significant
when the probability (P) was less than
0.05( P< 0.05)(14).
The Results
Measurement of vitamin C activity
Vitamin C levels in sera and
cervical secretions of infertile women
with unexplained infertility show
insignificant decrease (p>0.05) when
compared with fertile control as shown
in Table (1):
678
Table (1) Vitamin C levels(mg/l) in sera and cervical secretions of infertile women with
unexplained infertility and Control.
P value
Patients
Mean ±SD mg/l
Control
Mean ±SD mg/l
Sample
P>0.05
9.944 ± 1.549
10.383 ± 3.655
Serum Vitamin C
P>0.05
14.233 ± 3.458
16.447 ± 4.042
C.mucus Vitamin C
Vitamin C levels and types of
infertility
Vitamin C levels in sera and
cervical secretions of infertile women
with unexplained infertility show
insignificant differences(p>0.05)
between primary and secondary
infertility as shown in Figure (1):
9.713+1.882 10.112+1.329
15.189+2.430 14.198+2.872
0
4
8
12
16
20
Vitamin C (mg/l)
se cond aryprim ary second ary pr im ary
Serum Mucus
Figure (1) Vitamin C levels (mean ±S.D mg/l) in sera and cervical secretions in
primary and secondary infertile women with unexplained infertility(p>0.05).
Vitamin C levels and smoking
Vitamin C levels in sera and
cervical secretions show insignificant
differences(p> 0.05) between passive
and non smoker in infertile women with
unexplained infertility and fertile
control as shown in Figure (2) and (3):
679
11.17+3.494
9.947+3.778 10.338+1.116
9.658+1.798
0
2
4
6
8
10
12
14
16
S.vitamin C (mg / l )
patientscontrols
passive smokers
non smokers
Figure (2 ) The serum vitamin C levels (mean ±S.D mg/l)in passive and non smoker in
infertile women with unexplained infertility and fertile control(p>0.05) .
17.527+3.684 16.907+3.174 15.446+3.174
13.875+3.610
0
5
10
15
20
25
C.vitamin C (mg / l )
patientscontr ols
passive smoker
non smoker
Figure (3) Vitamin C level in cervical secretions (mean ±S.D mg/l)in passive and non
smoker in infertile women with unexplained infertility and fertile control(p>0.05) .
The Relationship between age and
vitamin C
Vitamin C levels in sera and
cervical secretions of infertile women
with unexplained infertility show a
significant negative correlation with
age increment when compared with
fertile controls (p<0.05) as shown in
Figure (4) and (5):
680
y = -0.1702x + 15.835
R2 = 0.2389
0
3
6
9
12
15
18
15 20 25 30 35 40 45
Age(years)
S.vitamin C(mg/l)
Contr ols
y = -0.2358x + 16.729
R2 = 0.6638
0
3
6
9
12
15
18
15 20 25 30 35 40 45
Age (years)
S.vitamin C ( mg/l )
Patients
Figure (4) Relationship between age ( years) and serum vitamin C levels (mean ±S.D
mg/l) in infertile women with unexplained infertility and fertile control.
y = -0.3131x + 26.647
R2 = 0.3835
0
5
10
15
20
25
30
15 20 25 30 35 40 45
Age(years)
C.vitamin C(mg/l)
Contr ols
y = -0.3872x + 25.833
R2 = 0.5794
0
5
10
15
20
25
30
15 20 25 30 35 40 45
Age (years)
C.vitamin C ( mg/l )
Patients
Figure (5) Relationship between age ( years) and vitamin C levels in cervical secretions
(mean ±S.D mg/l) in infertile women with unexplained infertility and fertile control.
