Effectiveness of phosphodiesterase type 5 inhibitors on the treatment of thin endometrium and pregnancy outcomes: An systematic review

Farnoosh Farahbod, Parham Talebi-Boroujeni, Catherine M.T. Sherwin, Saeid Heidari-Soureshjani
In: Journal of Endometriosis and Pelvic Pain Disorders · 2022 · vol. 14(3) , pp. 132–142 · doi:10.1177/22840265221094405 · W4280563240
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This systematic review investigated PDE5 inhibitors for thin endometrium in infertile women, finding they increase endometrial thickness and potentially pregnancy outcomes through various mechanisms, though effects vary with administration timing and patient factors.

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This systematic review evaluated the efficacy of phosphodiesterase type 5 inhibitors in improving endometrial thickness and pregnancy outcomes for infertile women with thin endometrium. The authors analyzed randomized controlled trials and observational studies to determine how these drugs influence vascular smooth muscle via nitric oxide signaling and angiogenesis through vascular endothelial growth factor A expression. While the findings indicate that PDE5 inhibitors can successfully increase endometrial lining, the impact on actual pregnancy success remains inconsistent and potentially influenced by timing, treatment type, and underlying pelvic conditions. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

Phosphodiesterase type 5 (PDE5) inhibitors are thought to play a role in increasing endometrial thickness and increasing the success rate of pregnancy outcomes. This study was done to investigate the effects of PDE5 inhibitors on infertile women with thin endometrium and pregnancy outcomes. In this systematic review, all randomized controlled trials (RCTs) and observational studies were retrieved from databases including Institute for Scientific Information (ISI), PubMed, and Scopus by interesting keywords. A checklist was designed to collect necessary data and pregnancy outcomes, and the required items were recorded. PDE5 inhibitors through various mechanisms such as induction of vasodilatory effect through the effect on NO/cGMP signaling on vascular smooth muscle, through regulating cells proliferation and induction angiogenesis by increasing the expression of tumor suppressor factor (p53), and vascular endothelial growth factor A (VEGF-A) and downregulating inflammation by downregulating proinflammatory cytokines, affect endometrial thickness that eventually increases and pregnancy outcomes. Although PDE5s inhibitors increase endometrial thickness by different mechanisms, especially in women with thin endometrial, this does not necessarily mean that they induce a positive effect in all situations. However, their positive effects on pregnancy outcome may be affected by the time of administration, type of infertility treatment, underlying diseases such as pelvic disorders and inflammation. So in this regard, there are still ambiguous aspects that required further RCTs study in this area.
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Effectiveness of Phosphodiesterase Type 5 Inhibitors on the Treatment of Thin Endometrium and Pregnancy Outcomes: An Systematic Review Document Type Article Publication Date 9-1-2022 Identifier/URL 113251493 (Orcid) Find in a Library Abstract Phosphodiesterase type 5 (PDE5) inhibitors are thought to play a role in increasing endometrial thickness and increasing the success rate of pregnancy outcomes. This study was done to investigate the effects of PDE5 inhibitors on infertile women with thin endometrium and pregnancy outcomes. In this systematic review, all randomized controlled trials (RCTs) and observational studies were retrieved from databases including Institute for Scientific Information (ISI), PubMed, and Scopus by interesting keywords. A checklist was designed to collect necessary data and pregnancy outcomes, and the required items were recorded. PDE5 inhibitors through various mechanisms such as induction of vasodilatory effect through the effect on NO/cGMP signaling on vascular smooth muscle, through regulating cells proliferation and induction angiogenesis by increasing the expression of tumor suppressor factor (p53), and vascular endothelial growth factor A (VEGF-A) and downregulating inflammation by downregulating proinflammatory cytokines, affect endometrial thickness that eventually increases and pregnancy outcomes. Although PDE5s inhibitors increase endometrial thickness by different mechanisms, especially in women with thin endometrial, this does not necessarily mean that they induce a positive effect in all situations. However, their positive effects on pregnancy outcome may be affected by the time of administration, type of infertility treatment, underlying diseases such as pelvic disorders and inflammation. So in this regard, there are still ambiguous aspects that required further RCTs study in this area. [ABSTRACT FROM AUTHOR] Repository Citation Farahbod, F., Talebi-Boroujeni, P., Sherwin, C. M., & Heidari-Soureshjani, S. (2022). Effectiveness of Phosphodiesterase Type 5 Inhibitors on the Treatment of Thin Endometrium and Pregnancy Outcomes: An Systematic Review. Journal of Endometriosis and Pelvic Pain Disorders, 14 (3), 228402652210944. https://corescholar.libraries.wright.edu/pediatrics/656 DOI 10.1177/22840265221094405

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