الفهرس 
INFERTILITYOnly 14 pages are availabe for public view
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Abstract
O
vulation is a complex process involving many organs. The three major organs that regulate the female ovulation are the hypothalamus, the pituitary and the ovary. The hypothalamus is a pulsatile generator of reproduction produces and secrete GnRH which by reaching the pituitary evokes the release of FSH and LH. In response to gonadotropin stimulation the ovaries initiate a dynamic process of steroidogenesis which results in the formation of mature ovum ready to be fertilized. Any defect in this group of complex processes results in failure of ovulation.
Infertility affects up to one in seven couples nowadays, a proportion of these couples may be able to ultimately conceive but for the majority conception in unlikely without some form of medical intervention.
Clomiphene citrate is the traditional first line treatment of anovulation, but only 75% of patient responds positively. Clomiphene citrate resistance was defined as failure to ovulate to a dose schedule of 200 mg / day for five days or failure of follicular maturation after receiving a dose of CC 100mg/day for 5 days for the three consecutive cycles.
Ovulation induction with gonadotropins is the standard treatment for clomiphene citrate resistance women however this is expensive and has added risks of ovarian hyperstimulation and multiple pregnancies.
Recently, a new regimen of clomiphene citrate with gonadotropin was used in ovulation induction with this was termed minimal stimulation protocol.
Sildenafil citrate is a phosphodiasterase inhibitors type 5 which increase level of nitric oxide lead to relaxation of vascular and non-vascular smooth tissue, increasing pelvic blood flow. So increase number of follicles and endometrial thickness which lead to increasing receptivity and implantation.
The aim of this study is to determine the effect of sildenafil citrate 25 mg on pregnancy rates in females undergoing induction of ovulation by clomiphene citrate 50mg.
Methodology
The study included 70 patients who were randomized into two groups. Group 1 included 35 patients who were given sildenafil citrate 25 mg from 7th day to 11th day of the cycle three times per day orally and clomiphene citrate 50 mg from 3rd day till 7th day of the same cycle three times per day orally. Group 2 included 35 patients who were given clomiphene citrate 50 mg from 3rd day to 7th day of the cycle three times per day orally. Transvaginal u/s was done to detect endometrial thickness and number of follicles on day 13 or 14 of the cycle, injection of 5000 IU HCG IM to trigger ovulation. Finally, pregnancy was detected chemically by measuring B-HCG.
Results
The use of oral sildenafil citrate 25 mg 3 times / day from 7th day to 11th day of the LMP in females undergoing induction of ovulation with clomiphene citrate 50 mg from 3rd day to 7th day lead to:
Increase number of follicles with sildenafil citrate versus placebo.
Increase endometrial thickness with sildenafil citrate versus placebo.
Increase pregnancy rate to be 65% with sildenafil citrate versus 40% with placebo.
Conclusion
It could be concluded from this study that oral use of sildenafil citrate 25 mg in females under going induction of ovulation lead to increase number of follicles, endometrial thickness and so increase pregnancy rate.
We recommend from this study to detect effect of oral sildenafil citrate on fetal outcome in pregnant women.