The Relationship between body mass
index and vitamin C
Vitamin C levels in sera and
cervical secretions of infertile women
with unexplained infertility show
insignificant negative
correlation(p>0.05) with BMI
increment when compared with fertile
control as shown in Figure (6) and (7):
P
<0.05
P
<0.05
P
>
0.05
P
>
0.05
681
y = -0.2191x + 15.836
R2 = 0.0911
0
3
6
9
12
15
18
18 20 22 24 26 28 30 32
BMI(kg/m2)
S.vitamin C(mg/l)
Contr ols
y = -0.2137x + 15.146
R2 = 0.1199
0
3
6
9
12
15
18
18 20 22 24 26 28 30 32
BMI (kg /m2 )
S.vitamin C (m g/l)
Patients
Figure (6 )Relationship between BMI ( kg/m2) and serum vitamin C levels (mean ±S.D
mg/l) in infertile women with unexplained infertility and fertile control.
y = -0.04x + 17.455
R2 = 0.0014
0
5
10
15
20
25
30
18 20 22 24 26 28 30 32
BMI(kg/m2)
C.vitamin C(mg/l)
Controls
y = -0.2607x + 21.147
R2 = 0.0756
0
5
10
15
20
25
30
18 20 22 24 26 28 30 32
BMI (kg/m2)
C.vitamin C ( mg/l )
Patients
Figure (7)The correlation between BMI ( kg/m2) and vitamin C levels in cervical
secretions (mean ±S.D mg/l) in infertile women with unexplained infertility and fertile
control.
The Relationship between duration of
infertility and vitamin C
Vitamin C levels in sera and
cervical secretions of infertile women
with unexplained infertility show
insignificant negative correlation
(p> 0.05) with duration of infertilityas
shown in Figure(4.38):
P
>
0.05
P
>
0.05
682
y = -0.2252x + 10.681
R2 = 0.1127
0
3
6
9
12
15
18
0 2 4 6 8 10 12
Infertility duration ( years )
S.vitamin C ( mg/l )
y = -0.2006x + 5.5653
R2 = 0.2711
0
2
4
6
8
10
0 2 4 6 8 10 12
Infertility duration(years)
C.vitamin E(mg/l)
Figure ( 8 ) Relationship between duration of infertility in years and vitamin C levels
(mean ±S.D mg/l) in sera and cervical secretions of in infertile women with
unexplained infertility.
Measurement of vitamin E levels
Vitamin E levels in sera and
cervical secretions of infertile women
with unexplained infertility show a
significant decrease ( p<0.05 and
p< 0.001) respectively when compared
with fertile control as shown in Table
(2):
Table (2) Vitamin E levels in sera and cervical secretions (mg/l) of infertile women
with unexplained infertility and fertile control.
P value
Patients
Mean ±SD mg/l
Control
Mean ±SD mg/l
Sample
p<0.05
5.272 ± 1.228
7.337 ± 3.535
Serum Vitamin E
p< 0.001
4.644 ± 1.343
7.023 ± 0.754
C.mucus Vitamin E
Vitamin E levels and types of
infertility
Vitamin E levels in sera and
cervical secretions of infertile women
with unexplained infertility show
insignificant differences(p>0.05)
between primary and secondary
infertility as shown in Figure(9):
Serum
Cervical secretion
P
>
0.05
P
>
0.05
683
5.658+0.848
4.983+1.437
5.183+0523
4.182+1.683
0
2
4
6
8
10
Vitamin E (mg/l)
secondaryprimary s econdary primary
Serum Mucus
Figure (9) The vitamin E levels in sera and cervical secretions (mean ±S.D mg/l) in
primary and secondary infertile women with unexplained fertility(p>0.05).
Vitamin E levels and smoking
Vitamin E levels in sera and
cervical secretions show insignificant
differences between passive and not
smoker in infertile women with
unexplained infertility and fertile
control (p> 0.05) as shown in
Figure(10) and (11):
6.929+3 .425
7.663+4 .157
4.882+1.407
5.793+0.76 3
0
2
4
6
8
10
12
S.vitamin E (mg/l)
patientscontrols
passive smokers
non smokers
Figure (10 )The serum vitamin E levels (mean ±S.D mg/l) in passive and non smoker
of infertile women with unexplained infertility and fertile control(p>0.05).
684
7.023+0.500
7.500+0.271
4.046+1.555
5.157+0.964
0
2
4
6
8
10
C.vitamin E (mg/l)
patientscontrols
passive smoker
non smoker
Figure (11)The vitamin E level in cervical secretions (mean ±S.D mg/l) in passive and
non smoker of infertile women with unexplained infertility and fertile control(p>0.05) .
