AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Eduardo Carvalho de Arruda Veiga, GERA Institute of Teaching and Research in Reproductive Medicine of São Paulo, Brazil.
Citation: Eduardo Carvalho de Arruda Veiga, Marise Samama, Soares Junior JM, Fabio Ikeda, Giovanna S. Cavalcanti, et al, (2024), Melatonin and Outcomes of Assisted Reproductive Technologies: Systematic Review and Meta-Analysis, J. Obstetrics Gynecology and Reproductive Sciences, 8(1) DOI:10.31579/2578-8965/196
Copyright: © 2024, Eduardo Carvalho de Arruda Veiga. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 27 December 2023 | Accepted: 15 January 2024 | Published: 29 January 2024
Keywords: melatonin; ovarian hyperstimulation syndrome; assisted reproduction outcomes; in vitro fertilization; human reproduction
Background: Melatonin is a hormone produced by the pineal gland and it has antioxidant properties.
Aim: This study aimed to evaluate the effects of melatonin on assisted reproductive technologies through a systematic review and a meta-analysis.
Materials and methods: Search strategies were used in PubMed and in other databases covering the last 15 years. After screening for eligibility, 17 articles were selected for the systematic review. For the meta-analysis statistics, two groups were formed, the treatment group (with melatonin) and the control group (without melatonin) for various assisted reproduction outcomes.
Results: The main results were that no statistical differences were found concerning the clinical pregnancy outcome (p = 0.64), but there was a statistical difference with respect to mature oocytes (MII) (p = 0.001), antral follicle count (p = 0.0002), and the fertilization rate (p ≤ 0.0001).
Conclusions: Melatonin had beneficial effects on outcomes in assisted reproductive technologies, but it had no influence on pregnancy.
Infertility affects millions of women worldwide and is one of the main causes of the unfulfilled dream of having a child (Graham et al, 2023). Assisted reproduction techniques may be accompanied by complications such as ovarian hyperstimulation syndrome (OHSS), which can be fatal (Zhang et al, 2022). As many as 20% to 33% of in vitro fertilization (IVF) cycles are affected by mild OHSS, whereas moderate to severe OHSS reportedly occurs in 3% to 8% of patients (Mourad et al, 2017).
Melatonin is a hormone that is primarily produced by the pineal gland. Two characteristics worth emphasizing are its antioxidant properties and its capacity to improve mitochondrial functions in female germ cells, which can lead to benefits in human reproduction treatments (Reiter et al, 2018; Tamura et al, 2020; Cheng et al, 2020). Melatonin plays a role in sleep and in physiological oocyte maturation (Yong et al, 2021). Both in vitro and in vivo studies, in animals and in humans, show the benefits of melatonin as a substance that reduces the oxidative stress of cells related to reproduction, even improving fertilization rates (Cosme et al, 2023).
Two recent works have demonstrated that melatonin not only alleviates reactive oxygen species, but also improves apoptosis, and that it may clinically benefit women who have developed OHSS (Li et al, 2019; Zheng et al, 2022).
Among the positive results of using melatonin for women on assisted reproductive technology (ART) are increases in the number of mature oocytes, the fertilization rate, the number of high-quality embryos, and, in some cases, increased pregnancy rates (Tamura et al, 2008; Liu et al, 2016; Ge et al, 2015).
Given the above, this study aimed to evaluate the effects of melatonin on assisted reproductive technologies through a systematic review and a meta-analysis.
For the systematic review, we drew on several articles and guidelines, including Berstock et al, 2019 (14), Hennessey et al, 2019 (15), and Page et al, 2021 (16). The meta-analysis was conducted in accordance with Higgins et al, 2022 (17).
The studies selected for this review were published between January 2008 and April 2023, and they are indexed in PubMed and Scielo (Figure 1). The initial search yielded 127 articles. After applying the eligibility criteria, they were narrowed down to the 17 articles included in this systematic review. Figure 1 shows the selection process in detail.
Figure 1: Flowchart of the systematic review
*Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers).
