Abstract
Objective: To study whether melatonin treatment can increase clinical pregnancy rate and live birth rate in assisted reproductive technology (ART) cycles.Methods: Literature searches were conducted to retrieve randomized trials that reported the effect of melatonin treatment on ART outcomes. Databases searched included PubMed, EMBASE, Cochrane Library, Web of Science, and Google Scholar.Results: Ten studies matched the inclusion criteria. Clinical pregnancy was reported in all of the included studies and live birth was reported in three studies. Melatonin treatment significantly increased the clinical pregnancy rate [OR = 1.43 (1.11, 1.86), power = 0.98, 10 RCTs, low-quality evidence] but not the live birth rate [OR = 1.38 (0.78, 2.46), power = 0.34, 3 RCTs, low-quality evidence]. Melatonin treatment increased the number of oocyte collected [SMD = 0.34 (0.01, 0.67), 7 RCTs, low-quality evidence], the number of maturated oocyte [SMD = 0.56 (0.27, 0.85), 7 RCTs, low-quality evidence], and the number of good quality embryo [MD = 0.36 (0.18, 0.55), 3 RCTs, low-quality evidence]. Melatonin treatment significantly increased the biochemical pregnancy rate [OR = 1.65 (1.14, 2.38), 6 RCTs, low-quality evidence] and had no significant effect on the miscarriage rate [OR = 1.28 (0.65, 2.51), 5 RCTs, low-quality evidence].Conclusion: Melatonin treatment significantly increases the clinical pregnancy rate but not live birth rate in ART cycles. Melatonin treatment also increases the number of oocyte collected, maturated oocyte, and good quality embryo. No clear evidence suggested that melatonin treatment increased the adverse events in ART cycles. The actual findings may be compromised due to the wide heterogeneity of the included IVF patients, from PCOS to low ovarian reserve.
Highlights
Infertility is defined as the inability to conceive for at least 1 year [1]
Three studies focused on women with polycystic ovarian syndrome (PCOS); the patients in 3 studies were none special; the other 4 studies focused on women with unexplained infertility, diminished ovarian reserve, poor oocyte quality, and sleep disturbances, respectively
One study included women undergoing intrauterine insemination (IUI) and 9 studies focused on women undergoing in vitro fertilization (IVF) and/or IntraCytoplasmic Sperm Injection Intra-Cytoplasmic Sperm Injection (ICSI) and subsequent embryo transfer ET
Summary
Infertility is defined as the inability to conceive for at least 1 year [1]. Infertility is a common condition affecting 10–20% of women at the reproductive age across different countries [2, 3]. Assisted reproductive technology (ART) has allowed millions of infertile couples in the world to conceive successfully since 1978 [4]. Melatonin in Assisted Reproduction decades, the chance of achieving a live birth through ART is not high [5, 6]. Several strategies aiming to increase the live birth rate are currently being used, such as endometrial scratching [7], assisted hatching of human embryos [8], the addition of drugs to improve successful rate [9, 10], etc. Increased oxidative stress can lead to reduced oocyte maturation rate and fertilization rate, which will result in a reduced possibility of full-term pregnancy [15]. Melatonin and its metabolites protect cells from oxidative stress by acting as a free radical scavenger [17]
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