Annals of Tropical Medicine and Public Health | 2021
Effect of Vaginal Sildenafil on Endometrial Receptivity and Pregnancy Outcome in IUI Cycles
Abstract
Background: Endometrial receptivity is essential for implantation and pregnancy to success. A lot of interventions have been tried in order to improve endometrial receptivity and one of these interventions is the vaginal administration of sildenafil. A number of researches have supported the hypothesis that vaginal sildenafil increases significantly the yield of intrauterine insemination (IUI) in terms of implantation rate and pregnancy outcome through improvement of endometrial receptivity. Silden afil citrate which is a specific phosphodiesterase5 (PDE5) inhibitor, improves endometrial receptivity through improvement of blood flow towards endometrium. Transvaginal ultrasound (TVUS) and Doppler study document these improvement in the endometrium growth and uterine blood flow by assessing endometrium morphology (thickness and pattern) and b lood flow status (zonal pattern: z1,z2,z3, resistance indexes of sub endometrial arteries(SARI) and uterine arteries(UARI)) receptively. Aim of Study: To evaluate the efficacy of vaginal sildenafil on endometrial receptivity and pregnancy outcomein infertile women undergoing IUI. Patients, materials and method: This randomize prospective comparative trial was planned and accomplished in the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies in AL-Nahrain University, Baghdad – Iraq, involving 70 infertile women. The first group (n = 35) received sildenafil tab. 25mgvaginally every six hours from cycle day 8 to day of human chorionic gonadotropin (HCG) trigger. The second group (n = 35) did not receive sildenafil. All women were undergone IUI procedure with controlled ovarian stimulation. At day of IUI, TVUS and Doppler study was performed to assess endometrial morphology (thickness and pattern) and blood flow status towards endometrium respectively. Fourteen days later with luteal support, βHCG test was taken for pregnancy. Results: statistical analysis of this study showed highly significant difference in mean endometrial thickness between sildenafil and nonsildenafil groups (P< 0.001), 10.83 ±1.04 versus 8.91 ±1.52, respectively; being higher in sildenafil group. Also, it showed highly significant difference in the distribution of infertile women according to endometrial pattern, triple layer versus monolayer, between sildenafil and non-sildenafil groups (P = 0.008); triple layer being higher in sildenafil group. There wasalso highly significant difference in the distribution of infertile women according to sub endometrial blood flow zonal pattern, between sildenafil and non-sildenafil groups (P<0.001); zone 1 being limited to non-sildenafil group, Zone2 being less frequent and zone3 being more frequent in sildenafil group. The overall pregnancy rate was higher in sildenafil group with marginal statistical significance (P = 0.06). Conclusion: sildenafil given vaginally in IUI is safe, cost effective and efficient way to significantly improving endometrial receptivity with positive impact on pregnancy outcome. Ibrahim et al (2021) : Effect of vaginal slidenafil in IUI Cycles © Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2021.24409 DOI: 84 | P a g e Recommendation: We recommend the sildenafil to be given routinely in all infertile women undergoing assisted reproductive technology (ART).