ISSN: 2047-2919 ANDROLOGY

ORIGINAL ARTICLE

Correspondence:
Azam Kouhkan and Abdolhossein Shahverdi, Association of vitamin D status with
Department of Embryology, Reproductive
Biomedicine Research Center, Royan Institute for semen quality and reproductive
Reproductive Biomedicine, ACECR, Tehran, Iran.
E-mails: akouhkan@royaninstitute.org and hormones in Iranian subfertile men
shahverdi@royaninstitute.org

1
Keywords: Sh. Abbasihormozi, 1A. Kouhkan, 2A.R. Alizadeh, 1A.H. Shahverdi,
hormone profile, male infertility, semen quality, 3
M.H. Nasr-Esfahani, 4,5M.A. Sadighi Gilani, 4R. Salman Yazdi,
vitamin D status 1
A. Matinibehzad and 6Z. Zolfaghari
Received: 11-Jan-2016 1
Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for
Revised: 23-Jul-2016 Reproductive Biomedicine, ACECR, Tehran, Iran, 2Department of Animal Science, Saveh Branch,
Accepted: 28-Jul-2016 Islamic Azad University, Saveh, Iran, 3Department of Reproductive Biotechnology, Reproductive
Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran, 4Department
of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive
doi: 10.1111/andr.12280
Biomedicine, ACECR, Tehran, Iran, 5Department of Urology, School of Medicine, Tehran University
of Medical Sciences, Tehran, Iran, and 6Department of Endocrinology and Female Infertility,
Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR,
Tehran, Iran [Correction added on December 5th, 2016 after online publication: Author affiliations
and names have been corrected.]

SUMMARY
Although vitamin D deficiency is one of the most common health problems throughout the world, including Iran, conflicting infor-
mation exists on the potential association between serum vitamin D levels and semen quality. This study intended to evaluate the
association between serum vitamin D [25(OH) D3] with semen quality and hormones in Iranian subfertile men. We also compared
mean vitamin D and hormone levels in normospermic men with oligoasthenoteratozoospermia (OAT) men. This cross-sectional
study was conducted on 278 men who were referred to Royan Infertility Clinic (Tehran, Iran) from March to September 2014. The
participants were categorized into two groups; of 186 normospermic and 92 OAT patients according to World Health Organization
2010 criteria. Each participant provided informed consent prior to launching research. Participants completed two general question-
naires of nutritional status. Blood and semen samples were obtained for assessment, and all data were adjusted for age, body mass
index (BMI), and season. Vitamin D levels were classified according to Institute of Medicine guidelines. Vitamin D deficiency, insuffi-
ciency, and normal levels were observed in 8.6%, 43.6%, 47.8% of participants, respectively. No association was found between daily
dietary intake of vitamin D and calcium with sperm parameters. Serum vitamin D was inversely correlated with PTH (p < 0.045). In
normospermic men, serum vitamin D levels categorized were not correlated with semen parameters and reproductive hormones
(FSH, LH, testosterone(T), and FT), whereas sperm motility showed a positive correlation with vitamin D categorized in OAT men
(rs = 0.131, p = 0.028). In conclusion, there was a high incidence of deficiency and insufficiency 25(OH) D Levels (<20ng/ml)
observed in Iranian men (52.2%). Moreover, our findings showed a correlation between vitamin D levels and sperm motility in OAT
men, which requires further studies.

