Abstract
Many subfertile couples, who failed to conceive naturally, seek help by means of artificial reproduction techniques such as in vitro fertilization (IVF) to achieve pregnancy. It is clear that oocyte and embryo quality depression are widely considered to be the main challenge of IVF in assisted reproduction. The aim of the study was to assess the effect and the role of melatonin combined with myoinositol on oocyte quality and to investigate its correlation with pregnancy outcome. A total of 315 patient, aged between 30-40, in a 12 month study period from Jan. 2017 to Dec. 2017, with history of one or multiple unsuccessful IVF cycles due to poor oocyte quality were included in this study. The study group (group 1, n=166) was treated with melatonin combined with myoinositol (Seidivid plus, SEIDLAB) for 3 months prior to a new IVF cycle and the control group (group 2, n =149) just received a standard IVF cycle without melatonin and myoinositol. IVF outcomes were compared between the two groups. Primary endpoint was the number of morphologically mature oocytes retrieved (MII oocytes). Secondary endpoints were fertilization rate per number of mature oocytes, embryo quality and pregnancy rate. After treatment, the number of mature oocytes, the fertilization rate, the number of top-quality embryos transferred and pregnancy rate were statistically higher compared to the previous IVF cycle, while there was no difference in the number of retrieved oocyte. The mean number of oocytes retrieved differ between the two groups being (11.56) in group 1 and (10.9) in control one (1920 vs. 1629) and the percentage of mature oocytes was significantly higher in melatonin-treated group (77.03% vs. 69.1%). Concurrently, the mean number of immature oocytes (germinal vesicles) was reduced (22.9% vs. 39.9%). Furthermore, the melatonin –myoinositol treated group showed an increase in fertilization rate (80.2% vs. 77.7%) and the mean number of grade one embryos resulted was also higher (60.05% vs. 49.5%). Clinical pregnancy rate was in tendency higher in the group treated with melatonin and myoinositol (48.3% vs. 40.8%), In the current study It was concluded that Melatonin and myoinositol treatment is likely to become a significant option for improving oocyte and embryo quality in women who cannot become pregnant because of poor oocyte quality.
Highlights
The growing interest by physicians to many infertile couples, who failed to conceive due to poor oocyte quality, the great advances in assisted reproductive technologies and the extensive experience gained over this long period had shed light on parameters determining ART outcomes
The study group was treated with melatonin combined with myoinositol (Seidivid plus, SEIDLAB) for 3 months prior to a new in vitro fertilization (IVF) cycle and the control group just received a standard IVF cycle without melatonin and myoinositol
Patients assigned to the study group were treated with melatonin combined with myoinositol (Seidivid plus, SEIDLAB) for 3 months prior to a new IVF cycle and Patients assigned to control group just received a standard IVF cycle without melatonin and myoinositol
Summary
The growing interest by physicians to many infertile couples, who failed to conceive due to poor oocyte quality, the great advances in assisted reproductive technologies and the extensive experience gained over this long period had shed light on parameters determining ART outcomes. It has been discovered that an imbalance of reactive oxygen species (ROS), or ‘oxidative stress’, can have a negative impact on the success of infertility treatments, and investigators have begun addressing potential mechanisms of preventing these effects with the use of novel oxygen scavengers such as melatonin, a pineal hormone that regulates circadian rhythms, which has been shown to exhibit a unique oxygen scavenging abilities. In-vitro, these oocytes are no longer protected by antioxidant-rich follicular fluid, leaving them more susceptible to oxidative damage [4,5,6]. They may be exposed to high oxygen concentrations in incubators and during handling throughout the IVF process, with higher concentrations of oxygen being associated with more ROS
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