The Relationship between age and
vitamin E
Vitamin E levels in sera and
cervical secretions of infertile women
with unexplained infertility show
insignificant negative correlation
(p>0.05) with age increment when
compared with fertile controls as shown
in Figure (12) and (13):
y = -0.0258x + 7.8543
R2 = 0.0136
0
2
4
6
8
10
12
15 20 25 30 35 40 45
Age (years)
S.vitamin E(mg/l)
Control
y = -0.0507x + 6.7285
R2 = 0.104
0
2
4
6
8
10
15 20 25 30 35 40 45
Age (years)
S.vitamin E(mg/l)
Patients
Figure (12 ) Relationship between age ( years) and serum vitamin E levels (mean ±S.D
mg/l) in infertile women with unexplained infertility and fertile control.
P
>
0.05
P
>
0.05
685
y = -0.0093x + 7.6143
R2 = 0.001
0
2
4
6
8
10
12
14
15 20 25 30 35 40 45
Age (yea rs)
C.vitamin E(mg/l)
Contr ols
y = -0.0465x + 6.0479
R2 = 0.0853
0
2
4
6
8
10
15 20 25 30 35 40 45
Age (years)
C.vitamin E(mg/l)
Patients
Figure ( 13 ) Relationship between age ( years) and vitamin E levels in cervical
secretions (mean ±S.D mg/l) in infertile women with unexplained infertility and fertile
control.
The Relationship between body mass
index and vitamin E
Vitamin E levels in sera and
cervical secretions of infertile women
with unexplained infertility show
insignificant decrease (p<0.05) with
body mass index increment when
compared with fertile controls as shown
in Figure (14) and (15):
y = -0.0734x + 8.8663
R2 = 0.0215
0
2
4
6
8
10
12
18 20 22 24 26 28 30 32
BMI (kg/m2)
S.vitaminE(mg/l)
Contr ols
y = -0.0822x + 7.3105
R2 = 0.0591
0
2
4
6
8
10
18 20 22 24 26 28 30 32
BMI(kg/m2)
S.vitamin E(mg/l)
Patients
Figure (14) Relationship between BMI ( kg/m2) and serum vitamin E levels (mean
±S.D mg/l) in infertile women with unexplained infertility and fertile control.
P
>
0.05
P
>
0.05
P
>
0.05
P
>
0.05
686
y = -0.1991x + 12.576
R2 = 0.0685
0
2
4
6
8
10
12
14
18 20 22 24 26 28 30 32
BMI (kg/m2)
C.vitaminE(mgl)
Control
s
y = -0.1x + 7.2232
R2 = 0.0882
0
2
4
6
8
10
18 20 22 24 26 28 30 32
BMI(kg/m2)
C.vitaminE(mg/l)
Patients
Figure (15) The correlation between BMI ( kg/m2 ) and vitamin E levels in cervical
secretions (mean ±S.D mg/l) in infertile women with unexplained infertility and fertile
control.
The Relationship between duration of
infertility and vitamin E
Vitamin E levels in sera and
cervical secretions of infertile women
with unexplained infertility show
insignificant negative correlation (p>
0.05) with duration of infertility as
shown in Figure(16):
y = -0.2142x + 6.1816
R2 = 0.317
0
2
4
6
8
10
0 2 4 6 8 10 12
Infertility duration (years)
S.vitam in E(mg/l)
y = -0.2006x + 5.5653
R2 = 0.2711
0
2
4
6
8
10
0 2 4 6 8 10 12
Infertility duration(years)
C.vitamin E (mg/l)
Figure ( 16 ) Relationship between duration of infertility ( years) and vitamin E levels
in sera and cervical secretions (mean ±S.D mg/l) in infertile women with unexplained
infertility .
Serum
Cervical secretion
P
>
0.05
P
>
0.05
P
>
0.05
P
>
0.05
687
Discussion
Measurement of vitamin C activity
In female reproductive tract,
vitamin C is located mainly in the
ovary.
