Friday, January 28, 2011

A fact and speculation filled science post

On Vitamin D supplementation : how much is enough?

Two weeks after my missed miscarriage discovery and subsequent D&C, almost by accident and as a decided afterthought, I ordered a vitamin D test on myself.

Much to my surprise, I was deficient---anything less than 20 ng/ml is considered 'deficient', while if your blood levels are below 10 ng/ml then you are reaa-aahllly in trouble. I know people who have had bouts of frozen shoulder and some other not-so-nice musculo-skeletal issues when in this state.

25(OH)D Blood test results
Vitamin D Status
ng/ml nmol/L
Severely Deficient 0-10 0-25
Deficient 11-20 26-50
Low-normal 21-32 51-81
Normal 33-49 82-124
Optimum 50-65 125-163
High, but not toxic 66-100 164-250
Toxicity possible above 100 above 250
Since then I've been on massive supplementation- 60,000 IU/week first for 2 weeks. Then I checked blood levels, and they had shot up to an impressive 70 ng/ml.  I then dropped my dose to 4000 IU/day for the next month. This is 10 times the recommended daily doseOne month later, I checked vitamin D levels again, and I'm only at 35 ng/ml.  The lab report states that to be considered in the healthy state, you need to be above 32 ng/ml, with the range being 32-100.

Its shocking to me, that despite having taken so much Vitamin D --a grand total of  over 200,000 IU in about 5 weeks, over 15 times the daily recommended dose, I'm JUST over the threshold for being sufficient and am still on the low end of the normal spectrum!

On Vitamin D and estrogen

It is my theory that my first pregnancy probably sucked up quite a bit of my vitamin D reserve. Interestingly, in the cycles following the end of my first pregnancy, I noticed something new and alarming.

I use the ClearBlue easy fertility monitor, that examines two hormones, estrogen and luetinizing hormone(LH).  My usual pattern was that I had 3-5 days of 'high' fertility(= high estrogen) before going on to 'peak' fertility(= high estrogen accompanied by a LH surge).  The alarming part was that in the two cycles following the end of my first pregnancy,  my days of high fertility had dropped off sharply, from 3-5 days to a stingy one day.  This did not seem good; high estrogen before you surge is pretty important for optimum egg maturation, a good lining, etc. Usually, you could set your clock on the happenings in my reproductive system, they are that spookily similar from cycle to cycle, so any change, especially one so drastic was jaw-droppingly strange.

I'm in a new cycle now. I'm on CD14, putting me 6 days away from ovulation. I used the fertility monitor this morning- I'm already on 'high fertility ie my estrogen is already high. If I ovulate on the 20 day as usual, that would give me 6 days of high estrogen at least!

Has there been any big change in my physiology ? The only think I can think of is the drastic change in my vitamin D levels. I have no concrete thing linking the two. I did my usual literature search and I could fine one study suggesting that vitamin D is involved in estrogen biosynthesis, atleast in mice.

I have no idea if vitamin D deficiency can effect estrogen production-all I have to go on is that when my vitamin D levels possibly fell a little, my days of high estrogen decreased. When I increased my vitamin D blood levels, coincidentally my estrogen production has seemingly increased. Sure as hell not enough to make any sort of case about anything, but documenting it here cannot hurt.

Unlike this speculation about vitamin D and estrogen, one thing seems fairly certain though-  vitamin D could be involved in implantation. I've talked about it my 'Science of infertility' section and yesterday my RE just showed me another study backing this theory up. Everybody having issues in this department, or even suffering from general, unexplained infertility- please get this checked out. If your insurance does not cover it, it would be worth getting it tested out of pocket.


  1. I really appreciate all the science and research you post. This post, in particular is interesting to me, since my RE recommended Vitamin D supplementation for me after testing my levels. I haven't had them re-tested--I don't really have access to that, but I'm really interested to read all the good effects it should have on my ability to stay pregnant next time around. Thanks!

  2. Interesting. I'll be getting my D tested with my next thyroid test. I'd be pretty shocked to find I'm deficient because I've been taking 4000IU-6000IU daily for about a year and a half, and I live in the desert and play outside a lot. 20 minutes of short-sleeves sun exposure *supposedly* give you 15-20k IU of Vitamin D.