INTRODUCTION 30% and 93% in the tropical countries (Hosseinpanah et al.,

Vitamin D level differs among various populations and is
attributed to the differences in exposure to sunlight, season,
style of clothing, skin pigmentation, geographic latitude, daily
dietary vitamin D intake, obesity, and air pollution (Hossein-
panah et al., 2010; LeFevre, 2015; Overton et al., 2015). Vitamin
D deficiency is considered a major public health problem in
both developing and developed countries. This is a widespread
health problem in tropical countries of the Persian Gulf region
(Iran, Bahrain, and Saudi Arabia) because of industrialization,
lifestyle, and nutritional changes (Fields et al., 2011). The preva-
lence of serum vitamin D deficiency (≤20 ng/mL) varies between
2010; Holick et al., 2011).
Recently, controversies on vitamin D metabolism reflect a
challenging worldwide research topic. Vitamin D is obtained
through dietary intake and synthesized in the derma by ultravio-
let B radiation (UV-B) from sun exposure. The endogenous form
of vitamin D (cholecalciferol or D3) is biologically inactive. UV-B
radiation converts 7-dehydroxycholesterol to cholecalciferol D3
in the skin. The activation occurs by two hydroxylation steps in
the liver and kidneys. The metabolites in these steps are known
as 25(OH) D3 and 1,25(OH)D3, respectively. Dietary forms of
vitamin D consist of D2 (ergocalciferol) and D3. D2 is

