THE EFFECT OF SILDENAFIL VERSUS ESTRADIOL VALERATE ON ENDOMETRIAL THICKNESS AND PATTERN IN INFERTILE FEMALES

Dalia Ibrahim MD*, Nadia Abozied MD, Samy Makary MD and Hamsa Rashwan

ABSTRACT

Background and aim: Female causes account for 30% of the total infertility cases of these causes 5% are due to uterine factors .very thin endometrium (< 7mm) seems to be accepted as a reliable sign of suboptimal implantation potential. Sildenafil enhances the effect of NO by inhibiting phosphodiesterase type 5 (PDE5) which is responsible for degradation of cGMP. Sildenafil is a selective inhibitor of the type V cGMP-specific phosphodiesterase. With the use of sildenafil, cGMP levels remain elevated, which leads to vascular relaxation and increased blood flow to improved the endometrial thickness. Objective: This case control study was designed to compare the use of estrogen alone or in combined with Sildenafil on the endometrial thickness and pattern in infertile women. Methods: 30 patients had primary or secondary infertility were attending to the outpatient infertility clinic. All patients undergo ovulation induction by clomiphene citrate and gonadotropins. And evaluated by TVS at day 8th, bad endometerium (thickness <6 mm) in 30 patients. Devided into 3 groups: G1: 10 patients of them did not receive any treatment to improve endometrial thickness. G2: 10 patients of them received Estradiol valerate 2mg 2 tab orally daily from day 8th of the cycle till ovulation, And G3: 10 patients of them received Estradiol valerate 2mg 2 tab orally daily and sildenafil citrate 25mg vaginally every 6 hours from day 8th of the cycle till ovulation. And those patients were reevaluated by TVS at day 13th of cycle for endometrial thickness and pattern with number and size of Graffian follicle. Results: In this study we found that a total of 30 infertile had a mean of endometrial thickness of 5.1±1.1 mm at 8th day of cycle. There was statistically significant increase in the endometrial thickness from day 8th to day 13th in G3 as compared to that of the patients in control group G1 and as compared to G2, the difference is highly significant. Conclusion: Sildenafil citrate with Estradiol valerate increase the endometrial thickness significantly as compared to control group or Estradiol valerate alone.

Keywords: Sildenafil citrate, infertile female, endometrial thickness, Estradiol valerate.