Melatonin Application in Assisted Reproductive Technology: A Systematic Review and Meta-Analysis of Randomized Trials.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 32292388 · doi:10.3389/fendo.2020.00160
What was done
A systematic review and meta-analysis of randomized controlled trials evaluated the effect of melatonin treatment on assisted reproductive technology (ART) outcomes. Searches were conducted in PubMed, EMBASE, Cochrane Library, Web of Science, and Google Scholar.
What was found
Ten randomized controlled trials met inclusion criteria. Melatonin treatment significantly increased the clinical pregnancy rate (OR = 1.43, 95% CI 1.11 to 1.86; power = 0.98; 10 RCTs; low-quality evidence), biochemical pregnancy rate (OR = 1.65, 95% CI 1.14 to 2.38; 6 RCTs; low-quality evidence), number of collected oocytes (SMD = 0.34, 95% CI 0.01 to 0.67; 7 RCTs; low-quality evidence), maturated oocytes (SMD = 0.56, 95% CI 0.27 to 0.85; 7 RCTs; low-quality evidence), and good quality embryos (MD = 0.36, 95% CI 0.18 to 0.55; 3 RCTs; low-quality evidence). Melatonin did not significantly increase live birth rate (OR = 1.38, 95% CI 0.78 to 2.46; power = 0.34; 3 RCTs; low-quality evidence) or miscarriage rate (OR = 1.28, 95% CI 0.65 to 2.51; 5 RCTs; low-quality evidence).
Why it matters
Melatonin improves intermediate reproductive markers and clinical pregnancy rates in ART cycles, but current evidence is insufficient to demonstrate a benefit for live birth rates.
Limits
All findings were graded as low-quality evidence. Live birth was assessed in only three trials and was underpowered. The total number of participants was not reported in the abstract. Patient populations had wide clinical heterogeneity, ranging from polycystic ovary syndrome to low ovarian reserve. Melatonin doses and treatment protocols were not detailed in the abstract.