    I know I have low estrogen, and I suspect I have low LH. I've never had it tested, but I never get positive OPKs, even though I know I ovulate. My positive OPKs (proven by charting) are never quite as dark as the control line, and to be positive they're supposed to be as dark or darker. I've never had one. I've done some preliminary googling, but it seems in most cases, low AMH/high FSH/low estrogen correlates to high LH, since it functions somewhat like LH. I haven't had my FSH tested either, only AMH; but my thyroid testing makes me think my pituitary gland is just asleep at the wheel - TSH is normal, but T3 and T4 are low. My LH is low, if the OPKs are to be believed. So I imagine my FSH, if tested, would be normal or even low, because my pituitary gland doesn't do jack. Which makes me pretty scared for what that means about my endocrine system as a whole, my ability to ever carry a pregnancy to term, and if I did, and I had a girl, would I just be cursing her with the same? (Chimp studies say epigenetic link)

    Yeah, you're welcome for the novel. I Just find all of this so crazy and fascinating and I wish we had an answer for correlation/causation question.

  3. My D has consistently been low 30's, so "acceptable" but I worked indoors at the time.

    I have since moved to a different city and am outdoors a lot more, and for a long time - a least few hours - at the beach at least once a week. Do you know how the natural vitamin D from sunshine translates into your levels? ie. How MUCH sun moves the levels up?

    I'd like of course, to be at least the 1/2 way mark between 33-65 recommended level. I like your 'scientific' approach to these subjects, I'm always learning from you!

  4. I know you've mentioned vit D quite a bit lately, but I think you've just convinced me to ask for a test. I also seemed to have more fertile days preceding ovulation before my miscarriage. This cycle was particularly puzzling - I had a 18mm follicle on cd11 and my lining was 10.5. Numbers like that would generally lead me to believe that I will ovulate within 48 hours. However, my E2 was still low enough to lead my RE to believe that I should hold off on triggering until cd 12, with IUI on cd14. Sure enough, I had a negative OPK on cd 11, suggesting that my natural lh surge hadn't started and that I was "safe" but on cd 13 my bbt was up 0.5 of a degree and has been constant since then. I can't prove it, but I think I may have ovulated on CD12, well before IUI. If this is the case, my E2 levels were likely really suboptimal when I did ovulate and my lh surge was also likely shortened. I had never thought to link any of this to vit D or to the m/c however...interesting food for thought.

  5. I too am fascinated by Vit D and fertility. I'm happy to report after 8 weeks of taking 50,000 IUs weekly and 1,000 IUs daily my level went up to 48.5

    I'm a hoping and praying that this will have a positive impact on my current IVF cycle's implantation and in the development of the two embryos (I hope are still) currently hanging out in my ute.

    Vitamin D levels are linked to cell division - making it important in combating cancer. I imagine that if you have a creature who is dividing and creating itself inside you that having sufficient Vit D would make an impact, too!

    Thanks for keeping this important topic alive!

  6. Its so bloody confusing is'nt it? First, to confirm that you truely have a LH issue, I'd probably check the day 3 LH: FSH ratio. Women with PCOS can have ok FSH, high LH. You might be approaching the same issue (high LH) by a completely different route. Nonetheless, its my feeling that a high LH is the start is problematic because it can cause premature release of the egg (documented as an issue in PCOS), and I don;t know if it also prevents you from have a true surge.

    Given that you take so much vitamin D3, its not likely that your deficinet. But still, I was deficient even though I was drinking tons of dairy and consuming nearly 2000 IU on a daily basis.

  7. I'm not PCOS, I'm DOR. The anti-PCOS.

  8. I remember that you are DOR ..that is why I said you might have the same issue as women with Pcos (high LH) except that you might be developing this by a completely different mechanism.

    2 completely opposite issues, same end result resulting in compromised egg quality... That is what I was getting at

    It might be useful to get that day3 workup done... Always best to have the complete baseline picture IMO. It took me 2 pregnancies and 2 losses just to finally get an AMH test done.. Wish I'd done it at the getgo.

  9. Hi Jay. Interesting chart re normal ranges (they differ from our lab but mainly in terms of breaking down into "normal/optimal" etc). We use nmol/L here and the range reported as "optimal for bone health" is a broad 50-150. My levels came in at 93nmol/L, so I am in the normal...but perhaps not optimal range?
    We don't have the lower preparations available here on prescription (only have 50,000IU tabs), so I may just go with 400IU daily from OTC supplements. Its hard to know, I'm still tempted to go with 50K per week. No question in my mind that vit D has a role in fertility, no question that my problem is one of egg quality or implantation failure, but too much of a good thing may cause problems of it's own. It's good to see that levels under 250nmol/L are not considered toxic...lots of room to move!

