Article Type

Original Study


Objective The oblective of this study was to evaluate the endometrial response of women with unexplained infertility after treatment with sildenafil citrate (viagra) suppositories. Background Unexplained infertility refers to failure to conceive in a couple with no definitive cause. Endometrial thickness (ED TH) and perfusion may have an important contribution to etiopathogenesis of unexplained infertility. Patients and methods A total of 50 women with unexplained primary infertility were treated with 25 mg of sildenafil citrate suppositories four times per day for 7 days starting from the fifth day of the menstrual cycle for three cycles. Ultrasonographic measurement of ED TH and the mean resistance index (RI) values of endometrial spiral artery (SA) assessed by transvaginal color-pulsed Doppler ultrasound were measured in women with unexplained infertility before and after sildenafil citrate treatment and compared with an equal number of a fertile control group receiving no treatment. The conception rate and pregnancy outcome were recorded in the two groups. Results Women with unexplained infertility in the present study had a significantly thinner endometrium and a higher SA-RI (6.52 + 0.77; 1.00 + 0.23 mm, respectively), meaning lower peri-implantation blood flow compared with fertile controls (11.98 + 1.23; 0.58 + 0.06 mm, respectively). Sildenafil citrate-treated women showed a statistically significant increase in ED TH (8.87 + 0.56 mm; P < 0.001) and a significant decrease in the mean SA-RI (0.61 + 0.07; P < 0.001), yielding a better conception rate. Conclusion Treatment with viagra suppositories enhances endometrial blood flow by decreasing the SA-RI and consequently improves endometrial growth and receptivity in cases of unexplained infertility, thus yielding a better conception rate.