الفهرس 
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Abstract
SUMMARY
he etiology of infertility is diverse. Despite the improvement
in ovarian stimulation protocols and techniques, results of in
vitro fertilization (IVF) has unfortunately reached a plateau.
Diverse and unexplained factors affecting implantation rates have
become a major limiting factor. Therefore, more attention needs
to be focused on implantation and endometrial receptivity.
Good embryo quality, appropriately timed and arranged
endometrial receptivity, and efficient crosstalk between the
embryo and the receptive endometrium are required for
successful implantation. Impairment of any one of these factors
may result in implantation failure.
Clomiphene has been used to induce ovulation in patients
suffering from chronic oligo-anovulation and ovulatory dysfunction.
Anti-estrogenic effects of clomiphene on the
endometrium are likely to be one of the causes of suboptimal
pregnancy rates in spite of good ovulation rates.
To improve poor endometrial response, several regimens
have been put forward, including treatment with estrogens and
low dose aspirin. Sildenafil citrate improves the uterine artery
blood flow and the endometrial thickness in women diagnosed
as unexplained infertility. Sildenafil citrate can be used orally
or vaginally to improve endometrial receptivity.
T
Summary ¨
67
To evaluate the efficacy of the orally administered
sildenafil citrate on the endometrial thickness and pattern,
uterine artery blood flow and pregnancy rate in infertility
patients undergoing induction of ovulation.
This study was conducted at the infertility outpatient
clinic in Ain Shams University Maternity Hospital during the
period from October 2017 to May 2018. Ninety patients were
involved in the current study. Patients incorporated in the study
were randomly allocated to 2 equal groups using a randomized
computer number generation by the closed envelope method.
According to inclusion and exclusion criteria of the
study, they were divided into two equal groups, Study group
received clomiphene citrate, estradiol valerate and sildenafil
and control group received clomiphene citrate and estradiol
valerate with no difference as regard demographic basal
maternal hormonal profile and basal partner’s semen analysis.
2-D Doppler transvaginal ultrasound was done,
Endometrial thickness, pattern and vascularity of all groups from
the day 10th day of the cycle every 48 hour till the dominant
follicle reach 18mm were assessed, Triggering of ovulation was
done by hCG IM injection single dose and the patient was asked
to have a coitus from 34-36 hours after triggering of ovulation,
then progesterone support was prescribed to every patient form
the day of ovulation for 14 days.
Summary ¨
68
Result
The current study showed that uterine artery resistive
indices (RI) after intervention was non-significantly lower
among study group than among control group (P= 0.078),
Endometrial blood flow RI after intervention was highly
significantly lower (P<0.001) among study group compared to
control group.
Ovarian volume on the day of trigger was significantly
higher among study group compared to control group.
There was no statistically significant difference between
study and control groups regarding basal endometrial thickness
(P>0.05). On the day of trigger, Study group had highly
significantly increase in endometrial thickness (P<0.001)
compared to control group.
Trilaminar pattern of endometrium was present more in
the study group than the control group with the difference being
highly statistically significant.
The present study depicted that chemical pregnancy
occurred more in the study group than control group, yet the
difference was not statistically different (P>0.05