**If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools.
Drawing on Page et al, 2020, the P (population) in the P.I.C.O. of this systematic review is patients, ie, the female research participants who were selected to take exogenous melatonin and who had or had not ovarian hyperstimulation syndrome, depending on the article; the I (intervention) is the administration of exogenous melatonin; the C (comparison) is the comparison of the control group and the experimental group (exposed to melatonin); the O (outcomes) is the outcomes as described in table 1.
| Authors | Years | Study design | Technique | Melatonin Treatment | Justifications for inclusion criteria | Main outcomes |
| Tamura et al | 2008 | Controlled Clinical Trial | IVF ET | 3 mg/day | The study has results that melatonin improves among other aspects of ARTs and fertility rates | improves oocyte and embryo quality and better fertility taxes. |
| Unfer et al | 2011 | Clinical Trial | IVF | 3 mg/day | The study has results that melatonin improves oocyte quality | had improved on pregnancy rate |
| Batioglu et al | 2012 | Randomized Controlled Trial | IVF ET | 3 mg/day | The justification for the inclusion is the efficacy of melatonin administered in improving oocyte quality | improves oocyte and embryo quality |
| Fernando et al | 2014 | Clinical Trial | IVF ICSI | 4 mg/ twice per day | Double-blind randomized study evaluating melatonin in infertility treatments | Melatonin in ART will be the first trial designed to determine a relationship of melatonin on Clinical pregnancy rates. |
| Nishihara et al | 2014 | Clinical Trial | IVF | 3 mg/day | The justification for the inclusion is the efficacy of melatonin administered in improving oocyte quality | improves oocyte and embryo quality |
| Jahromi et al | 2017 | Randomized Controlled Trial | IVF | 3 mg/day | Double-blind randomized study evaluating melatonin in infertility treatments in women with low ovarian reserve | improves oocyte and embryo quality |
| Tong et al | 2017 | Clinical Trial | IVF ICSI | Melatonin measument in folicular fluid with range was 2.3-1000 pg/mL. | The justification for the inclusion is that melatonin levels can be markers and predictors of low ovarian reserve and better results in IVF | improves oocyte and embryo quality |
| Zheng et al | 2017 | Clinical Trial | IVF | Melatonin measument in folicular fluid. | The work seals the concentrations of melatonin in the follicular fluids and their role in human reproduction | We have demonstrated that higher folicullar fluid melatonin concentrations were related to better ART outcomes |
| Ma et al | 2018 | Clinical Trial | IVF ICSI ET | This study was the only one that did not have the presence of melatonin, therefore it was important for the inclusion criteria in the present systematic review because it worked with studies of two fluids of two follicular follicles in women with ovarian hyperstimulation syndrome. | Follicle count measured on the day of hCG administration was the only predictive factor for the occurrence of OHSS | |
| Espino et al | 2019 | Clinical Trial | IVF | 3 mg/day or 6 mg/day | The authors studied the use of melatonin in infertilities with no apparent or apparent cause in unexplained infertilities | improves oocyte and embryo quality |
| Fernando et al | 2019 | Randomized Controlled Trial | IVF | 2,4 or 8 mg/twice a day | This work, despite having arguments that go against current literature, is important for studying melatonin in ovarian vascular indices | Melatonin and vascular indices cannot predict the number or quality of oocytes or embryos obtained in an IVF cycle. |
| Li et al | 2019 | Case control Study | IVF ICSI ET | Melatonin measument in folicular fluid. | The authors studied in the same work the functions of melatonin in ovarian hyperstimulation syndrome | Role of melatonin as a predictor of ovarian hyperstimulation syndrome |
| Zheng et al | 2019 | Clinical Trial | IVF | Melatonin measument in folicular fluid | This work was important to be selected because it was the first to demonstrate that melatonin in the follicular fluids is significantly increased in women with OHSS | The authors studied in the same work the functions of melatonin in ovarian hyperstimulation syndrome |
| Espinola et al | 2020 | Prospective Randomized and Controlled Pilot Study | IVF | 1 mg/day | As justifications for the inclusion of this work, there is a randomized study that studied vitamin D, melatonin, or myo-inositol and folic acid in assisted reproduction | The main failure was that increased vitamin D levels were positively correlated with IVF implantation rates. |
| Wdowiak et al | 2020 | Prospective Randomized and Controlled Trial | IVF ICSI | 1 mg/day | A study comparing other two substances together with melatonin in women with OHSS | A combination of myo-inositol, vitamin D and melatonin including better fertilization and pregnancy outcomes as well as reduced risk of OHSS |
| Li et al | 2021 | Randomized Controlled Trial | IVF IVM | MT in fluid folicular in IVF and addition in in vitro culture of 10-5 mol/L melatonina in IVM. | It was a pilot study that compared IVF protocols with in vitro maturation and the presence of melatonin and its results in human reproduction. | Melatonin supplementation has efficacy in clinical results of assisted reproduction as higher rates of oocytes in IVF |
| Zheng et al | 2022 | Clinical Trial | - | Melatonin treatment in 10 µM cell culture | The authors studies the functions of melatonin in ovarian hyperstimulation syndrome | Melatonin attenuated reactive oxygen species during apoptosis |
Table 1: Exogenous Melatonin in Previous Clinical Studies
This review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) recommendations (16).