© 2016 American Society of Andrology and European Academy of Andrology Andrology, 2017, 5, 113–118 113
S. Abbasihormozi et al.
synthesized by fungi and yeast following UV exposure (Blomberg
Jensen, et al., 2014).
Vitamin D deficiency is linked to various adverse events
including hypertension, cardiovascular disease, stroke, diabetes,
and cancer (Chowdhury et al., 2014). However, the role of vita-
min D on the male reproductive system is still debated. The
presence of a vitamin D receptor (VDR) in several parts of the
male system is likely related to various functions of the human
reproductive axis (Blomberg Jensen, 2014). VDR and metaboliz-
ing enzymes are expressed in human spermatozoa (Nangia
et al., 2007; Aquila et al., 2009; Blomberg Jensen et al., 2010;
Blomberg Jensen & Dissing, 2012). Therefore, it seems that vita-
min D has a direct effect on semen quality. On the other hand,
evidence indicates that vitamin D deficiency may alter reproduc-
tive function indirectly through a calcium-dependent Mechan-
ism (Blomberg Jensen & Dissing, 2012). Hammoud et al., (2012)
reported an association between low or high vitamin D levels
and semen parameters. Most reports consisted of cross-sectional
studies in healthy men and the general population with discor-
dant results (Blomberg Jensen et al., 2011; Ramlau-Hansen
et al., 2011; Hammoud et al., 2012). Recent studies reported a
relationship between vitamin D and poor semen quality in infer-
tile men (Yang et al., 2012; Tak et al., 2015). In addition, an asso-
ciation between vitamin D and serum androgen has been
reported (Wehr et al., 2010). However, the issue of whether vita-
min D statuses contribute to male reproductive biology has not
been resolved.
In the present investigation, we attempted to elucidate the
relationship between serum vitamin D levels with reproductive
hormones and semen quality in Iranian subfertile men. We also
compared these factors between normospermic and OAT subfer-
tile men who referred to Royan Institute Infertility Clinics.
Another objective was to determine the incidence of vitamin D
deficiency in these subjects.
MATERIALS AND METHODS
Study population and nutritional evaluations
We conducted this cross-sectional study from March to Sep-
tember 2014 on 278 subfertile men (range: 20–50 years) who
attended Royan Institute Infertility Center, a referral infertility
clinic in Tehran, Iran. Each participant provided informed con-
sent for their engagement. In order to ascertain different param-
eters that might contribute to control of vitamin D status, two
questionnaires were designed. The general questionnaire con-
sisted of demographic data, medical and drug histories, smoking
status, alcohol intake, sunlight exposure, sunscreen use, and
infertility history. Exclusion criteria encompassed of the pres-
ence of urogenital infections, systematic and chronic diseases
(e.g. renal and liver disease, type 2 diabetes), osteometabolic dis-
orders, malignancy, malabsorption and intake of supplements,
as well as vitamin intake. The second questionnaire, the Food
Frequency Questionnaire (FFQ) (Mirmiran et al., 2010), asked
questions about nutritional status.
Semen collection and analysis
Semen analysis was examined after 2–5 days of sexual absti-
nence based on World Health Organization (WHO) (2010).
Semen volume was measured with conical graduated tubes. We
used the CASA system [SPERM CLASS ANALYZER software (SCATM,
114 Andrology, 2017, 5, 113–118
ANDROLOGY
Microptic, Version 4.2, Barcelona, Spain)] to assess sperm
motility and concentration. This system consisted of a phase
contrast microscope (NikonTM Eclipse E-200, Tokyo, Japan) with
a heat plate. The images were captured with a video camera
(Basler Vision TecnologieTM A312FC, Ahrensburg, Germany) at
50 fps and 1009 magnification. The Makler chamber was used
for motility scoring. In this study, we only assessed progressive
and overall motilities. We divided the 278 subjects into two
groups based on the WHO criteria. There were 186 normosper-
mic men (motility: >40%, morphology: >4%, concentration: > 15
million/mL) and 92 astheno-, oligo-, and teratospermic (OAT)
men (Jorgensen et al., 2006) in the two groups.
Blood sampling and analysis methods
Fasting venous blood samples were obtained between 8:00
and 10:00 AM. Serum samples were separated by centrifugation
