title: Effect of vaginal sildenafil on the outcome of in vitro fertilization (IVF) after multiple IVF failures attributed to poor endometrial development.
abstract: OBJECTIVE
  To evaluate the effects of vaginally administered sildenafil on endometrial thickness and IVF outcome in a large cohort of infertile women with poor endometrial development.
  
  
  METHODS
  Retrospective cohort analysis.
  
  
  METHODS
  Private practice setting.
  
  
  METHODS
  A cohort of 105 infertile women aged <40 years, with normal ovarian reserve and at least two consecutive prior IVF failures attributed to inadequate endometrial development.
  
  
  METHODS
  Patients underwent IVF using a long GnRH-a protocol with the addition of sildenafil vaginal suppositories (25 mg, 4 times per day) for 3-10 days.
  
  
  METHODS
  Peak endometrial development, pregnancy, and implantation rates.
  
  
  RESULTS
  Of 105 patients, 73 (70%; Group A), attained an endometrial thickness of >/=9 mm, whereas 32 (30%; Group B) did not. Implantation and ongoing pregnancy rates were significantly higher for Group A (29% and 45%) than for Group B (2% and 0). Of 11 women in Group B who had embryos transferred in that cycle, only one conception occurred, which resulted in a miscarriage. In Group B, 59% of women had a history of endometritis, compared with 44% in Group A.
  
  
  CONCLUSIONS
  Vaginal administration of sildenafil enhanced endometrial development in 70% of patients studied. High implantation and ongoing pregnancy rates were achieved in a cohort with a poor prognosis for success. Previous endometritis may decrease the response to sildenafil.
authors.affiliation: Sher Institute for Reproductive Medicine, Las Vegas, Nevada, USA. gsher@sherinstitute.com
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Sher
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Fisch
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D015331:Cohort Studies; D010064:Embryo Implantation; D004717:Endometrium / Q000187:drug effects / Q000503:physiopathology; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D010879:Piperazines / Q000008:administration & dosage* / Q000627:therapeutic use; D011247:Pregnancy; D018873:Pregnancy Rate; D011687:Purines; D019233:Retreatment; D012189:Retrospective Studies; D000068677:Sildenafil Citrate; D013450:Sulfones; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate