Effect of Viagra in Pregnancy Rate of Female Fertility - Case Study Example

Effect of Viagra (sildenafil citrate) in pregnancy rate of female fertility July 22, Effect of Viagra (sildenafil citrtate) in pregnancy rate offemale fertility During the 1980s, when medical science had not advanced to the current level, the subject of female infertility was not clearly understood (Thorner, et al. 1975; Hull, et al. 1985). In those days, doctors assumed a number reasons for infertility, many of them untested, and a cure to address infertility was not available (Healy, et al. 1994; Thonneau, et al. 1991; Navot, et al. 1991). Research to isolate, test, and treat infertility problems was still in its infancy (Connolly, et al. 1992; Silber, et al. 1992; Templeton, et al. 1996). During this time, a few doctors took up important and fundamental research, along with clinical and field trials, in an attempt to understand and diagnose the reasons for infertility. This paper discusses the research undertaken by Sher, Chanona, and others. The paper examines the research on infertility and on the use of sildenafil citrate for the treatment of infertility. Dr. Sher (et al. 1985) relate their experiences in IVF fertilisation methods in clinical trials for 206 infertile women. In the study, 37.2% out of the control group of patients conceived and carried the baby beyond the sixth week of gestation. Reasons for failure in the remaining cases remained uncertain. Sher and Statland (1985) presented findings from a research that examined the reasons for Abruptio Placentae, the condition where the placenta is separated before the birth of the baby, in the first few months of the pregnancy. The findings indicate that this condition occurs when the blood supply to the uterine wall is reduced. Sher, along with a number of other authors, built up on this research and published a number of articles on the subject of infertility, and treatment with sildenafil citrate. Infertility treatment procedures in the 1990s were dangerous, and the mortality rate for women undergoing such procedures was high. Sher (et al. 1993a) undertook a research to find new methods of preventing life threatening complications that arose with treatment of menotropin-induced severe ovarian hyperstimulation. The research included 17 women who were treated to one cycle of ovarian hyperstimulation with menotropins, to prepare them for IVF. Complications became evident when nine women developed tubal occlusion, six developed endometriosis, while the remaining two remained infertile. The researchers concluded that severe ovarian hyperstimulation was to be avoided and menotropin therapy stopped. It was decided to treat the patients with other medication to increase blood flow in the uterine wall and to induce fertility. As a follow up, Sher (et al. 1993b) undertook a research to examine if fecundity rates of women with organic pelvic disease and those suffering from antiphospholipid antibodies, could be improved with intervention of heparin, and aspirin mixed with sildenafil citrate, during IVF embryo transfer procedures. Patients were orally administered, 81 mg of aspirin, and 5000 IU s.c of heparin, along with 30% mix of sildenafil citrate. The study concluded that ultrasound foetal cardiac activity was confirmed in 49 percent from the control group, while it remained unconfirmed in 16 % of the control group. Sher (et al. 1998) used these findings to conduct longitudinal studies on evaluating the impact of mini-dose heparin/aspirin, combined with sildenafil citrate and intravenous immunoglobulin G (IVIg), on IVF birth rates for patients who tested seropositive for antiphospholipid antibodies. The study conducted for four years in multicenter research centres, examined 687 APA+ patients, below 40 years. The results indicated that 477 or 46% of patients conceived, and gave birth through 923 IVF cycles. The research concluded that IVF birth rates for APA+ women improved with the treatment. Sher (et al. 2003) undertook a research to evaluate the graduated embryo score to predict the outcome of ART in comparison with one morphologic evaluation on day 3 of culture. Sample size for the study was 106 women, all above 40 years, and who had undergone treatment of the uterine cavity with ART. For 77 women, implementation of the embryo was accompanied by administering sildenafil citrate vaginally, while others were not administered the drug. The graduated embryo scoring, used as a predictor for pregnancy and implantation rates, showed 47% results for the 77 women, while for the other women, the score was less than 7%. The conclusions drawn were that