Embryological Indicators and Incidence of Pregnancy in Women With Infertility Undergoing Assisted Reproductive Tecnology Programs With the Use of Melatonin

Abstract

The technology of intracytoplasmic sperm injection into the egg cell (ICSI) has taken the mail place among assisted reproductive technologies (ART) in the treatment of infertility. Improving the effectivenessof ART remains a complex medical problem. To a large extent, the success of ICSI depends on the quality of theoocytes, which, in its turn, depends on the number of follicles, which is determined by the ovulatory = ovarianreserve (OV) and effective preparation of patients for ART. The markers of OV are well known, and attention has been drawn to melatonin as a possible prognostic factor for the effectiveness of ART and OV in the last ten years. The indicators of melatonin content in the follicular fluid of stimulated ovaries have not been studied. At the same time, the assessment of embryological indicators of fertilization when using the medication melatonin for the preparation of patients and the effectiveness of ART programs in general can be useful for the furtherdevelopment of treatment algorithms for patients with infertility. The objective of the study. Evaluation of embryological indicators, the effectiveness of ICSI programs andthe incidence of pregnancy in women with infertility during their preparation with melatonin. Materials and methods. 67 women with various infertility factors participated in the prospective study.All patients were prepared for controlled ovarian stimulation (COS), and subsequently for follicular puncture, oocyte retrieval and fertilization by ICSI. All obtained blastocysts were cryopreserved, stored in liquid Nitrogen and thawed when embryo transfer was necessary. Embryological indicators, the number of transfers and the effectiveness of pregnancy incidence were evaluated. According to the purpose of the task, the patients were divided into two groups by the method of even-odd numbers: group 1 – 29 patients with infertility, who received the preparation "Vita-melatonin" 3 mg orally before bedtime, during one month before the follicles puncture,group 2 – 38 patients with infertility, who did not receive this medicine. Statistical processing of the obtainedresults was carried out using the licensed programs "Microsoft Excel" and "Statistica".The research design and all the methods we used in this prospective study were reviewed and approved by the bioethics commission of the higher education institution "Bukovinian State Medical University" (protocol No. 7 dated 04/21/2022). SRW "Preservation and restoration of reproductive health of women and girls with obstetric andgynecological pathology" (state registration number 0121U110020. Implementation period – 01.2021-12.2025). Results of the research. The incidence of pregnancy after thawing of blastocysts and embryo transfers ingeneral in women who received melatonin was significantly (p ˂ 0.05) higher compared to women who didnot receive melatonin, respectively, 86.2 ± 6.41% and 76.3 ± 6.95%. For all performed embryo transfers, theincidence of pregnancy was 56.8 ± 8.24% and 52.8 ± 7.62% (p > 0.05), respectively, for the first embryo transfer 58.1 ± 8 .85% and 55.3 ± 8.15% (р > 0.05), for the second - 43.5 ± 16.53% and 33.3 ± 21.14% (р > 0.05), for the third – 100.0 ± 7.00% and 80.0 ± 17.95% (р > 0.05).When assessing embryological indicators, it was found that in women who received melatonin, the number of mature oocytes was 83.4 ± 6.94%, and in women who did not receive melatonin, 81.5 ± 6.36%, but there was no significant (p > 0.05) difference. Out of mature oocytes in the process of incubation after the ICSI technology,49.5 ± 9.54% and 47.2 ± 8.72 (р > 0.05) blastocysts were formed, respectively, and from them blastocysts of class I – 48.6 ± 9 .36% and 46.4 ± 8.17% (р > 0.05), class II – 36.8 ± 8.94% and 44.4 ± 8.13% (р > 0.05), class III – 14.6 ± 6.67% and 9.3 ± 4.78% (р > 0.05).Conclusion. The use of melatonin in the preparation of women with infertility for the use of assisted reproductive technologies has shown its effectiveness in terms of pregnancy incidence.