    PS.I also got paranoid and checked my anti-cardiolipin antibodies (just in case)...they were very low. Felt a little neurotic getting back totally normal blood work but it gave me some peace of mind! I am now looking into every lifestyle factor I can research that may help maximise my egg quality prior to IVF in May.

  10. How much sun exposure is needed to get your levels up is a tough one- depends on many factors.
    This is a link that discusses it in detail

    If you are seriously trying to get your levels up though, I'd suggest supplements because it might be hard to spend too much time in the sun, with enough of your body exposed. Get on atleast a 2000 or 4000 IU day dosage and do a blood test. I was really shocked at how little my levels have risen, even after taking so much. But each person is different in this regard, I'd think.

    The other question I had was: when did you get your vitamin D3 levels tested? Before, during or after a pregnancy? I've never tested this but logically I'd assume that a pregnancy would deplete some of your vitamin D stores, so if you are low 30s before you got pregnant, its possible you went even lower as the pregnancy progressed.

  11. 400 IU is a really puny dose- maybe you can just take more pills a day?

    Another option is taking the large doses in parts- In India I'd get sachets of 60000 IU which drove me nuts...I'd have one sachet slowly over a weeks time. Maybe take a prescription dose of 50000 IU over a period of 2 weeks? You can always get a pill cutter!

    This is what I take over here... I like this brand.

  12. Yes, the OTC tabs only have 200IU in them, very puny! Maybe I'll just go with my initial thought and take the 50K tab once per month (std maintenance dose here). My only hesitation is that my calcium and phosphate are top of the normal range...still, the risk of hypercalcaemia is probably not high at this dose (with normal renal fxn). This would basically give me very decent levels of vit D in the 3 months leading up to IVF and therefore during the entire egg maturation cycle...Thanks Jay!! For your help with my musings :)

    (PS. I checked your link but Amazon won't sell medications to NZ, which is fair enough!).

  13. Good luck Jem!! I hope those embryos have latched on strong :)

  14. Why don't you get an entire cycle monitored to check?

    - Day 2 (or 3) FSH/LH/progesterone/oestradiol,
    - then maybe a day 10/11/12 LH/oestradiol/prog (depending on your cycle length and the result)
    - and then a day 21 equivalent LH/prog/oest (about 7 days after ovulation).

    The aim would be to catch the LH surge (if you have one) and then confirm the ovulation (by progesterone level).

    Maybe you know all this already? The OPKs are not a reliable reflection of LH levels, even a light positive should indicate a surge. I think its important to know as you won't ovulate without an LH surge (unless you are injecting a trigger?). I agree with Jay about high LH at the start of your cycle not being a good thing either, you always want it low except during the mid-cycle surge that triggers ovulation. I do these basic labs on women all the time to assess their fertility prior to ttc, if you have known DOR then it would be good to know how your hormones are cycling appropriately.

  15. Wow, I came across your blog a few days ago, and I'm glad I did! With all the research I do, I don't know how this is all new to me, but it is.

    Anyways, I have D3 drops at home, 500IU each. Would you recommend I take 10,000IU/day for a few weeks, then lower to 5,000IU/day? Obviously I should have my vit D levels tested first...but still, this is very interesting!

    Thanks for sharing.

  16. Glad you found me:) Yes, you would have to have your D3 levels tested first. This is a fat soluble vitamin, so its possible to suffer from toxicity if your blood levels are too high. Its essential IMO, to tailor your dosage to your blood level, especially if you want to take large doses.

    I only started the massive supplementation after I found a deficiency, and I'm definitely feeling the subtle differences already!

  17. Yes, that makes sense. I got a req from my doctor today, so we'll see I guess! Thanks again :)

  18. Holy moly. I knew Vitamin D was important, but I didn't realize how much so. I also read on your timeline that Vitamin D can influence AMH!?!? Yowza. This has really made me think.

    Thanks for your comments on my blog. They are very appreciated.

  19. so I just got my results back, and I'm deficient! Thanks so much for this info, otherwise I would have never known.