pregnancy rates and implantation rates are better for morphologic evaluation on day 3, and have higher success rates for ART. The technology of oocyte cryopreservation that suffers from poor pregnancy rates of less than 4%, and low implantation rates appears to have obtained a fresh lease, as per the research reported by Sher (et al. 2008). Technical limitations of the freezing process and since less than 40% of oocytes are euploid, meaning that the oocytes are unable to produce embryos, reduces the efficiency of the cryo-preserving process. For the research, 16 donors contributed oocytes, out of which 78 were vitrified and fertilized using sperm injection. These eggs were transferred to the uterus of 19 recipients, along with a dosage of sildenafil citrate to boost blood circulation of the uterine wall. Out of the 19 recipients, 17 produced healthy babies. The study indicated a six times improvement in the pregnancy rate using cryo-preserved oocyte. If the method is validated and commercialised with egg cryo-banking processes, then women can expand their reproductive choices. Chanona (et al. 2004) conducted a research on the use of vaginal sildenafil citrate on patients who had a less than average endometrial response. The study was aimed at assessing the effectiveness of the chemical on women who had an endometrial thickness of less than 7 mm. The chemical was administered through vaginal application on 23 women of Mexican origin with a previous record of unsuccessful IVF treatment. After application and subsequent embryo transfer, the researchers reported a success rate of 73% for the control group, thus indicating that sildenafil citrate has an acceptable rate of success in treating women with fertility problems caused by less endometrial thickness. A number of other doctors have conducted research on the efficacy of sildenafil citrate for IVF. Neithardt (et al. 2005) examined the process of embryo after loading, after placing the catheter along with a dose of vaginally applied sildenafil citrate. With a sample size of 127 patients, it was observed that the clinical pregnancy rate of the group with ET, and with sidenafil was 52.4%, while it was 34.9% for the group without the dose. The researchers conclude that the chemical has a significant effect on the success of embryo transplant after loading. Zinger (et al. 2006) tested the efficacy of sildenafil citrate in the treatment of women with Ashermans syndrome, a problem when uterine synechiae is detected. Two patients were selected and after surgical resection of uterine synechiae, it was observed that they had inadequate endometrium along with thin endometrium, and the patients had failed to conceive despite repeated fertility treatment sessions. The patients were subsequently treated with vaginal sildenafil citrate. Transvaginal ultrasound was used to measure the endometrial thickness before and after treatment, and it was observed the the thickness had increased after application of the chemical. The researchers conclude that sildenafil citrate can be used after careful examination and testing of the patinet to improve fertilisation. Among the large number of infertility cases, or of pregnancy not carried to the full term, about 90% of the problems are due to premature delivery and intrauterine growth retardation (IUGR) problems. Research mentioned in the previous pages of this document does not indicate any evidence of treating IUGR cases. Villanueva-García (et al. 2007) carried out an extensive review of publications, and research report in the databases of PubMed and Science Citation Index to verify the effects of sildenafil on myometrium and IUGR cases. The research examined more than a thousand reports and clinical trials to find the effect of sildenafil on women with IUGR problems. A few cases were reported where negative and positive effects were observed on the uterine blood flow and endometrial development after the dosage of intravaginal sildenafil. The researchers conclude that there is limited information, and research on tackling the main reasons for infertility. Therefore, the claims and research reports from the eminent doctors may be true, but the validity and applicability is less, considering that the main reason for infertility remains untested. References Chanona, J., Garcı́a, M., Ruvalcaba, L., Bermúdez, A., Muñiz, M., Beltrán, M. and Cuneo, S., 2004. The Mexican experience in the use of vaginal sildenafil in patients with poor endometrial response. International Congress Series, 1271, pp: 19-21 Connolly, K. J., Edelmann, R. J., Cooke, I. D., and Robson, J., 1992. The impact of infertility on