EFFECT OF VAGINAL SILDENAFIL ON IN VITRO FERTILIZATION SUCCESS RATES IN WOMEN WITH PREVIOUS FAILED IN VITRO FERTILIZATION ATTEMPTS

Ensieh Shahrokh Tehraninejad; Noushin Khazei; Elnaz Ayati; Ali Movafegh; Omid Azimaraghi

doi:10.22159/ajpcr.2018.v11i6.25645

Authors

Ensieh Shahrokh Tehraninejad Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Iran.
Noushin Khazei Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Iran.
Elnaz Ayati Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Iran.
Ali Movafegh Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Iran.
Omid Azimaraghi Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Iran.

DOI:

https://doi.org/10.22159/ajpcr.2018.v11i6.25645

Keywords:

Infertility, Sildenafil, In vitro fertilization

Abstract

Objectives: Endometrial thickness of <9 mm is a predictor of in vitro fertilization (IVF) failure, although neither pregnancy rates nor the pregnancy outcomes are dependent on the endometrial thickness alone. The impact that uterine artery blood flow has on endometrial growth is dependent on nitric oxide which concentrations could be altered by halting a cyclic guanosine monophosphate-mediated pathway with a phosphodiesterase type 5 selective inhibitor such as sildenafil.

Methods: In this clinical trial, 72 patients aged below 45 years which have had at least two earlier failed IVF attempts were randomly split into two groups each consisting of 36 patients. Both groups were started on a long IVF protocol. The case group was also administered 100 mg vaginal sildenafil suppositories daily, starting on day 3 of menstruation which was continued until human chorionic gonadotropin administration. Endometrial thickness was measured using ultrasonography in both groups plus pregnancy rates were assessed in both groups.

Results: The mean age of the patients in Group A who received sildenafil; in this clinical trial, 72 patients aged below 45 years which have had at least two previous failed IVF attempts were randomly split into two groups each consisting of 36 patients was 33.8Â±4.8 in contrast to Group B (control group) with the mean age of 33.8Â±4.8. Mean endometrial thickness of 8.6Â±0.1 mm was recorded in Group B compared to 9.0Â±0.7 mm in Group A (p=0.03). Of all the 36 participants who received sildenafil citrate during the IVF cycle, 12 (33.3%) patients had successful pregnancies while 24 (66.7%) failed to get pregnant. In the control group, out of the 36 participants, 10 (27.8%) patients got pregnant while 26 (72.2%) failed the cycle (p=0.9).

Conclusion: This study showed that although using vaginal sildenafil during the IVF cycle does improve endometrial thickness before implantation, this does not necessarily lead to higher pregnancy rates.

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References

Hanson B, Johnstone E, Dorais J, Silver B, Peterson CM, Hotaling J. Female infertility, infertility-associated diagnoses, and comorbidities: A review. J Assisted Reprod Genet 2017;34:167-77.

Kukla R. Infertility, epistemic risk, and disease definitions. Synthese 2017:1-20.

Ramgir SS, Abilash VG. Genetic and environmental factors involved in human male infertility: A review. Asian J Pharm Clin Res 2015;8:34 43.

Anwar S, Anwar A. Infertility: A review on causes, treatment and management. Womenâ€™s Health Gynecol 2016;2:2-5.

Zoe R. Causes of infertility in women at reproductive age. Health Sci J 2009;3:80-7.

Sahu MC, Mishra SP, Panda R, Patnaik T. Surveillance of microbial flora for infertility couples in an indian tertiary care teaching hospital. Asian J Pharm Clin Res 2017;8:409-16.

Griesinger G, Trevisan S, Cometti B. Endometrial thickness on the day of embryo transfer is a poor predictor of IVF treatment outcome. Hum Reprod Open 2018;2018:hox031.

Alexander BT, Kassab SE, Miller MT, Abram SR, Reckelhoff JF, Bennett WA, et al. Reduced uterine perfusion pressure during pregnancy in the rat is associated with increases in arterial pressure and changes in renal nitric oxide. Hypertension 2001;37:1191-5.

Wareing M, Myers JE, Oâ€™hara M, Baker PN. Sildenafil citrate (Viagra) enhances vasodilatation in fetal growth restriction. J Clin Endocrinol Metab 2005;90:2550-5.

Unegbu C, Noje C, Coulson JD, Segal JB, Romer L. Pulmonary hypertension therapy and a systematic review of efficacy and safety of PDE-5 inhibitors. Pediatrics 2017;139:e20161450.

Holden EC, Dodge LE, Sneeringer R, Moragianni VA, Penzias AS, Hacker MR. Thicker endometrial linings are associated with better IVF outcomes: A cohort of 6331 women. Hum Fertil 2017:1-6.

Sher G, Fisch JD. Vaginal sildenafil (Viagra): A preliminary report of a novel method to improve uterine artery blood flow and endometrial development in patients undergoing IVF. Hum Reprod 2000;15:806 9.

Sher G, Fisch JD. Effect of vaginal sildenafil on the outcome of in vitro fertilization (IVF) after multiple IVF failures attributed to poor endometrial development. Fertil Steril 2002;78:1073-6.

Barroso RP, Osuamkpe C, Nagamani M, Yallampalli C. Nitric oxide inhibits development of embryos and implantation in mice. Mol Hum Reprod 1998;4:503-7.

Zinger M, Liu JH, Thomas MA. Successful use of vaginal sildenafil citrate in two infertility patients with Ashermanâ€™s syndrome. J Womenâ€™s Health 2006;15:442-4.