Inclusion and exclusion criteria
The exclusion criteria covered animal studies (n = 74), articles whose titles or abstracts did not fall within the scope of our study (n = 11), and review articles (n = 8). An additional 16 articles were excluded for lack of access to the full text because they were not freely accessible. The remaining 24 articles were fully read. By applying a second round of exclusion criteria, 7 more studies were screened out. The 17 articles that remained met the inclusion criteria of this study (see table 1 for details) and were thus included in the study (Figure 1). The inclusion and exclusion criteria were based on Page et al, 2020.
For descriptive analysis, calculations were made for means, standard deviations, mean differences, and odd ratios with a 95% confidence interval. Meta-analysis was carried out with the Review Manager 5.4.1 software program (Cochrane Collaboration, Oxford, UK). For the 95% CI and the overall effect size, values of p ≤ 0.05 were assumed for significant differences.
Melatonin is involved in a number of the body’s physiological processes, one of which is regulating fertility. The articles included in this study are detailed in table 1, which also includes information about the authors, publication year, methods, melatonin treatment, rationale for article inclusion, and key results or outcomes. A significant finding of this systematic review was that melatonin plays a role in the improvement of oocyte and embryo quality. (Tamura et al, 2008; Fernando et al, 2014 Batioglu et al, 2012; Nishihara et al, 2014; Jahromi et al, 2017; Tong et al, 2017; Jing et al, 2017; Espino et al, 2019; Zheng et al, 2017; Unfer et al, 2011; Ma et al, 2020, Fernando et al, 2020, Espinola et al, 2021; Wdowiak et al, 2020; Li et al, 2021, Zheng et al, 2023).
Meta-analysis of assisted reproduction outcome variables
The comparison between melatonin intake and the clinical pregnancy rate of assisted reproduction yielded no statistical difference. Only 6 studies included this variable and with the following results: p = 0.64, I2 = 37% (Figure 2); risk ratio of 1.22 [0.71-2.09]. Caution is needed in interpreting this outcome, for there are numerous other variables involved in a healthy pregnancy resulting from assisted reproduction techniques, including the physiological conditions necessary for achieving pregnancy.
Figure 2: Meta-analysis of clinical pregnancy rate in patients receiving and not receiving melatonin
The meta-analysis of the fertilization rate outcome in percentage (%) showed a positive effect of the melatonin treatment, as the difference between the melatonin treatment groups and the control groups was statistically
significant (p ≤ 0.00001, I2 = 88%, Figure 3; risk ratio = 0.84 [0.79, 0.90]). The fertilization rate is an important indicator of reproductive outcomes, and the group of women who took melatonin had improved results compared to the group of women who did not take it (Figure 3).
Figure 3: Meta-analysis of fertilization rate in patients receiving and not receiving melatonin
In the only four studies addressing follicle count, melatonin had positive effects on the growth of follicles as shown by p ≤ 0.00001, I2 = 85% (Figure S2), which point to statistical significance.
