DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20162109

To study and compare the effect of vaginal sildenafil and estradiol valerate on endometrial thickness, blood flow and pregnancy rates in infertile women undergoing intrauterine insemination

Suchika Mangal, Shuchita Mehirishi

Abstract


Background: The objective of this study was to study and compare the effect of vaginal sildenafil citrate and estradiol valerate on endometrial thickness, blood flow and pregnancy rates in infertile women undergoing intrauterine insemination (IUI).

Methods: It is a comparative prospective study including 100 women with primary or secondary infertility with stimulated cycles undergoing IUI. Patients with thin endometrium were randomly distributed in two groups. In group A, 50 patients were included and given sildenafil citrate 25 mg vaginally every 6 hours from day 8th of the cycle. In group B, 50 patients were given tablet estradiol valerate 2 mg 6-8 hourly. Patients were evaluated by trans-vaginal sonography (TVS) on day 13th of cycle for endometrial thickness and pattern with number and size of Graffian follicle.

Results: Mean endometrial thickness at the time of hCG trigger was 9.42 mm in sildenafil group and 9.94 mm in estradiol group (p value 0.14). 64% patients given sildenafil vaginally had vascularity up to zone 3 whereas 48% patients given estradiol valerate orally had zone 3 endometrial vascularity (p value = 0.038). The clinical pregnancy rates were 10 (20%) in group 1 and 7 (14%) in group 2 after 3 cycles of IUI. (p value = 0.042).

Conclusions: Both estradiol valerate and Sildenafil citrate can be used for improving the endometrium. Sildenafil when compared to estradiol valerate has better results as far as endometrial vascularity is concerned and marginally increased pregnancy outcome in patients undergoing IUI.


Keywords


Infertility, Sildenafil, Estradiol valerate, Endometrial thickness

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References


Schachter M, Strassburger D, Bern O, Ron-El R, Friedler S. Favorable influence of local injury to the endometrium in intracytoplasmic sperm injection patients with high-order implantation failure. Fertil Steril. 2007;87:198-201.

Gnainsky Y, Granot I, Aldo PB, Barash A, Or Y, Schechtman E. Local injury of the endometrium induces an inflammatory response that promotes successful implantation. Fertil Steril. 2010;94:2030-6.

Richter KS, Bugge K, Bromer J, Levy M. Relationship between endometrial thickness and embryo implantation, based on 1,294 cycles of in vitro fertilization with transfer of two blastocyst-stage embryos. Fertil Steril. 2007;87:53-9.

Kovacs P, Matyas S, Boda K, Kaali SG. The effect of endometrial thickness on IVF/ICSI outcome. Hum Reprod. 2003;18:2337-41.

Wells CS, Williams DB, Odem RR, Gast MJ, Strickler RC. Endometrial thickness is a valid monitoring parameter in cycles of ovulation induction with menotropins alone. Fertil Steril. 1996;65:262-6.

Paulson RJ. Hormonal induction of endometrial receptivity. Fertil Steril. 2011;96:530-5.

Xhang X, Chen CH, Confino E, Barnes R, Milad M, Kazer RR. Increased endometrial thickness is associated with improved treatment outcome for selected patients undergoing in vitro fertilization-embryo transfer. Fertil Steril. 2005;83:336-40.

Gleicher N, Vidali A, Barad DH. Successful treatment of unresponsive thin endometrium. Fertil Steril. 2011;95:2123-3.

Tsai HD, Chang CC, Lo HY, Chen CL. Low-dose aspirin for infertile women with thin endometrium receiving intrauterine insemination: a prospective, randomized study. J Assist Reprod Genet. 2000;17:174-7.

Bhojwani JT, Marshburn PB, Papadakis MA, Loeb TA, Matthews ML. Low-dose aspirin does not improve ovarian stimulation, endometrial response, or pregnancy rates for in vitro fertilization. J Exp Clin Assist Reprod. 2005;2:8.

Michael A. The uterine biophysical profile (UBP). Endosonography in obstetrics and gynaecology. Gautam Allahabadia (Ed). Rotunda Medical Technologies (P) Ltd. Mumbai, India; 1997:343-52.

Takasaki A, Tamura H, Miwa I, Taketani T, Shimamura K, Sugino N. Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium. Fertil Steril. 2010;93(6):1851-8.

Torres RF, Habana AE, Tansengco LG. The Effect of estrogen supplementation on the endometrium and pregnancy rate among infertile women treated with clomifene citrate: a meta-analysis. Fertil Steril. 2005;84:S162-S3.

Cetinkaya K, Kadanal─▒ S. The effect of administering vaginal estrogen to clomiphene citrate stimulated cycles on endometrial thickness and pregnancy rates in unexplained infertility. J Turk Ger Gynecol Assoc. 2012;13(3):157-61.

Jimenez PT, Schon SB, Odem RR, Ratts VS, Jungheim ES. A retrospective cross-sectional study: fresh cycle endometrial thickness is a sensitive predictor of inadequate endometrial thickness in frozen embryo transfer cycles. Reprod Biol Endocrinol. 2013;11:35.

Firouzabadi DR, Davar R, Hojjat F, Mahdavi M. Effect of sildenafi l citrate on endometrial preparation and outcome of frozen-thawed embryo transfer cycles: a randomized clinical trial. Iran J Reprod Med. 2013;11(2):151-8.

Jerzak M, Kniotek M, Mrozek J, G├│rski A, Baranowski W. Sildenafi l citrate decreased natural killer cell activity and enhanced chance of successful pregnancy in women with a history of recurrent miscarriage. Fertil Steril. 2008;9(5):1848-53.