Moini A, Zafarani F, Jahangiri N, Jahanian Sadatmahalleh SH, Sadeghi M, Chehrazi M, Ahmadi F. The Effect of Vaginal Sildenafil on The Outcome of Assisted Reproductive Technology Cycles in Patients with Repeated Implantation Failures: A Randomized Placebo-Controlled Trial.
INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2019;
13:289-295. [PMID:
31710189 PMCID:
PMC6875854 DOI:
10.22074/ijfs.2020.5681]
[Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 03/02/2019] [Indexed: 11/23/2022]
Abstract
Background
The aim of this study was to investigate the effects of vaginal sildenafil on the outcome of patients with
at least two unsuccessful in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) attempts.
Materials and Methods
In this randomized placebo-controlled trial study, a total of 66 infertile women aged ≤38
years, with a history of normal ovarian reserve, two prior consecutive failed IVF/ICSI attempts, human chorionic
gonadotropin (hCG) day endometrial thickness <7 mm in all prior IVF/ICSI cycles, normal endometrial appear-
ance by either hysteroscopy, hysterosonography, or hysterosalpingography enrolled in this study. The conventional
gonadotropin-releasing hormone (GnRH) protocol was used for ovarian stimulation. The patients were randomly
divided into three groups: vaginal sildenafil (suppository-100 mg/daily), vaginal placebo/sildenafil (suppository-100
mg/daily), and vaginal placebo (suppository). Each patient underwent colour Doppler ultrasound on day 14 of their
previous cycle to investigate any abnormalities in the uterus and adnexa. Endometrial thickness, echo pattern, uterine
artery resistance, and pulsatility indices were recorded pre- and post-treatment. The primary outcome measures were
implantation, chemical and clinical pregnancy rates. For data analysis, SPSS version 20 software was used. In all tests,
the significance level was considered less than 0.05.
Results
There was no significant difference between three groups in endometrial thickness on the hCG injection day.
The chemical pregnancy in women who received sildenafil (alone or in combination with placebo) showed a two-fold
increase in comparison to the placebo group. This increase was clinically meaningful, but according to sample size,
it was statistically non-significant. The results of our study showed that the implantation was higher in women who
received placebo/sildenafil compared to the other groups. The abortion rate was not statistically significant among the
groups.
Conclusion
Vaginal sildenafil may conceivably improve chemical pregnancy rates in repeated IVF failure patients.
Further randomized clinical trials using oral or vaginal sildenafil with higher sample size are recommended (Registra-
tion number: NCT03192709).
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