at 3000 g for 15 min, and stored at 20 °C until the time of anal-
ysis. Serum levels of vitamin D, parathyroid hormone (PTH),
testosterone, luteinizing hormone (LH), and follicle-stimulating
hormone (FSH), were measured using Electro-chemilumines-
cence immunoassay (ECLIA) kits (manufactured by Roche Diag-
nostics GmbH, Mannheim, Germany) on Elecsys 2010
immunoassay analyzer. Intra-assay and inter-assay CV for vita-
min D, PTH, testosterone, LH, and FSH, were 7.8% and 10.7%,
2.0% and 6.5%, 4.7% and 8.4%, 2.0% and 5.3%, 1.8% and 5.2%,
respectively.
Serum-free testosterone level was determined by a commer-
cial ELISA kit (AccuBind ELISA Microwells, Monobina Inc., Lake
Forest, CA, USA). Intra-assay and inter-assay CV for free testos-
terone was 4.8% and 9.9%, respectively. Serum calcium levels
were measured using colorimetric method (Calcium Arsenazo,
Biorexfars Co., Tehran, Iran). Vitamin D levels were classified
according to Institute of Medicine (IOM) (Scientific IoMUSCot,
1997; Rosen et al., 2012) guidelines into four levels as follows:
deficiency, insufficiency, and normal levels based on 25(OH)
D < 10 ng/mL, 10 ng/mL ≤25(OH) D ≤ 20 ng/mL, 25(OH)
D > 20 ng/mL, respectively.
Statistical analysis
Quantitative variables were presented as Mean  SD and med-
ian for sperm concentration. Qualitative variables were presented
as percentages. PASW GRADPACK 22.0 (SPSS Inc., Chicago, IL, USA)
was used for statistical analysis. The Kolmogorov–Smirnov test
was used for normality. Comparisons between groups were made
using the t-test, one-way ANOVA, or the Kruskal–Wallis H suitable.
Pearson correlation analysis was conducted to analyze the corre-
lations between different parameters. Backwards multiple linear
regression was used to adjust for relevant confounders (include
criteria a = 0.05) after correlations were found between variables.
RESULTS
Patients’ characteristics
A total of 278 men participated in this study; 186 and 92 were
categorized into normospermic and OAT groups, respectively.
Participants’ average age was 33.5  4.8 years. The mean body
mass index (BMI) was 26.9  0.5 kg/m2. Their mean serum vita-
min D concentration was 20.43  0.56 ng/mL (range: 5–68 ng/
mL). No associations were detected between daily dietary intake
of vitamin D and calcium with sperm parameters in OAT and
© 2016 American Society of Andrology and European Academy of Andrology
VITAMIN D STATUS AND SEMEN QUALITY ANDROLOGY
normospermic men (p > 0.05). None of the participants took Table 3 Characteristics of subjects’ hormone parameters according to
vitamin D supplements. Daily sun exposure and sunscreen use stratification of serum vitamin D levels (mean  SE) are adjusted in compli-
ance with age, season, and body mass index (BMI)
did not differ between both groups. Vitamin D deficiency, insuf-
ficiency, and normal levels were observed in 8.6%, 43.6%, and Variable 25(OH)D concentration p-value
47.8% of participants, respectively.
<10 ng/mL 10–20 ng/mL >20 ng/mL
Table 1 shows the characteristics of normospermic and OAT
n = 24 n = 121 n = 133
subjects. FSH, LH, and T levels showed significant differences
between normospermic and OAT men. However, no significant FSH (U/L) 3.600  0.69 3.54  0.29 3.33  0.18 0.806
LH (U/L) 2.90  0.35 2.59  0.15 2.42  0.10 0.322
differences existed in total vitamin D, calcium, and PTH levels
T (nmol/L) 4.42  0.41 5.22  0.21 5.35  0.25 0.288
between the two groups. FT (nmol/L) 12.60  0.61 12.63  0.73 12.09  0.63 0.846
The characteristics of sperm parameters in the total popula- PTH (pg/mL) 38.34  3.24 41.75  1.65 37.21  1.27 0.087
tion categorized by vitamin D are illustrated in Table 2. Vitamin 25OHD (ng/mL) 7.51  0.27c 14.71  0.24b 27.95  0.69a 0.00*
Calcium (mmol/L) 10.22  0.329 9.88  0.08 9.82  0.04 0.104
D status did not significantly affect the semen parameters.
The mean concentrations of hormone parameters, calcium, FSH, follicle-stimulating hormone; LH, luteinizing hormone; T, testosterone; FT,
and PTH of the total population according to vitamin D levels free testosterone; PTH, parathyroid hormone. a,b,c values with differing letters
within the same rows are significantly different.
are shown in Table 3. We have observed no significant differ-
ences in hormone parameters and calcium levels in men with