psychological functioning. Journal of psychosomatic Research, 36(5), pp: 459-468. Healy, D. L., Trounson, A. O., and Andersen, A. N., 1994. Female infertility: causes and treatment. The Lancet, 343(8912), pp: 1539-1544. Hull, M. G., Glazener, C. M., Kelly, N. J., Conway, D. I., Foster, P. A., Hinton, R. A., and Desai, K. M., 1985. Population study of causes, treatment, and outcome of infertility. British medical journal, 291(6510), pp: 1693. Navot, D., Bergh, R. A., Williams, M. A., Garrisi, G. J., Guzman, I., Sandler, B. and Grunfeld, L., 1991. Poor oocyte quality rather than implantation failure as a cause of age-related decline in female fertility. The Lancet, 337(8754), pp: 1375-1377. Neithardt, A. B., Segars, J. H., Hennessy, S., James, A. N. and McKeeby, J. L., 2005. Embryo afterloading: A refinement in embryo transfer technique that may increase clinical pregnancy. Fertility and Sterility, 83 (3), pp. 710-714 Sher, G., Knutzen, V., Stratton, C., Chotiner, H. and Mayville, K., 1986. In Vitro Fertilization and Embryo Transfer: Two-Year Experience. Obstetrics & Gynecology, 67(3), pp: 309-315. Sher, G. and Statland, B., 1985. Abruptio Placentae With Coagulopathy: A Rational Basis for Management. Clinical Obstetrics & Gynecology, 28 (1), pp. 15-23. Sher, G., Feinmen, M., Dodge, S., Zouves, C. and Knutzen, V., 1993a. Eliminating the Risk of Life-Endangering Complications Following Overstimulation With Menotropin Fertility Agents: A Report on Women Undergoing In Vitro Fertilization and Embryo Transfer. Obstetrics & Gynecology, 81 (6), pp: 2137-2149 Sher, G., Michael, F., Zouves, C., Kuttner., G., Ghanima, M., Rifaat, S., Matzner, W., Wendell, C. and Penny, Chong. 1993b. Immunology: High fecundity rates following in− vitro fertilization and embryo transfer in antiphospholipid antibody seropositive women treated with heparin and aspirin. Human Reproduction, 9 (12), pp: 2278-2283 Sher, G., Matzner, W., Feinman, M., Maassarani, G., Zouves, C., Chong, P. and Ching, W., 1998. The Selective Use of Heparin/Aspirin Therapy, Alone or in Combination with Intravenous Immunoglobulin G, in the Management of Antiphospholipid Antibody-Positive Women Undergoing In Vitro Fertilization. American Journal of Reproductive Immunology, 40 (2), pp: 74-82. Sher, G., Fisch, J., Adamowicz, M. and Keskintepe, L., 2003. The graduated embryo score predicts the outcome of assisted reproductive technologies better than a single day 3 evaluations and achieves results associated with blastocyst transfer from day 3 embryo transfer. Fertility and Sterility, 80 (6), pp: 1352-1358. Sher, G., Keskintepe, L., Mukaida, T., Keskintepe, M.,Ginsburg, M., Agca, Y., Maassarani, G., and Bayra, A., 2008. Selective vitrification of euploid oocytes markedly improves survival, fertilization and pregnancy-generating potential. Reproductive BioMedicine Online, 17 (4), pp: 524-529. Sher, G., Keskintepe, L., Keskintepe, L., Maassarani, G. and Ginsburg, M. 2009. Genetic analysis of human embryos by metaphase comparative genomic hybridization (mCGH) improves efficiency of IVF by increasing embryo implantation rate and reducing multiple pregnancies and spontaneous miscarriages. Fertility and Sterility, 92 (6), pp: 1886-1894. Silber, S. J., Nagy, Z., Devroey, P., Camus, M., and Van Steirteghem, A. C.; 1997. The effect of female age and ovarian reserve on pregnancy rate in male infertility: treatment of azoospermia with sperm retrieval and intracytoplasmic sperm injection. Human Reproduction, 12(12), pp: 2693-2700. Templeton, A., Morris, J. K., and Parslow, W., 1996. Factors that affect outcome of in-vitro fertilisation treatment. The Lancet, 348(9039), pp: 1402-1406. Thonneau, P., Marchand, S., Tallec, A., Ferial, M. L., Ducot, B., Lansac, and Spira, A., 1991. Incidence and main causes of infertility in a resident population (1 850 000) of three French regions (1988–1989). Human Reproduction, 6(6), pp: 811-816. Thorner, M. O., Besser, G. M., Jones, A., Dacie, J., and Jones, A. E., 1975. Bromocriptine treatment of female infertility: report of 13 pregnancies. British medical journal, 4(5998), pp: 694-701. Villanueva-García1, D., Mota-Rojas, R., Hernández-González, P., Sánchez, A., Alonso-Spilsbury, M., Trujillo-Ortega, M. E. and Necoechea, R. R., 2007. A systematic review of experimental and clinical studies of sildenafil citrate for intrauterine growth restriction and pre-term labour. Journal of Obstetrics & Gynaecology, 27 (3), pp. 255-259. Zinger, M., Liu, J. H. and Thomas, M. A., 2006. Successful Use of Vaginal Sildenafil Citrate in Two Infertility Patients with Ashermans Syndrome. Journal of Womens Health, 15(4), pp: 442-444. Read More