Micronutrient Deficiencies and Conception in Idiopathic Infertility: A Prospective Single-Centre Cohort Study
Micronutrient supplementation may enhance pregnancy rates in idiopathic infertility, but larger trials are needed to confirm these findings.
Where it sits
this study against the rest of the hcg (human chorionic gonadotropin) corpusSummary and findings
This study evaluated micronutrient deficiencies in 27 women with idiopathic infertility and the impact of individualized supplementation on pregnancy rates. Iron deficiency was most common, and supplementation led to significant improvements in lab values. A 74.1% clinical pregnancy rate was observed within 12 months.
Abstract
<title>Abstract</title> <p> <bold>STRUCTURED ABSTRACT</bold> <bold>Objective</bold> To determine the prevalence of micronutrient deficiencies in women with confirmed idiopathic infertility, document laboratory improvement following individualised supplementation, and assess the association between deficiency correction and clinical pregnancy rates over 6 to 12 months. <bold>Design</bold> Prospective, single-centre, interventional cohort study. <h4>Setting:</h4> primary care fertility clinic, Dubai, United Arab Emirates, September 2023 to December 2024. STROBE-compliant. <bold>Subjects</bold> Twenty-seven women aged 18 to 40 years with confirmed idiopathic infertility after full standard workup per WHO 2021 criteria. Excluded: polycystic ovary syndrome, endometriosis, thyroid dysfunction, uterine anomaly, male-factor infertility, recent supplementation. No dropouts. <bold>Exposure</bold> Individualised supplementation targeting identified deficiencies: oral or intravenous iron; cholecalciferol; methylfolate; hydroxocobalamin and cyanocobalamin; calcium carbonate; magnesium glycinate; zinc picolinate. Structured dietary counselling provided to all. <bold>Main Outcome Measures</bold> Primary: confirmed clinical pregnancy (serum beta-hCG 25 mIU/mL or greater on two measurements 48 hours apart, with transvaginal ultrasound confirmation). Secondary: laboratory normalisation, time to conception, subgroup conception rates by age, infertility duration, prior IVF attempts, and chronic disease status. <bold>Results</bold> All 27 participants had at least one deficiency. Iron deficiency was most prevalent (70.4%), followed by vitamin D (55.6%), folate (51.9%), calcium (48.1%), vitamin B12 (25.9%), magnesium (25.9%), and zinc (22.2%). All values improved significantly after supplementation (all p less than 0.001); ferritin rose from 12.3 to 56.2 ng/mL and 25-hydroxyvitamin D from 18.4 to 35.8 ng/mL. Twenty of 27 women (74.1%) achieved confirmed pregnancy within 12 months. On exploratory logistic regression, infertility duration (OR 1.35, 95% CI 1.05 to 1.78) and absence of chronic disease (OR 2.10, 95% CI 1.02 to 4.34) were independent predictors (AUC 0.78). Ten of 20 conceptions occurred without concurrent assisted reproductive technology. <bold>Conclusion</bold> Micronutrient deficiencies were near-universal and largely undetected in this cohort. Supplementation was associated with a 74.1% clinical pregnancy rate. These hypothesis-generating findings support routine nutritional screening in the idiopathic infertility workup, pending larger randomised trials with live-birth endpoints. </p>
Background
The study addresses the prevalence of micronutrient deficiencies in women with idiopathic infertility and their potential impact on conception rates. Previous research has suggested that micronutrient levels may influence fertility, but comprehensive data in idiopathic infertility cases are limited. This study aims to fill this gap by evaluating the effects of targeted supplementation on pregnancy outcomes.
Methods
This was a prospective, single-centre cohort study conducted at a primary care fertility clinic in Dubai, UAE, from September 2023 to December 2024. It included 27 women aged 18 to 40 with idiopathic infertility, excluding those with conditions like PCOS or recent supplementation. Individualized supplementation was provided based on identified deficiencies, and primary outcomes included clinical pregnancy rates confirmed by serum beta-hCG and ultrasound.
Results
All participants had at least one micronutrient deficiency, with iron deficiency being the most prevalent at 70.4%. Post-supplementation, significant improvements in laboratory values were observed, such as ferritin levels rising from 12.3 to 56.2 ng/mL. Within 12 months, 74.1% of participants achieved confirmed pregnancy. Logistic regression identified infertility duration and absence of chronic disease as independent predictors of conception.
Interpretation
The study suggests that addressing micronutrient deficiencies may improve pregnancy rates in women with idiopathic infertility. However, the small sample size and lack of a control group limit the generalizability of these findings. While the results are statistically significant, the clinical significance requires further investigation in larger, randomized trials with live-birth endpoints.
Key findings
- Iron deficiency prevalence was 70.4%.
- Vitamin D deficiency prevalence was 55.6%.
- Folate deficiency prevalence was 51.9%.
- 74.1% of participants achieved confirmed pregnancy within 12 months.
- Ferritin levels increased from 12.3 to 56.2 ng/mL post-supplementation.
Limitations
- small n=27
- single-centre study
- no control group
- short follow-up of 12 months
- hypothesis-generating findings