Figure S2: Meta-analysis of antral follicle count in patients receiving and not receiving melatonin
Five studies measured the mature oocyte (MII). Statistically significant values were found, and they are p = 0.001, I2 = 87% (Figure S1). The MII oocyte is the female germ cell in an ideal state of maturation for fertilization.
Figure S1: Meta-analysis of mature oocyte outcome (MII) in patients receiving and not receiving melatonin
A meta-analysis of maternal age in years was performed in 11 studies, and no statistically significant difference was found (p = 0.64 and I2 = 64%). Body mass index (kg/m2) was a sociodemographic variable analyzed in 8 studies, with no significant differences as outcome (p = 0.59, I2 = 77%). A third sociodemographic variable was women’s infertility time, and it approached the significance level at best (p = 0.06, I2 = 0%).
In short, melatonin had beneficial effects as shown by the increased fertilization rate and other outcomes of the reproductive process. The clinical pregnancy rates, however, were not significantly different in the group comparison.
Our main findings were that women who took melatonin had an improved fertilization rate and reaped other benefits from assisted reproductive technologies. However, melatonin intake did not result in a higher clinical pregnancy rate.
Of the 17 studies selected for this systematic review, only two articles, those by Li et al, 2019 (26) and Zhang et al, 2022 (27), deal directly with the subject of ovarian hyperstimulation and the way in which melatonin can be a hormone that aids reproductive results. Li et al, 2019, concluded that melatonin produced by the follicular follicle helps predict OHSS, while Zhang et al, 2020, took a deeper approach. They demonstrated how melatonin, in addition to having anti-apoptotic properties, can improve oxidative stress in OHSS and concluded that it can indeed prevent OHSS. In a recent study by Hu et al, 2020, promising results were obtained, but they differ from those of our meta-analysis, in which the clinical pregnancy rate improved with the administration of melatonin to patients with an OR of 1.43. However, their study comprised only articles with an RTC design, an advantage offset mainly by the low-quality bias and the heterogeneity of the articles.
Some recent studies demonstrate that melatonin either from follicular fluid, granulosa cells, or exogenous sources has important roles concerning the quality of oocytes. It can delay the aging of the ovaries and their functions and improve the antioxidant properties of the oocytes, leading to improved reproductive outcomes such as an improved fertilization rate (5) (28, 29, 30, 31). The strength of our work lies in demonstrating through meta-analysis that variables analyzed at the onset of assisted reproduction techniques improved to benefit the women who used exogenous melatonin. On the other hand, in the author’s judgement, an important limitation is that in nearly half of the studies the risk of bias was unclear or was not mentioned, impairing the quality of the studies. Another limitation, and the most important one, is that there was no difference in the clinical pregnancy rate between the groups. Further, there were not enough studies among the selected articles to analyze the main variable of assisted reproduction, namely the rate of live births.
This study has two main limitations. First, it is a systematic review and as such there is no data collection. Also, the results are those of previously published articles. Second, with respect to the meta-analysis of the clinical rate of pregnancy variable, there is no statistical difference between the use and the nonuse of melatonin, despite its beneficial molecular and cellular effects as judged by the values presented in the articles.
Melatonin is not a substance that has been used frequently in assisted reproduction. However, it has the following advantages for use in clinical practice: it is low cost; it is commercially available; it is a hormone produced by our own body and thus has no side effects; it has, as one of its main physiological actions, the capacity to reduce the oxidative stress of oocytes, but due to the few existing studies, this feature is still being overshadowed by the main results of human reproduction, such as clinical pregnancy rate and live birth rate. Therefore, we suggest that this line of research into melatonin use in assisted reproductive technologies be expanded with double-blind randomized multicenter studies. Through a systematic review and meta-analysis, we have demonstrated that melatonin improves the outcomes of assisted reproductive technologies, but that it has no influence on clinical pregnancy. Additional studies, such as double-blind randomized clinical trials with many participants, are needed, particularly as regards melatonin action on ovarian hyperstimulation syndrome.
The authors declare that they have no competing interests.
No funding.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