different levels of vitamin D except for PTH levels. shown in Table 5, sperm motility (rs = 0.13, p < 0.05) and cal-
No significant differences existed in semen quality and hor- cium (rs = 0.15, p < 0.05) positively correlated with vitamin D in
mone parameters between OAT and normospermic men strati- OAT men.
fied according to vitamin D levels (Table 4).
Vitamin D levels showed no correlation with sperm parame- DISCUSSION
ters and hormone profiles in normospermic men. However, as Vitamin D is a steroid hormone that has a well-established
function in calcium hemostasis and bone health. Clinically, vita-
Table 1 Characteristics of normospermic and oligoasthenoteratozoospermia
min D status is indicated by measuring the serum concentration
(OAT) men adjusted for age, season, and body mass index (BMI) (mean  SE)
and median for sperm concentration) of vitamin D which is associated with serum calcium, phospho-
rus, and PTH. Serum vitamin D reflects both dermal production
Characteristics Normospermic men OAT men p-value and dietary intake of vitamin D in the body (Blomberg Jensen,
N 186 92 2014). In recent decades, pandemic vitamin D deficiency reports
Age 33.69  0.60 33.63  0.60 0.33 have extended the spectrum of extra-skeletal research on vitamin
BMI 27.02  0.62 26.49  0.57 0.84 D and a recent area of interest is male reproductive function.
Sperm concentration 77.79  3.94 38.68  5.83 0.00
In this study, there was a noticeable prevalence of vitamin D
(M/mL)
Sperm motility (%) 81.90  1.15 37.26  1.53 0.00 deficiency and insufficiency (52.2%). We did not observe any
Morphologically normal (%) 10.26  0.52 1.65  0.19 0.00 associations among serum vitamin D levels, semen quality, and
Progressive motile 57.33  3.31 44.52  1.52 0.52 reproductive hormones in the total population. However, vita-
spermatozoa (%)
FSH (U/L) 3.25  0.16 4.61  0.73 0.00
min D levels had positive correlations with sperm motility in the
LH (U/L) 2.45  0.09 2.76  0.27 0.02 OAT group.
TT (nmol/L) 4.97  0.15 5.89  0.42 0.00 Previous investigations reported a prevalence of vitamin D
FT (nmol/L) 11.90  0.49 13.59  1.05 0.09
deficiency among women who underwent assisted reproductive
PTH (pg/mL) 38.50  1.12 41.82  2.01 0.90
Total vitamin D (ng/mL) 20.49  0.64 20.22  1.20 0.32 technology (ART) procedures that ranged between 21% and 99%
Calcium (mmol/L) 9.84  0.05 9.89  0.09 0.80 (Anifandis et al., 2010; Ozkan et al., 2010; Rudick et al., 2012,
2014). A study in Iran revealed the highest frequency of vitamin
FSH, follicle-stimulating hormone; LH, luteinizing hormone; T, testosterone; FT,
free testosterone; PTH, parathyroid hormone. D deficiency among women candidates for IVF (Aleyasin et al.,
2011; Firouzabadi et al., 2014).
Previously, four cross-sectional studies in healthy men
Table 2 Characteristics of subjects’ semen quality according to serum vita-
min D stratifications (mean  SE) and median for sperm concentration. The reported a vitamin D deficiency prevalence from 12.4% to 48.6%
numbers are adjusted in compliance with age, season, and body mass index (Tak et al., 2015). Our data showed vitamin D deficiency and
(BMI) insufficiency levels in subfertile men. Similarly, Rahnavard
reported that 69% of 2396 Iranian healthy men in a study
Variables 25(OH)D concentration p-value
suffered from vitamin D deficiency (Rahnavard et al., 2010).
<10 ng/mL 10–20 ng/mL >20 ng/mL The effect of vitamin D on maintaining calcium homeostasis
n = 24 n = 121 n = 133 and promoting bone mineralization is well-known (Uhland
Semen 2.15  0.17 2.11  0.10 2.36  0.11 0.248 et al., 1992). Recently, increasing evidence points to a crucial
volume (mL) role for vitamin D in different tissues and organs, particularly
Sperm concentration 79.91  16.9 62.89  5.76 75.31  5.70 0.254 those in reproductive function and spermatogenesis in men.
(M/mL)
Sperm motility (%) 71.50  4.77 69.90  2.38 75.68  2.19 0.192
However, the specific mechanisms by which vitamin D influ-
Morphologically 6.29  1.44 9.36  0.9 7.64  0.64 0.139 ences male reproduction remain obscure (Cornwall, 2009). Opti-
normal (%) mal sperm function may thus depend on a direct effect of
Progressive motile 54.55  5.75 52.69  2.42 52.97  2.18 0.953
vitamin D. However, it may also be influenced indirectly through
spermatozoa (%)
calcium homeostasis as impaired fertility in animal models was

