COMPARATIVE CHARACTERISTICS OF COMORBIDITY IN THE CONTEXT OF MELATONIN LEVELS IN PATIENTS WITH IDIOPATHIC INFERTILITY AND FAILED IVF ATTEMPTS

Ichmelyan Albert Misakovich, Bogdasarov Azat Yuryevich, Davidyan Liana Yuryevna

The role of melatonin in regulating reproductive function remains a topic of active study. The aim of this study was to compare the clinical and anamnestic characteristics of women with idiopathic infertility for more than two years and a history of failed IVF attempts, based on their melatonin levels. The study included 238 women, divided into two groups: a study group (n=115) with normal melatonin levels and a comparison group (n=123) with low melatonin levels. A retrospective analysis of 72 parameters was conducted, including somatic and gynecological history, reproductive function, and menstrual cycle characteristics. Qualitative analysis was performed using a four-field table method with the χ² test. The presented groups were comparable in age (mean age 38.4±3.1 years in the group with normal melatonin versus 39.1±3.4 years in the group with low melatonin, p>0.05). Women with low melatonin levels were significantly more likely to be overweight and obese: BMI ≥25.0 kg/m² was detected in 51.2% (63/123) of patients in group 2 versus 36.5% (42/115) in group 1 (χ²=5.43, p<0.05). In the structure of gynecological pathology in the 2nd group, chronic endometritis was statistically significantly more frequently recorded - 29.3% (36/123) versus 16.5% (19/115) in the 1st group (χ²=5.67, p<0.05), as well as pelvic pain syndrome - 22.0% (27/123) versus 10.4% (12/115), respectively (χ²=5.89, p<0.05). Analysis of menstrual function revealed a higher frequency of dysmenorrhea in the 2nd group: 45.5% (56/123) versus 31.3% (36/115) in the 1st group (χ²=5.12, p<0.05). Among the concomitant somatic pathologies in the 2nd group, diseases of the nervous system were significantly more common - 19.5% (24/123) versus 9.6% (11/115) (χ²=4.52, p<0.05) and autoimmune thyroiditis (AIT) - 14.6% (18/123) versus 6.1% (7/115) (χ²=4.76, p<0.05). No statistically significant intergroup differences were found in education, social status, age of menarche, duration of the menstrual cycle, and number of previous pregnancies. Thus, a complex of aggravating factors was identified in women with idiopathic infertility, failed IVF attempts, and low melatonin levels, including a higher incidence of excess body weight, chronic endometritis, pelvic pain, dysmenorrhea, nervous system pathologies, and autoimmune thyroiditis. These findings support the rationale for adjusting melatonin levels in comprehensive IVF preparation programs for this category of patients.

Keywords:idiopathic infertility, in vitro fertilization, melatonin, chronic endometritis, body mass index, autoimmune thyroiditis