292 IJSR - INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH Volume : 4 | Issue : 8 | Aug 2015 • ISSN No 2277 - 8179 Research Paper Medical Science Mishra V. V. B.J. Medical College, Civil Hospital, Ahmedabad – 380016 Choudhary S. B.J. Medical College, Civil Hospital, Ahmedabad – 380016 Bandwal P. B.J. Medical College, Civil Hospital, Ahmedabad – 380016 Aggarwal R. B.J. Medical College, Civil Hospital, Ahmedabad – 380016 Agarwal R. B.J. Medical College, Civil Hospital, Ahmedabad – 380016 Gandhi K. B.J. Medical College, Civil Hospital, Ahmedabad – 380016 Vaginal Sildenafil: Role in Improving Endometrial Blood Flow in Women Undergoing IVF With Frozen- awed Embryo Cycles- A Study Over ree Cycles KEYWORDS : ABSTRACT OBJECTIVE: To investigate the effect of vaginal sildenafil on endometrial blood flow in infertile women with prior poor endometrial response. MATERIAL AND METHODS: is study was carried out in the Department of Obstetrics and Gynecology of IKDRC-ITS, Ahmedabad from January 2014 to December 2014. A total of 55 infertile women with an antecedent poor endometrial vascularity and frozen embryos were included in this study. e women were given oral estradiol valerate tablets (6- 20 mg daily), and tablet ecospirin ( 75 mg daily)from day 2-14 of the cycle to prepare the endometrium . Womenwere advice to take sildenafil capsule intravaginally, 25 mg thrice a day, starting from day 5-13 of the cycle. Assessment of endometrial thickness, pattern and vascularity was done on day 14 of the cycle on voluson E8 using transvaginal probe (5-9 MHz). RESULTS: Twenty seven (49.9%) women showed improvement in vascularity. Embryo transfer was done in 19 women, out of which 9(47.36%) conceived. CONCLUSION: As our study shows, intravaginal use of sildenafil is a good way to improve endometrial vascularity and receptivity. We recom- mend the routine use of vaginal sildenafil in women with a previous failure of assisted reproductive technology cycles due to poor endometrial response. Introduction e 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. Di- verse and unexplained factors affecting implantation rates have become a major limiting factor. erefore, 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 implanta- tion failure (1). Endometrial receptivity during the implantation window de- pends on various factors , the morphological markers are (2): 1. Endometrial thickness 2. Endometrial echogenic pattern 3. Endometrial and sub endometrial blood flow To improve poor endometrial response, several regimens have been put forward, including treatment with estrogens and low dose aspirin (3,4).In the past few years, much interest has been focused on the role of nitrous oxide(NO) as a modulator of uter- ine blood flow (5) Estrogen induced endometrial proliferation is, in large depend- ent upon blood flow to the basal endometrium (6). NO is a key signaling molecule involved in the vasodilatory response of smooth muscle cells. NO activates the cyclic guanosine monophosphate (cGMP)/protein kinase G (PKG) pathway within smooth muscle cells to promote smooth muscle cell relaxation. Sildenafil citrate inhibits phosphodiesterase 5 (PDE5) maintain- ing activation of cGMP and PKG and maximizing the effect of existing NO, thus facilitating smooth muscle cell relaxation. e potent vasodilatory action of sildenafil has led researchers to evaluate sildenafil as a treatment in assisted reproduction where low uterine blood flow is perceived to be a contributor to im- plantation failure (7,8).e current study was designed to inves- tigate the effect of vaginal sildenafil on the subendometrial and endometrial blood flow. Materials and methods is prospective study was carried out in the Department of Obstetrics and Gynecology of Institute of Kidney Disease and Research Centre, Ahmedabad from January 2014 to December 2014. A total of 55 women with frozen embryos with an anteced- ent poor endometrial vascularity were included in this study. e project was approved by the ethical committee of this insti- tute. e women participating gave their informed written con- sent. e study was carried out over 3 continuous cycles. Inclusion criteria: 1. Age < 45 years 2. Have high quality frozen embryos Exclusion criteria: 1. History of endocrine diseases. 3. Cardiovascular, renal and liver diseases. 4. Hypotension (blood pressure <90/50 mmHg). 5. History of stroke or myocardial infarction. Women who met these conditions were recruited in the study. e women were given oral estradiol valerate tablets (6 mg- 20 mg daily), dose depending upon the day-14 endometrial thickness in previous cycles and tablet ecospirin (75 mg daily) from day- 2- 14 of the cycle to prepare the endometrium .Women were advised to ad- minister sildenafil capsule intravaginally, 25 mg thrice a day, start- ing from day-5 to day 13 of the cycle. Assessment of endometrial thickness, pattern and vascularity was done on 14 th day of the cycle. Transvaginal Ultrasonography was done using transvaginal probe (5 to 9 MHz) on Voluson E8 ( GE medical systems).After obtaining a