The effect of pentoxifylline and tocopherol combination on endometrium thickness: A systematic review and meta-analysis

Maryam Akbari‐Fakhrabadi, Mahdi Sepidarkish, Samira Vesali, Amirhossein Omidi, Maryam Khazdouz, Motahareh Hasani, Javad Heshmati
In: Journal of Food Biochemistry · 2018 · vol. 42(5) , pp. e12547 · doi:10.1111/jfbc.12547 · W2800095940
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This systematic review and meta-analysis found that while some quasi-experimental studies showed a significant increase in endometrial thickness with pentoxifylline and tocopherol, a single RCT did not confirm this benefit, indicating uncertainty about the combination's effectiveness.

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Abstract

Endometrial thickness is a key factor involved in achieving desired outcomes in assisted reproductive technology (ART). Various therapeutic modalities have been proposed to patients with thin endometrium. This study aimed to summarize the available findings regarding the effect of Pentoxifylline (PTX) and Tocopherol combination on improving endometrial thickness. The review included interventional studies, including randomized controlled trials (RCTs) and quasi-experimental studies, assessing PTX and vitamin E (Tocopherol) combination in women with thin endometrium. Electronic searches using the MeSH terms were conducted in the following databases: Medline, Embase, Scopus, Web of Science, and The Cochrane Library. The effect was measured as weighted mean difference (MD) and 95% confidence intervals (CI) by the random-effects model. The initial search yielded 66 potentially relevant articles. After studying these publications, 4 were potentially eligible and retrieved in full text (three before–after studies and one RCT). A meta-analysis of three quasi-experimental studies showed a significant difference in endometrial thickness after treatment (MD: 1.96 mm; 95% CI: 0.94–2.98, p < .001) but there was no difference in the mean of endometrial thickness between case and control groups (10.8 vs. 10.48 mm, p = .467) in aforementioned RCT. Although the effect of intervention was seen in quasi experimental studies but this finding was not confirmed in the only retrieved RCT. Due to the methodological weakness of the retrieved studies as well as the lack of appropriate clinical trial studies, there is no certainty about the effectiveness of the PTX and Tocopherol combination. Future trials with desirable design and larger sample size that address the limitations in the current evidence are needed before definitive claims can be made about the effect of PTX and Tocopherol combination. Practical applications Endometrial thickness is affected by many factors including age, genetic, estradiol levels, and previous injuries to endometrium. Many drugs and nutritional supplements have been studied on endometrial thickness in which PTX and Tocopherol in combination have been shown to have restoring effects on endometrium. It seems that the properties of PTX and Tocopherol could be favorable for endometrium restoration.

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