Vitamin C levels in sera and cervical
secretions of infertile women with
unexplained infertility show
insignificant decrease (p>0.05) when
compared with fertile controls as shown
in Table (1)
Many studies indicate that the addition
of ascorbic acid does prevent oocyte
membrane damage and increases
basement membrane turnover (15),
leading to increased follicle integrity
and survival. Other researchers propose
that certain concentrations of alpha-
tocopherol or ascorbic acid facilitate
meiotic maturation of cumulus free
oocytes and can protect cumulus cell
DNA damage and apoptosis (16).
Supplementation inhibits follicular
apoptosis and causes premature
resumption of meiosis (1).
Vitamin C levels and types of
infertility
Vitamin C levels in serum and
cervical secretion of infertile women
with unexplained infertility show
insignificant differences between
primary and secondary infertility
(p>0.05) as shown in Figure
(1).Therefore, this result may be
explained b y the fact of dietary vitamin
C intake in which each type of female
infertility are near equal.
Vitamin C levels and smoking
Vitamin C levels in sera and
cervical secretions of infertile women
with unexplained infertility show
insignificant differences between
passive and not passive smoker in
infertile women with unexplained
infertility and fertile controls (p> 0.05)
as shown in Figure (2) and (3).
Ayaori ,et al. (2000) report that plasma
ascorbic acid is inversely associated
with smoking(17).Vitamin C helps to
combat the pollution surrounding us.
Moreover; it has been shown to reduce
the DNA damage (18).No dietary
difference between passive smoker and
not smoker might be the cause behind
such a result..
The Relationship between age and
vitamin C
A significant negative
correlation between vitamin C levels in
sera, cervical secretions of infertile
patients and the age increment when
compared with fertile controls (p<0.05,
r = -0.814, p<0.05, r = -0.761) as
shown in Figure (4) and (5). Tarín ,et
al.(1998) find that supplementation of
vitamin C reduces the risk of ovulating
aneuploid and diploid oocytes in aged
female mice. Furthermore, dietary
supplementation of mice with the
antioxidants vitamins C and E, resulted
in improvements in both the quantity
and quality of oocytes when compared
to unsupplemented older mice (19).
This reduction of vitamin C with age
may be due to increase OS with age
increment which leads consequently to
depletion of antioxidants(19).
The Relationship between body mass
index and vitamin C
Vitamin C levels in serum and
cervical secretion of infertile women
with unexplained infertility show
insignificant negative correlation with
BMI increment when compared with
fertile controls (p>0.05, r = -0.346;
p>0.05, r = -0.274)respectively as
shown in Figure (6) and (7).This result
may be regarded to increase of
polyunsaturated lipid , increase lipid
peroxidation which consequently leads
to decrease antioxidants levels.
The Relationship between duration of
infertility and vitamin C
Vitamin C levels in sera and
cervical secretions of infertile women
688
with unexplained infertility show
insignificant negative correlation with
duration of infertility (p>0.05, r = -
0.335; p>0.05, r = -0.217) respectively
as shown in Figure(8) and this result is
in agreement with a result obtained by
Crha ,et al.(2003) who report higher
pregnancy rate with vitamin C
supplementation when compared to the
a controling group(20).
Measurement of vitamin E levels
Vitamin E is a major chain
breaking antioxidant in membranes,
located mainly in the ovary specially in
follicular fluid.
Vitamin E levels in sera and
cervical secretions of infertile women
with unexplained infertility show a
significant decrease (p<0.05 ;p< 0.001)
respectively when compared with fertile
controls as shown in Table (2). This
result matches with the results got by
Makinde and Adedeji(1994) and
Mehendale, et al.(2009) who state that
plasma vitamin E level is greater in
fertile women than in infertile
women(21&22).
Savita, et al.(2009) suggest that
the increased OS are associated with the
decrease of antioxidants and associated
with infertility(23).
Vitamin E directly neutralizes
superoxide anion, hydrogen peroxide,
and hydroxyl radical ;so increase these
types of free radical may lead to
depletion of vitamin E. Also vitamin E
increases number of embryos
developing to the expanded blastocysts
and increases viability of embryos
exposed to heat shock. So any change in
its concentration may have a role in
infertility(1).
Vitamin E may increase oocyte
quality. In a human trial, infertile
couples given vitamin E show a
significant increase in fertility (24).