© 2016 American Society of Andrology and European Academy of Andrology Andrology, 2017, 5, 113–118 115
S. Abbasihormozi et al. ANDROLOGY
Table 4 Comparison of semen quality and hormone parameters stratified according to vitamin D levels between normospermic and oligoasthenoterato-
zoospermia (OAT)

Variables 25(OH)D concentration (ng/mL) p-value

<10 10–20 >20

OAT men Normospermic men OAT men Normospermic men OAT men Normospermic men
n=6 n = 18 n = 24 n = 97 n = 27 n = 106

Semen 2.6  0.53 2.02  0.29 1.97  0.24 2.13  0.12 2.11  0.23 2.42  0.11 0.41
volume (mL)
Sperm concentration 28.11  26.15 97.18  15.10 39.29  13.08 68.60  6.64 34.66  12.29 85.67  6.20 0.37
(M/ml)
Sperm motility (%) 40.00  7.43 82.00  4.29 35.62  3.71 78.19  1.85 38.55  3.48 85.14  1.76 0.74
Morphologically 1.16  3.23 8.00  1.86 1.91  1.61 11.31  0.80 1.40  1.51 9.22  0.76 0.74
normal (%)
Progressive motile 31.19  11.33 61.42  6.14 47.55  5.17 53.69  2.61 41.85  4.96 55.72  2.47 0.2
spermatozoa (%)
Total number 1124.46  24.97 8447.93  1441.90 1380.07  1248.72 6109.97  634.35 1352.57  1177.30 7818.35  597.18 0.57
of motile
spermatozoa (n)
FSH 4.25  1.12 3.37  0.66 4.76  0.57 3.19  0.28 3.41  0.55 3.31  0.27 0.25
LH 3.05  0.61 2.85  0.36 2.80  0.31 2.50  0.15 2.46  0.30 2.41  0.15 0.87
T 5.38  1.05 4.08  0.62 6.00  0.54 5.03  0.26 6.08  0.49 5.15  0.26 0.96
FT 14.11  3.06 12.07  1.82 15.02  1.56 12.01  0.77 12.59  1.49 11.96  0.75 0.61
PTH (pg/mL) 45.30  6.66 36.017  3.84 43.18  3.33 41.44  1.67 39.82  3.16 36.54  1.59 0.68
Calcium (mmol/L) 9.66  0.31 10.44  0.21 9.91  0.17 9.87  0.08 9.80  0.15 9.82  0.08 0.15

FSH, follicle-stimulating hormone; LH, luteinizing hormone; T, testosterone; FT,free testosterone; PTH, parathyroid hormone.

Table 5 Correlations among semen quality, hormone, and vitamin D levels in oligoasthenoteratozoospermia (OAT)

Variable Count Motility Morph Volume Progressive FSH LH T FT Ca PTH Vit D

Count 1 0.38* 0.92 0.94 0.08* 0.03 0.06 0.023 0.11 0.03 0.01 0.04
Motility 1 1.00 0.54 0.19 0.02 0.05 0.07 0.14* 0.00 0.05 0.13*
Morphology 1 0.45 0.80 0.06 0.021 0.01 0.11 0.02 0.13 0.06
Volume 1 0.73 0.01 0.08 0.07 0.03 0.05 0.12 0.04
Progressive 1 0.03 0.01 0.03 0.03 0.17* 0.11 0.02
FSH 1 0.31* 0.01 0.03 0.06 0.01 0.05
LH 1 0.18* 0.06 0.25* 0.04 0.07
T 1 0.43* 0.15* 0.13* 0.88
FT 1 0.05 0.06 0.02
Ca 1 0.13* 0.15*
PTH 1 0.11
Vit D 1

*p-value <0.05. FSH, follicle-stimulating hormone; LH, luteinizing hormone; T, testosterone; FT,free testosterone; PTH, parathyroid hormone.

partly restored solely after normalization of serum calcium levels
(Kidroni et al., 1983; Uhland et al., 1992; Menegaz et al., 2009).
Based on the results obtained, 20% of young men had sperm
levels below the recommended WHO levels and 40% presented
with sperm concentrations below a level considered optimal for
fertility. We did not observe any correlation between vitamin D
levels and semen quality in total subjects. However, after divid-
ing the patients into normozoospermic and OAT groups, we
observed a significant relation between sperm motility, calcium,
and vitamin D levels in the OAT group.
In vitro studies showed the positive impact of vitamin D on
human spermatozoa (Blomberg Jensen et al., 2011; Yang et al.,
2012). Although the most recent cross-sectional investigations
reported an association of serum vitamin D levels and semen
parameters in young fertile healthy men, the results were discor-
dant with other researchers (Blomberg Jensen et al., 2011; Ham-
moud et al., 2012; Yang et al., 2012). A study revealed that no
significant association between vitamin D levels and sperm
motility (Ramlau-Hansen et al., 2011), whereas others observed
a negative association with both low and high levels of vitamin D
to sperm parameters in young healthy men (Hammoud et al.,
2012). In accordance with our results, a recent cross-sectional
study reported a positive association between vitamin D levels
and sperm motility (Yang et al., 2012). We did not observe
any correlation between high levels of vitamin D and semen
quality because only few subjects had high vitamin D levels,
similarly, some researchers reported no association with total
sperm count and sperm concentration (Blomberg Jensen et al.,
2011; Ramlau-Hansen et al., 2011; Blomberg Jensen & Dissing,
2012).
The role of vitamin D in sex hormone production is unclear.
Some studies have shown a positive association between serum
vitamin D levels and total T (Wehr et al., 2010; Lee et al., 2012).
Researchers observed a weak link among sex hormones, vitamin
D, and Phosphorus in men and reported no associations among
men with vitamin D levels above the median (Wulaningsih et al.,
2014). In agreement with other studies, we found no correlation
between vitamin D and reproductive hormones (Blomberg Jen-
sen et al., 2011; Bjerrum et al., 2011). It seems that the effect of
low vitamin D levels on sperm parameters might not be

