Effect of Oral Estradiol Valerate versus Vaginal Sildenafil on Endometrial Receptivity Evaluated by Ultrasound and Pregnancy Rate in Iraqi Infertile Females

Abstract

Sundus Ali Dawood, Huda Ali Hussaini, Mufeda Ali.

Female causes account for 30 percent of the overall infertility cases, five percent were attributed to uterine factors. Endometrial thickness (ET) is one of the best predictors of implantation rate and continued success rate for pregnancy. There were possible beneficial effects of sildenafil citrate or estradiol on endometrial receptivity so some reports discussed these potential effects
The aim: of this study is to compare the effect of estradiol valerate and vaginal sildenafil citrate on endometrial receptivity (endometrial thickness, serum Vascular Endothelial Growth Factor) and pregnancy rate in infertile Iraqi women
Subjects and Methods: Sixty infertile women were included in this comparative prospective study undergoing stimulated cycles and timed intercourse. Patients diagnosed previously to have thin endometrium were divided randomly into two groups. In group A, thirty patients were given estradiol valerate 2 mg tablet 12 hourly. In group B, 30 patients were given sildenafil citrate 25 mg vaginally every 6 hours. Patients were evaluated by using trans-vaginal sonography (TVS) to determine and compare the effects of estradiol valerate and vaginal sildenafil citrate on endometrial thickness, pattern, and serum assessment of Vascular Endothelial Growth Factor VEGF levels and pregnancy outcome in both groups.
Results: Mean endometrial thickness at HCG day was 9.19 mm in estradiol treated group and 8.86 mm in sildenafil treated group which was more in estradiol group but statistically insignificant (p>0.05). And endometrial triple line pattern in the Estradiol and sildenafil citrate groups was 96.6%, and 90% respectively. VEGF level in estradiol treated group was (220.5 ng/l) compared to sildenafil treated group (232.2), which is statistically significant difference (p <0.05). The pregnancy rates were 4 (16.7%) in group A and 11(73.3%) in group B which was statistically significant difference between the two groups (p<0.05)
Conclusions: Both Sildenafil citrate and estradiol valerate may be used to improve endometrial receptivity, but this study showed that the pregnancy rate with Sildenafil was significantly higher than with estradiol.