Role of Sildenafil in Improvement of Endometrial Receptivity Markers in Fresh ICSI Cycles

Receptivity of endometrial is a series of events which enhance implantation of the embryo. It is controlled by several growth factors, cytokines and steroid hormones. The current study aims to assess the influences of vaginally managed sildenafil in ICSI patients on the thickness of endometrial, sub endometrial resistance index and pulsatility index, serum level of vascular endothelial growth factor (VEGF) and pregnancy outcome. The study was planned as a controlled randomized trial (interventional experimental study) involved a total of sixty women who attend High Institute of Infertility Diagnosis and Assisted Reproductive Technologies who undergo ICSI cycle. Enrolled patients divided into two groups: 1) Study group: thirty (30) infertile women had received sildenafil 25mg tablet intravaginally four times daily form the day of stopping blood of menstrual cycle to the day of hCG injection. 2) Control group: thirty (30) infertile women had not treated by sildenafil. In our study, we found the following results: the level of vascular endothelial growth factor was highly significant in the study group. The sub endometrial Doppler study, the mean pulsatility index was significantly lower in the study group, while no significant difference in the resistant index and mean systolic to the diastolic ratio between study and control groups. The thickness of endometrial on the same day of ova pickup was higher in the study group, although statistically not significant. The pregnancy rate of sildenafil group was higher. However, the difference was not statistically significant. We concluded the using vaginal sildenafil during fresh ICSI cycle improve endometrial receptivity by enhancing sub endometrial blood flow through reducing pulsatility index and increasing vascular endothelial growth factor.