The Effect of Estradiol Valerate with and without Oral Sildenafil on Endometrial Thickness and Pregnancy Rates in Infertile Women: A R.C.T

Abstract

Abstract Objectives To evaluate the effect of sildenafil-estrogen combination compared to estrogen alone on endometrium thickness in infertile women received induction of ovulation by clomiphene citrate. Study design Randomized controlled clinical trial. Settings University hospital, Ain Shams University Maternity Hospital. Materials and methods 90 infertile women with unexplained infertility, were recruited and randomly allocated into two equal groups, 45 patients in each. Both groups received induction of ovulation with CC 100mg/d from 2nd to 6th day of cycle and oral estradiol valerate 2mg 12 hourly from 2nd day of the cycle till the day of trigger of ovulation. In study group oral sildenafil citrate 25mg every 8 h from 2nd day of the cycle till the day of HCG trigger was added. Endometrium was evaluated as regards both endometrial thickness and pattern, uterine artery resistive index (RI) was measured at the day of trigger. Qualitative serum B-hCG level was checked 14 days after ovulation to assess chemical pregnancy rate. Results Mean endometrial thickness at the time of hCG trigger was 9.8 mm in study group and 8.42 mm in control group (P value <0.001). 88.9% patients given sildenafil had trilaminar endometrium whereas 29% patients without sildenafil had bilaminar endometrial pattern (P value = 0.006). Mean uterine artery resistive index (RI) after adding sildenafil was non-significantly lower among study group than among control group, the value were 0.66 and 0.72 respectively (P = 0.078). Pregnancy rates in study group and control group was 17.8% and 11.1% respectively. Conclusion Sildenafil-estrogen combination has a potent effect on improving the endometrium (thickness and pattern) in patients undergoing induction of ovulation by clomiphene citrate. This improvement in endometrial development has a weak positive feedback on pregnancy rate.