Effect of Vaginal Sildenafil on in Vitro Fertilization Success Rates in Women With Previous Failed in Vitro Fertilization Attempts

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.

Sildenafil Supplementation for Women Undergoing Infertility Treatments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…We analyzed all outcomes according to the assisted reproductive technique used. Considering the number of included studies, we performed analyses firstly together and then separately by TI/IUI (TI/IUI group) [ 19 , 37 , 38 , 39 , 40 , 41 ] and IVF fresh-ET and frozen-ET (IVF fresh-ET/frozen-ET group) [ 12 , 42 , 43 , 44 , 45 , 46 ]. Full details about the included studies are available in Table 1 and Table 2 .…”

“…Six RCTs have been included in the IVF Fresh-ET/Frozen-ET section ( Table 2 ) with a total of 393 participants. Three RCTs reported data about COS with fresh embryo transfer with 198 patients included [ 42 , 45 , 46 ], and three RCTs reported data about FET with 195 patients included [ 12 , 43 , 44 ].…”

“…One study [ 46 ] did not report random sequence generation, and in three studies [ 12 , 43 , 45 ], an adequate method of random sequence generation was used, and the randomizing methods of last two studies [ 42 , 44 ] were judged at high risk of bias. Two studies [ 42 , 45 ] were double blinded, and four studies [ 12 , 43 , 44 , 46 ] did not report the blindness of participants and personnel. Two studies were placebo-controlled [ 42 , 45 ]; three [ 12 , 44 , 46 ] were treatment versus no treatment, and the remaining study [ 43 ] was vaginal Sildenafil vs. vaginal estradiol.…”

Effect of sildenafil citrate in women undergoing assisted reproduction: a meta-analysis based on randomized controlled trials

“…Trials were conducted between 2010 and 2020, of which 11 trials were published after 2016. The trials were conducted in Iran (4 trials) [18][19][20][21], Egypt (7 trial) [22][23][24][25][26][27][28], India (3 trials) [29][30][31], Korea (1 trial) [32], and one in Russia [33]. All trials were parallel.…”

Effect of sildenafil citrate on treatment of infertility in women with a thin endometrium: a systematic review and meta-analysis

“…11 Sildenafil citrate can be applied to patients with a thin endometrium, and it is effective for improving endometrial growth and pregnancy outcomes. 12,13 However, sildenafil citrate has also been shown not to have an effect on the endometrium. 14 Therefore, we performed a systematic review on the efficacy of sildenafil citrate for treating a thin endometrium.…”