What is the effect of sildenafil citrate intake on women undergoing assisted reproduction? A systematic review and meta-analysis of randomized controlled trials/Sildenafil sitrat aliminin yardimci ureme teknikleri uygulanan kadinlar uzerinde etkisi nedir? Randomize kontrollu calismalarin sistematik bir incelemesi ve meta-analizi

• Published in: Turkish journal of obstetrics and gynecology Vol. 20; no. 4; p. 293
• Main Authors: Baradwan, Saeed, Abuzaid, Mohammed, Alshahrani, Majed Saeed, Sabban, Hussein Talal, Alkhamis, Waleed H, Badghish, Ehab, Alkhiary, Ammar Y, Bukhari, Ibtihal Abdulaziz, Alyousef, Abdullah, Alomar, Osama, Abu-Zaid, Ahmed
• Format: Journal Article
• Language: English
• Published: Galenos Yayinevi Tic. Ltd 01.12.2023
• Subjects: Care and treatment; Evaluation; Infertility, Female; Patient outcomes; Pharmaceutical research; Reproductive technology; Sildenafil; Saudi Arabia
• ISSN: 2149-9322
• DOI: 10.4274/tjod.galenos.2023.59207

Assisted reproductive technologies (ART) have become a vital option for women facing fertility challenges. One of the potential interventions being explored is the use of sildenafil citrate (SC) to improve clinical outcomes in ART procedures. The aim of this study was to assess the impact of SC on clinical outcomes in women undergoing ART. A comprehensive literature search was conducted using multiple databases, including PubMed, Scopus, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. The search covered studies from inception until April 15, 2023, and identified relevant randomized controlled trials (RCTs) for inclusion in the analysis. The endpoints were summarized as risk ratio (RR) or standardized mean difference (SMD) with 95% confidence interval (CI). After meticulous analysis, twenty-eight RCTs comprising 3,426 women were included in the study. The results revealed significant findings regarding the impact of SC on clinical pregnancy (CP) rates. Women receiving SC demonstrated a significantly higher probability of CP compared to the control group (n=21 RCTs, RR=1.43; 95% CI: 1.29, 1.59). Additionally, when SC was combined with other medications like clomiphene citrate (CC) or estradiol valerate, it further improved the likelihood of CP compared to these medications alone (RR=1.35, 95% CI: 1.19, 1.53; RR=1.55, 95% CI: 1.08, 2.22, respectively). Furthermore, the study observed that the mean endometrial thickness (ET) was significantly higher in women who received SC compared to the control group, which involved other active interventions or placebo (SMD=0.77, 95% CI: 0.20, 1.34). Particularly, the administration of SC resulted in a notably higher ET level compared to the placebo (SMD: 1.33, 95% CI: 0.15, 2.51). The findings suggest that luteal supplementation of SC can be considered a beneficial approach to enhance ET and improve the CP rate in women undergoing ART. Keywords: Assisted reproduction technology, sildenafil citrate, endometrial thickness, chemical pregnancy, clinical pregnancy Yardimci ureme teknolojileri (YUT), dogurganlik sorunlari yasayan kadinlar icin hayati bir secenek haline geldi. Arastirilan potansiyel mudahalelerden biri, YUT prosedurlerinde klinik sonuclari iyilestirmek icin sildenafil sitratin (SS) kullanilmasidir. Bu calismanin amaci, YUT uygulanan kadinlarda SS'nin klinik sonuclar uzerindeki etkisini degerlendirmektir. PubMed, Scopus, Embase, Web of Science ve Cochrane Central Register of Controlled Trials dahil olmak uzere bircok veri tabani kullanilarak kapsamli bir literatur arastirmasi yapildi. Arastirma, baslangictan 15 Nisan 2023'e kadar olan calismalari kapsadi ve analize dahil edilecek ilgili randomize kontrollu calismalari (RKC'ler) belirledi. Sonlanim noktalari, risk orani (RR) veya %95 guven araligi (GA) ile standartlastirilmis ortalama fark (SOF) olarak ozetlendi. Titiz bir analizin ardindan calismaya 3.426 kadini kapsayan 28 RKC dahil edildi. Sonuclar SS'nin klinik gebelik (KG) oranlari uzerindeki etkisine iliskin onemli bulgular ortaya cikardi. SS alan kadinlar, kontrol grubuyla karsilastirildiginda anlamli olarak daha yuksek KG orani gosterdi (n=21 RKC, RR=1,43; %95 GA: 1,29, 1,59). Ek olarak SS, klomifen sitrat veya ostradiol valerat gibi diger ilaclarla birlikte kullanildiginda, KG olasiligini bu ilaclarin tek olarak kullanimi ile karsilastirildiginda daha da artirdi (sirasiyla, RR=1,35, %95 GA: 1,19, 1,53; RR=1,55, %95 GA: 1,08, 2,22). Ayrica bu calismada, diger aktif mudahaleleri veya plaseboyu iceren kontrol grubuyla karsilastirildiginda SS alan kadinlarda ortalama endometrial kalinligin (EK) anlamli derecede daha yuksek oldugu gozlemlendi (SOF=0,77, %95 GA: 0,20, 1,34). Ozellikle SS'nin uygulanmasi, plaseboya kiyasla belirgin sekilde daha yuksek bir EK seviyesiyle sonuclandi (SOF: 1,33, %95 GA: 0,15, 2,51). Bulgular, SS'nin luteal takviyesinin, YUT uygulanan kadinlarda EK'yi artirmak ve KG oranini iyilestirmek icin yararli bir yaklasim olarak degerlendirilebilecegini gostermektedir. Anahtar Kelimeler: Yardimci ureme teknolojisi, sildenafil sitrat, endometrial kalinlik, kimyasal gebelik, klinik gebelik