A novel approach for treating infertile patients with diminished ovarian reserve (DOR)

Ovarian reserve (OR) decreases throughout life and has a physiological limit around the age of 50. The diagnosis of diminished ovarian reserve (DOR) is based on menstrual cycle day 2-4 follicle-stimulating hormone (FSH) and estradiol levels, antral follicle counts, and anti-mullerian hormone (AMH) titers. In particular, FSH levels increase and AMH levels decrease with age, providing diagnostic criteria across the reproductive spectrum. In the clinical IVF practice, it is crucial to improve stimulation protocols in order to obtain higher quality oocytes and embryos, and this is of the utmost importance especially for DOR patients. In the present study, we aimed to evaluate the effect of two well-known compounds, myo-inositol and melatonin, on serum AMH levels. Indeed, several studies have suggested that AMH is a predictor of IVF outcome. 11 patients (35.40+/-5.1 years old, mean+/-SD) diagnosed with DOR were selected and treated with a combination of 2g of myoinositol and 3mg of melatonin (Inofolic (R) Plus, Lo.Li.pharma, Roma; Italy) once daily for one month. After treatment, patients showed a significant increase in AMH levels. AMH levels increased from 0.58+/-0.16 ng/ml at baseline to 1.24+/-0.25ng/ml (p<0.05). Obtaining high quality oocytes is essential for a positive IVF outcome, particularly for patients with diminished ovarian reserve. In the present study, we presented preliminary evidence that daily administration of a combination of 2g of myo-inositol and 3mg of melatonin can positively impact serum AMH levels. This, in turn, might result in more positive IVF outcomes.