title: Vitamin D and assisted reproduction: should vitamin D be routinely screened and repleted prior to ART? A systematic review.
abstract: OBJECTIVE
  To review the current literature regarding the role of vitamin D status in pregnancy outcomes in women undergoing assisted reproductive technology (ART) and to assess cost-effectiveness of routine vitamin D deficiency screening and repletion prior to initiation of ART.
  
  
  METHODS
  A systematic literature review was conducted using PubMed. Relevant study outcomes were compared among the selected studies. A cost-benefit analysis was performed using a decision tree mathematical model with sensitivity analyses from the perspective of direct societal cost. Published data were used to estimate probabilities and costs in 2014 US dollars.
  
  
  RESULTS
  Thirty-four articles were retrieved, of which eight met inclusion criteria. One study demonstrated a negative relationship between vitamin D status and ART outcomes, while two studies showed no association. The remaining five studies concluded that ART outcomes improved after vitamin D repletion.
  
  
  CONCLUSIONS
  The majority of reviewed studies reported a decrement in ART outcomes in patients with vitamin D deficiency. Cost-benefit analyses suggested that screening and supplementing vitamin D prior to ART might be cost effective, but further evidence is needed. Given the absence of Level I evidence regarding vitamin D status and ART outcomes, full endorsement of routine vitamin D screening and supplementation prior to ART is premature.
authors.affiliation: Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Pacis
authors.forename: Chelsea N
authors.initials: CN
authors.lastname: Fortin
authors.forename: Shvetha M
authors.initials: SM
authors.lastname: Zarek
authors.forename: Sunni L
authors.initials: SL
authors.lastname: Mumford
authors.forename: James H
authors.initials: JH
authors.lastname: Segars
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D012098:Reproduction / Q000187:drug effects; D027724:Reproductive Techniques, Assisted; D014807:Vitamin D / Q000008:administration & dosage* / Q000235:genetics; D014808:Vitamin D Deficiency / Q000175:diagnosis / Q000178:diet therapy* / Q000378:metabolism
chemical_list: D014807:Vitamin D