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

Alaa Tahir Tawfeeq, Muayad Sraibet Abbood, Mufeda Ali Jwad
In: Journal of Pharmaceutical Negative Results · 2022 · pp. 227–235 · doi:10.47750/pnr.2022.13.s05.29 · W4309043801
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Pentoxifylline vaginal gel, oral pentoxifylline with vitamin E, and vaginal sildenafil improved endometrial vascularity, thickness, and pregnancy rates in infertile women with thin, poorly vascularized endometria.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 · read from full text ⓘ

This randomized study evaluated five drug protocols in 200 infertile women with thin, poorly vascularized endometrium, comparing oral and vaginal estrogens (estrogen/progesterone preparations), vaginal sildenafil gel, pentoxifylline tablet plus vitamin E, and pentoxifylline vaginal gel. Across up to six cycles, all groups showed significant increases in mean endometrial thickness after one month, and pentoxifylline-based regimens showed the lowest uterine artery resistance and pulsatility indices on the right or left sides depending on the specific formulation, with vaginal sildenafil intermediate and estrofem/vagifem showing higher indices in those measures. The paper concludes that the pentoxifylline tablet plus vitamin E, pentoxifylline vaginal gel, and vaginal sildenafil gel improved vascularity indices, thickness, and pregnancy rates without serious adverse events, but it does not provide detailed pregnancy-rate numbers in the text provided. This paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Background: Pregnancy has been one of life’s great mysteries. The endometrium is where life begins, and a receptive endometriumlies 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, andpregnancy rates and to find out the best medical protocol could be used to improve endometrial thickness, vasculature, and pregnancyrate 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, afterthey 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 Breceived 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 tillthe day of ovulation trigger, group D received pentoxifylline ( oral 800 mg daily) with vitamin E ( oral 400 IU daily) during the 6cycles (this study period), and group E received 4 gm of pentoxifylline vaginal gel which is containing 200 mg pentoxifylline dailywhich was timed to be 3 hours before intercourse from the 7th day of menstrual cycle till day 21 of the cycle. The endometrialthickness, 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, vaginalsildenafil, 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 groupsrespectively 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. Thestudy showed that the lowest mean of right uterine artery resistance index achieved after treatment was in the Pentoxifylline gelgroup which was comparable to the results achieved by pentoxifylline+vit E group, followed by sildenafil, then estrofem andvagifem groups who showed the highest resistance indeces for the right uterine artery among the study groups (unlike other drugs inthe study vagifem and esterofem has shown to increase the resistance index instead of improving it) . While for The left uterineartery, the study showed that the lowest mean of resistance index was achieved by the pentoxifylline + vit E group which wascomparable to the results achieved by the sildenafil group, pentoxifylline gel , then estrofem and vagifem groups who showed thehighest resistance indeces for the left uterine artery among the study groups. Regarding the uterine arteries pulsatility index, the studyalso showed that the lowest mean of right uterine artery pulsatility index achieved after treatment was in the pentoxifylline+ vit Egroup, followed by pentoxifylline gel group then by vaginal sildenafil , while estrofem and vagifem groups showed the highestpulsatility indeces for the right uterine artery among the study groupsConclusions: Pentoxifylline vaginal gel, pentoxifylline tablet plus vitamin E capsule, and Sildenafil vaginal gel are found to be ableto improve the vascularity indeces of endometrium and uterine arteries, improve the endometrial thickness, and enhance thepregnancy rates for patients with thin poorly vascularized endometrium with no seriuos adverse events.
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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.

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