EFFECT OF SILDENAFIL CITRATE ON ENDOMETRIAL PREPARATION AND UTERINE ARTERY BLOOD FLOW IN INFERTILITY PATIENTS UNDERGOING INDUCTION OF OVULATION–A RANDOMIZED CONTROLLED TRIAL

Abstract

The etiology of infertility is diverse. Despite the improvement in ovarian stimulation protocols and techniques, results of in vitro fertilization (IVF) has unfortunately reached a plateau. Diverse and unexplained factors affecting implantation rates have become a major limiting factor. Therefore, more attention needs to be focused on implantation and endometrial receptivity. Good embryo quality, appropriately timed and arranged endometrial receptivity, and efficient crosstalk between the embryo and the receptive endometrium are required for successful implantation. Impairment of any one of these factors may result in implantation failure. To improve poor endometrial response, several regimens have been put forward, including treatment with estrogens and low dose aspirin. Sildenafil citrate improves the uterine artery blood flow and the endometrial thickness in women with a prior failed assisted reproductive cycle due to poor endometrial response .Sildenafil citrate can be used orally or by vaginal to improve endometrial receptivity.

The aim of the study is to evaluate the efficacy of the orally administered sildenafil citrate on the endometrial thickness and pattern, number of follicles, uterine artery blood flow and pregnancy rate in infertility patients undergoing induction of ovulation. • The study included one hundred and twenty eight patients who were randomized into two groups. Group A included sixty four patients who were given sildenafil citrate 25mg from 8th day to 13th day of the cycle four times per day orally and clomiphene citrate 50mg from 2nd day till 6th day of the same cycle two times per day orally. Group B included sixty four patients who were given clomiphene citrate 50 mg from 2nd day to 6th day of the cycle two times per day orally and placebo tablets from cycle day 8 till day 13 four times /day orally. Transvaginal U/S was done to detect endometrial thickness and number of follicles on day 8 and day 13 for comparison. • Uterine artery Doppler was done on day 8 and day 13 using colored Doppler U/S for comparison. • Serum B-HCG was done to detect pregnancy occurrence.