Correlation Between Vascularity Index And Pregnancy Rate During Improve Endometrial Receptivity In Thin Poorly Vascularized Endometrium Therapy

Abstract

Background: Pregnancy has been one of life’s great mysteries. The endometrium is where life begins, and a receptive endometrium
lies at the crossroads of menstruation and pregnancy.
Aim of the study: To evaluate the effects of different medical drugs used routinely to improve endometrial thickness, vascularity, and
pregnancy rates and to find out the best medical protocol could be used to improve endometrial thickness, vasculature, and pregnancy
rate for patient with thin and poorly vascularized endometrium regardless the cause.
Materials and methods: The study was carried out on 200 infertile women who have thin , poorly vascularized endometrium, after
they matched the inclusion and exclusion criteria , those patients were divided randomly into five groups ; 40 patient in each group,
group A received esterofem oral 2mg tablet every 12 hours from day 2 of menstrual cycle till the day of ovulation trigger , group B
received vagifem vaginal tablets 25 microgram from the fourth day of menstrual cycle for 15 days or till the day of ovulation trigger,
group C received sildenafil citrate gel 3 gm which containing 37.5 mg sildenafil every 12 hours from the 2nd day of menstruation till
the day of ovulation trigger, group D received pentoxifylline ( oral 800 mg daily) with vitamin E ( oral 400 IU daily) during the 6
cycles (this study period), and group E received 4 gm of pentoxifylline vaginal gel which is containing 200 mg pentoxifylline daily
which was timed to be 3 hours before intercourse from the 7th day of menstrual cycle till day 21 of the cycle. The endometrial
thickness, vascularity zones, sub endometrial flow and both uterine arteries resistance and pulsatility indices measured at mid cycle
(day11-14) on monthly basis for 6 cycles or till positive pregnancy test was achieved.
Results: The study showed that the mean of endometrial thickness before starting treatment for esterofem , vagifem, vaginal
sildenafil, pentoxifylline + vitamin E, and vaginal pentoxifylline gel groups were (4.770±0.842, 4.725±0.933,
4.663±0.996,5.002±0.993,and 4.855±1.138) respectively, after one month of treatment the means of the mentioned groups
respectively changed to (5.173±0.736,5.620±0.776,5.425±1.016,5.403±0.864,and5.373±1.095) which was asignificant change. The
study showed that the lowest mean of right uterine artery resistance index achieved after treatment was in the Pentoxifylline gel
group which was comparable to the results achieved by pentoxifylline+vit E group, followed by sildenafil, then estrofem and
vagifem groups who showed the highest resistance indeces for the right uterine artery among the study groups (unlike other drugs in
the study vagifem and esterofem has shown to increase the resistance index instead of improving it) . While for The left uterine
artery, the study showed that the lowest mean of resistance index was achieved by the pentoxifylline + vit E group which was
comparable to the results achieved by the sildenafil group, pentoxifylline gel , then estrofem and vagifem groups who showed the
highest resistance indeces for the left uterine artery among the study groups. Regarding the uterine arteries pulsatility index, the study
also showed that the lowest mean of right uterine artery pulsatility index achieved after treatment was in the pentoxifylline+ vit E
group, followed by pentoxifylline gel group then by vaginal sildenafil , while estrofem and vagifem groups showed the highest
pulsatility indeces for the right uterine artery among the study groups
Conclusions: Pentoxifylline vaginal gel, pentoxifylline tablet plus vitamin E capsule, and Sildenafil vaginal gel are found to be able
to improve the vascularity indeces of endometrium and uterine arteries, improve the endometrial thickness, and enhance the
pregnancy rates for patients with thin poorly vascularized endometrium with no seriuos adverse events.