Vaginal sildenafil (Viagra): a preliminary report of a novel method to improve uterine artery blood how and endometrial development in patients undergoing IVF
Vaginal sildenafil (Viagra): a preliminary report of a novel method to improve uterine artery blood how and endometrial development in patients undergoing IVF
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DOI：
10.1093/humrep/15.4.806
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发表时间：
2000-04-01
影响因子：
6.1
通讯作者：
Fisch, JD
中科院分区：
文献类型：
--
作者：
Sher, G;Fisch, JD
子宫内膜的生长被认为依赖于子宫动脉的血液，子宫内膜发育对体外受精(IVF)结局的方式和重要性已有报道。一氧化氮(NO)通过cGMP介导的途径松弛血管平滑肌，并在子宫中发现了一氧化氮合酶同工酶。柠檬酸西地那非(Viagra)是一种5型特异性磷酸二酯酶抑制剂，它通过阻止cGMP的降解来增强NO的血管扩张作用。在这份初步报告中，我们描述了在4例因子宫内膜反应不良而导致辅助生殖周期失败的患者中，使用阴道西地那非改善子宫动脉血流和超声子宫内膜外观的情况。用Lupron下调垂体后，在模拟周期中测定子宫动脉搏动指数(PI)。服用西地那非7天后，PI下降(表明血流增加)，并在安慰剂治疗后恢复到基线水平。西地那非和戊酸雌二醇联用改善了所有患者的血流和子宫内膜厚度。这些发现在随后的促性腺激素刺激周期中重现。四名患者中有三名怀孕了。虽然需要更多的患者和随机评估来验证这种治疗，但阴道西地那非可能在改善子宫动脉血流和子宫内膜发育方面对先前子宫内膜反应不良的体外受精患者有效。
Endometrial growth is thought to depend on uterine artery blood how and the importance of endometrial development on in-vitro fertilization (IVF) outcome has been previously reported. Nitric oxide (NO) relaxes vascular smooth muscle through a cGMP-mediated pathway and NO synthase isoforms have been identified in the uterus. Sildenafil citrate (Viagra), a type 5-specific phosphodiesterase inhibitor, augments the vasodilatory effects of NO by preventing the degradation of cGMP. In this preliminary report we describe the use of vaginal sildenafil to improve uterine artery blood flow and sonographic endometrial appearance in four patients with prior failed assisted reproductive cycles due to poor endometrial response. The uterine artery pulsatility index (PI) was measured in a mock cycle after pituitary down-regulation with Lupron. The PI was decreased after 7 days of sildenafil (indicating increased blood flow) and returned to baseline following treatment with placebo. The combination of sildenafil and oestradiol valerate improved blood flow and endometrial thickness in all patients. These findings were reproduced in an ensuing gonadotrophin-stimulated cycle. Three of the four patients conceived. Although greater numbers of patients and randomized evaluation are needed to validate this treatment, vaginal sildenafil may be effective for improving uterine artery blood how and endometrial development in IVF patients with prior poor endometrial response.