Vitamin E levels and types of
infertility
Vitamin E levels in sera and
cervical secretions of infertile women
with unexplained infertility show
insignificant differences between
primary and secondary
infertility(p>0.05)as shown in
Figure(9). This result may be due to the
lack of vitamin E in diet as well as to
other factors such as environmental
factors which nearly affect both types of
female infertility equally .
Vitamin E levels and smoking
Vitamin E levels in serum and
cervical secretion of infertile women
with unexplained infertility show
insignificant differences between
passive and not passive smoker in
infertile women with unexplained
infertility and fertile controls (p> 0.05)
as shown in Figure (10) and (11) .
Tiboni, et al. (2004)(25) state that no
smoking-related differences in follicular
fluid or plasma concentrations of
vitamin E between fertile and infertile
women as well as to Dietrich ,et al.
(2003) research who find that no
significant differences in plasma
concentrations of alpha-tocopherol
between fertile and infertile smoker.
This result may be due to the same level
of vitamin E in diet in both passive
smoker and non smoker(26).
The Relationship between age and
vitamin E
Vitamin E levels in serum of
infertile women with unexplained
infertility show a insignificant negative
correlation (p>0.05, r = -0.332;
p>0.05, r = -0.292)respectively with
age increment when compared with
fertile controls as shown in Figure (12)
and (13).This result approves with the
results obtained by Yeh, et al.(2005)
who say that decrease in vitamin E and
other antioxidant defense with age(27).
In this respect, Makinde and
Adedeji (1994) show that vitamin E
values are increased with age up to the
25-29 year age group(21). Other
evidences researching by Carbone , et
al. (2003) show that the aged ovaries
have elevated vitamin E content. Thus, a
shift toward a higher concentration of
vitamin E (and low serum vitamin E
level) may occur to help protect the
689
aging ovary during luteolysis and
compensate for the decline in the luteal
cell ability to quench ROS, as evidenced
by lower glutathione reductase enzyme.
Other researchers, such as Ruder,et
al.(2008) (1)find that vitamin E
supplementation reduces the risk of
ovulating aneuploid and diploid oocytes
in aged female mice and increases
survival of explanted rat conceptuses in
vitro. In general, when supplemental
vitamins E is given to older mice, the
age-associated reduction in ovulation is
partially prevented (29).
The Relationship between body mass
index and vitamin E
Vitamin E levels in serum and
cervical secretion of infertile women
with unexplained infertility show
insignificant decrease (p>0.05, r = -
0.243; p>0.05, r = -0.296)respectively
with body mass index when compared
with fertile controls as shown in Figure
(14) and (15). Increase BMI may lead to
increase unsaturated lipid which lead to
higher ROS levels production . Higher
ROS levels production would lead to
reduce levels of antioxidants such as
vitamin E that would ultimately reduce
ROS-scavenging ability and prevent the
neutralization of toxic ROS effects (30)
.
The Relation between duration of
infertility and vitamin E
Vitamin E levels in serum and
cervical secretion of infertile women
with unexplained infertility show
insignificant negative correlation with
duration of infertility (p>0.05, r = -
0.563; p>0.05,
r = -0.520) respectively as shown in
Figure(16).
This result may be due to the
fact that the vitamin E level may be
affected by the level of free radical
production and level of vitamin E intake
during time of infertility.Antioxidant
levels in patients with unexplained
infertility are significantly lower than
those of healthy controls (31).Ruder, et
al., (2009) find that the use of
multivitamins, impacts the generation of
ROS and may play a beneficial role in
female fertility(1).
Conclusions
The present study shows that the
vitamins level plays an important role in
human fertility:
- Vitamin E levels is significantly
decreased in sera and cervical
mucus secretion in patients with
unexplained infertility.
- There is an inverse significant
relationship between vitamin C
level and age increment in
patients with unexplained
infertility.
Recommendations
- Studying the role of oxidants in
multiple sites such as ovary,
peritoneal cavity and uterus
separately.
- Study the role of oxidants in other
types of infertility.
- Strategies to overcome OS in-vitro
conditions and balancing between
in vivo and in vitro environments
can be utilized in assisted
reproductive technique , to
successfully treat infertility.
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