116 Andrology, 2017, 5, 113–118 © 2016 American Society of Andrology and European Academy of Andrology
VITAMIN D STATUS AND SEMEN QUALITY
mediated by the hypothalamic–pituitary–gonadal axis. Our data
showed no associations between daily dietary intake of vitamin
D and calcium with sperm parameters in total subjects, or in
OAT and normospermic men. Accordingly, daily sun exposure
and sunscreen usage were similar in both groups. Some studies
indicated that vitamin D levels depended mainly on sunlight
exposure and showed seasonal variation was reported (Tak
et al., 2015). A positive correlation between T and FT levels with
serum vitamin D levels in relation to seasonal variation was
reported (Tak et al., 2015). In this study, we collected data during
the Spring and Summer. Additionally, we adjusted our results for
several confounding factors – age, season, and BMI. Our results
showed no differences prior and post-adjustments for season. As
expected, there were significant differences in reproductive
hormones (FSH, LH, and T) between normospermic and OAT
subfertile men, and agreed with previous studies (Babu et al.,
2004; Yang et al., 2012).
Serum PTH is suspected to be a prominent factor for regula-
tion of vitamin D (Glerup et al., 2000). Significant association
has been found between PTH and vitamin D classifications. For-
mer study showed that the PTH level was higher in those sub-
jects who had low vitamin D levels (Ogard et al., 2005). Calcium
is essential for male reproductive functions that include hyper-
activation, acrosomal reaction, spermatogenesis, and sperm
motility. Vitamin D regulates calcium levels through the VDR
(Benoff et al., 1994; Rahman et al., 2014). Researchers reported
that VDR and vitamin D-metabolizing enzymes were expressed
in elongated and round spermatids in humans (Blomberg Jensen
et al., 2010). Therefore, it was suggested that vitamin D defi-
ciency and insufficiency affect sperm motility (Blomberg Jensen
et al., 2011). Our data in OAT men have supported a unique role
of vitamin D in sperm motility. The impaired reproductive func-
tion induced by vitamin D deficiency is adjustable and change-
able for the body, and influenced mainly by calcium
homeostasis. It seems that impaired reproductive function can
be corrected by vitamin D and calcium supplements, and
fortification.
No consensus exists on the optimal concentration of vita-
min D in the reproductive system and other organs. Causal
role of vitamin D deficiency as a marker of poor reproductive
health or the underlying etiological problems is unclear (Lee
et al., 2012) and future studies may provide new insights into
the complex pathogenesis and treatment of infertility by
vitamin D.
CONCLUSION
Vitamin D deficiency probably has a direct effect on sperm
motility in AOT men. Whether vitamin D levels may be associ-
ated with altered male infertility remains controversial and is
not documented. This theory can be supported by randomized
clinical trials and vitamin D supplement therapy in infertile men
with low motility. The prevalence of low vitamin D levels among
Iranian men is considerable, considering Iranian lifestyle and
geographical zones.
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