The Effect of Sildenafil Citrate on Poor Endometrium in Patients Undergoing Frozen-Thawed Embryo Transfer following Resection of Intrauterine Adhesions: A Retrospective Study

Abstract

<b><i>Background:</i></b> The recent studies have shown that sildenafil citrate can enhance estrogen-induced proliferation of the endometrium in infertile women. <b><i>Objective:</i></b> This study was aimed to investigate whether sildenafil citrate could affect pregnancy outcomes in infertile women receiving frozen-thawed embryo transfer (FET) after resection of intrauterine adhesions (IUAs). <b><i>Materials and Methods:</i></b> A total of 310 subjects who met the inclusion criteria were recruited and divided into the control group (group A) and the sildenafil citrate group (or the SC group, group B). The 2 groups were, respectively, divided into 2 subgroups based on the severity of reformed adhesions: (1) group A1 (with mild IUAs) and group A2 (with moderate to severe IUAs) and (2) group B1 (with mild IUAs) and group B2 (with moderate to severe IUAs). Therapeutic effects of sildenafil citrate on the cases were evaluated after resection of IUAs during FET cycles. Endometrial thickness, endometrial pattern, and pregnancy outcomes were evaluated and compared between the 2 groups. <b><i>Results:</i></b> There was no significant difference in the number of embryos transferred between the 2 groups. The endometrial thickness in group B (0.80 [0.68–0.90] cm) was significantly higher than that in group A (0.73 [0.35–0.80] cm). Besides, the biochemical pregnancy rate, clinical pregnancy rate, and live birth rate (LBR) were 71.60, 50.83, and 39.17% in group B, which were significantly higher than those in group A, namely, 57.36, 34.73, and 23.68%, respectively (<i>p</i> < 0.05). The univariate analysis and multivariate logistic regression showed that the LBR in either subgroups of group B after vaginal sildenafil treatment was significantly higher than that in the corresponding control group (<i>p</i> < 0.05). <b><i>Conclusions:</i></b> It was observed that the administration of sildenafil citrate during FET could effectively improve the poor endometrial conditions after FET following the resection of IUAs.

What is the effect of sildenafil citrate intake on women undergoing assisted reproduction? A systematic review and meta-analysis of randomized controlled trials

“…Regarding the effects of SC on frozen-thawed embryo transfer (FET) cycles in the setting of ART, our results from included studies advocate that SC may positively affect endometrial receptivity, potentially enhancing blood flow to the uterus and improving the implantation rates of embryos during FET ( 19 ) . The medication is thought to exert influence by relaxing uterine smooth muscles and increasing blood flow, which could contribute to a more favorable environment for embryo implantation ( 56 ) . However, research on this topic is ongoing, and while some studies have shown promising results, further investigation is needed to establish the optimal dosage, timing, and overall efficacy of SC in the context of FET cycles ( 57 ) .…”

Effectiveness of phosphodiesterase type 5 inhibitors on the treatment of thin endometrium and pregnancy outcomes: An systematic review

“…12,39 On the other hand, the effect of sildenafil may be differ depending on the cause of thin endometrium. 19 These disorders and underlying factors must be diagnosed and treated before attempting another cycle for achieving fertility.…”

Injectable “Homing‐Like” Bioactive Short‐Fibers for Endometrial Repair and Efficient Live Births

“…Common manifestations of IUA include thin endometrium (TE), fibrosis, reduced endometrial receptivity, [ 6 , 7 , 8 , 9 , 10 ] and consequently, a low embryo implantation rate and live birth rate. [ 11 ] Current therapeutic approaches for the treatment of endometrial damage consist of hysteroscopic intrauterine adhesiolysis, [ 12 ] implementation of physical barriers such as intrauterine devices (IUDs) and Foley catheter balloons, [ 13 , 14 ] hormone therapy by exogenous estrogen administration and sildenafil, [ 15 , 16 ] and cell therapy such as colony‐stimulating factor, growth factors, and stem cells. [ 17 , 18 ] However, the clinical use of these strategies remains problematic due to complications such as recurrent postoperative adhesions, notable disparities in hormonal responses, and secondary infections.…”