OBJECTIVE
To study follicular melatonin levels as a predictor of the outcome of assisted reproductive technology programs in patients with anovulatory infertility.
MATERIAL AND METHODS
A total of 150 patients, divided into 3 groups, were selected for the examination. Group 1 consisted of 50 patients with anovulatory infertility and low ovarian reserve (antimueller hormone ≤1.2 ng/ml). Every third patient in this group was given a 10-day course of treatment with the drug “Pineamin” containing 10 mg of water-soluble polypeptide fractions of the bovine epiphysis (pineal gland) at the pregravid stage starting on the 2nd—3rd day of the menstrual cycle. Group 2 consisted of 50 patients with anovulatory infertility and high ovarian reserve (antimueller hormone >2 ng/ml). The control group included 50 patients with infertility caused by the male factor. Stimulation of superovulation was performed using a short protocol, individually selected doses of drugs, taking into account the ovarian reserve. Follicular fluid samples were obtained during aspiration of preovulatory dominant follicles. The efficacy of the assisted reproductive technology programs was evaluated based on the results of pregnancy per embryo transfer, hCG level, and echographic confirmation of clinical pregnancy.
RESULTS
We found that the average melatonin level in the follicular fluid of Group 1 patients was the highest (5.02±0.4 pg/ml), which was probably due to the use of pineamine at the pre-pregnancy stage, while in Group 2 it was the lowest — 4.63±0.33 pg/ml, in Group 3 — 4.82±0.44 pg/ml. Correlation analysis between melatonin levels and the number of mature oocytes, as well as between melatonin levels and the number of high quality embryos, revealed a strong relationship between the evaluated indices. In group 1, the number of pregnancy on the number of embryos was 31.8%; in the control group, it was 33.3%; in group 3, the figure was 29.7%. The reference values of follicular endogenous melatonin ranging from 3.248 to 6.644 pg/ml were found to be necessary for predicting the production of mature oocytes and high quality embryos in patients with both anovulatory infertility and male factor infertility.
CONCLUSION
To increase the production of endogenous melatonin in the follicular fluid, it is advisable to use pineamine, a lyophilizate for preparation of a solution for intramuscular injection, at the pregravidarial stage from the 2nd—3rd day of the menstrual cycle, containing 10 mg of water-soluble polypeptide fractions of bovine epiphysis for a course of 10 days, which significantly affects the ovarian reserve, the quality of oocytes and embryos and the effectiveness of treatment of anovulatory sterility patients by the methods of assisted reproductive technologies in general.
