[version 1; peer review: awaiting peer review]
No competing interests were disclosed.
This case report describes the application of sildenafil citrate treatment in a cervical tuberculosis (TB) patient seeking in vitro fertilization (IVF) treatment. The patient, a 34-year-old female with a history of cervical TB and primary infertility, underwent anti-TB treatment before fertility treatment. Cervical stenosis and a thin endometrium were identified during a transvaginal ultrasound, posing challenges to successful IVF outcomes. Sildenafil citrate, a phosphodiesterase-5 (PDE-5) inhibitor known to improve endometrial blood flow, was administered orally at a dosage of 50 mg, three times daily, starting on the fifth day of the menstrual cycle. The patient exhibited an increase in endometrial thickness, indicating improved receptivity. Clinical pregnancy was achieved. These findings suggest that sildenafil citrate may have the potential as an adjunct therapy to enhance IVF success in cervical TB patients, although further research is needed to validate these results in larger studies.
Infertility is the inability for a woman to get pregnant after a year or after engaging in unprotected intercourse for an extended period. Primary and secondary infertility are the two different types of infertility.
A predictive indicator of assisted reproduction success is endometrial thickness. One of the main reasons why embryo implantation attempts fail is poor endometrial receptivity, which is essential for a healthy pregnancy. In fresh
This case was treated at the Wardha Test Tube Baby Centre, in Wardha. The patient, who was 34 years old at time of treatment, and her partner, who was 36 years old, are the couple featured in this case study. The patient has come for a treatment for infertility because the couple was unable to conceive after two abortions. Out of those, there was an abortion of a three-month fetus. She also had a history of failed IVF treatment. The male partner did not have a habit of smoking, tobacco and alcohol consumption, or any other drugs uses. He did not have any genetic abnormality or any other medical history or treatment history himself or in his family. The male partner’s semen analysis revealed normal sperm parameters, suggesting no male infertility.
After 11 years of marriage, they faced the problem of infertility for ten years. The patient has a significant medical history of cervical TB, which was diagnosed and successfully treated with anti-TB therapy. However, the treatment resulted in scarring and stenosis of the cervix along with effects on the endometrium.
The patient was treated with laparoscopy in 2016 due to abnormality in the pelvis. She was suffering from cervical TB due to an adhesion issue or infection in the lymph. The anti-Mullerian hormone (AMH) value of the patient was 0.62 ng/mL which is a marker for the normal ovarian reserve.
In the first ovum pick-up cycle, three oocytes were retrieved, among which two oocytes of the M2 phase and one oocyte of the germinal vesicle stage. Embryos were formed and transferred to the patient. However, no clinical pregnancy was reported as the patient reportedly had a thin endometrium. The couple was referred for a second IVF treatment. We planned for sildenafil citrate treatment for the treatment of thin endometrium in the second cycle of IVF treatment. The patient started receiving sildenafil citrate oral solution at a dose of 50 mg, three times daily, from the fifth day of the menstrual cycle. This time aligns with the endometrium’s proliferative phase to maximize endometrial development and receptivity during the IVF treatment cycle.
The six oocytes of the M2 phase and four oocytes of the M1 phase were retrieved and on day three, the five embryos were formed and frozen. The first frozen embryo was transferred on July 2021. The patient was prescribed sildenafil citrate orally at a dose of 50 mg, to be taken 1 hour before the planned embryo transfer. Embryos were formed and transferred on day 5 as fresh embryo cycle transfer. No complications were observed during treatment.
The IVF procedure followed standard protocols, including controlled ovarian stimulation, oocyte retrieval, and embryo culture. Clinical monitoring following embryo transfer revealed encouraging findings. The embryo transfer procedure was successful, with two high-quality embryos transferred into the patient’s uterus.
The doctor suggested medication for her treatment. The medicine prescribed by the doctor was famotidine, dicyclomine hydrochloride and mefenamic acid, ondansetron, diclofenac sodium, estradiol, norethisterone, aspirin, and atorvastatin. After the 14 th day, the β-HCG test was performed at our laboratory in Wardha and was positive. The β-HCG was 1026 mIU/mL.
An uncommon kind of extrapulmonary TB, cervical tuberculosis can harm fertility.
In this instance, sildenafil citrate was used to increase endometrial receptivity and improve endometrial blood flow.
This case involved a 34-year-old female patient with primary infertility and a history of cervical TB. A transvaginal ultrasound revealed a thin endometrium and cervical stenosis, raising concerns about the efficacy of IVF treatment. Because sildenafil citrate may improve endometrial receptivity, the patient was advised to start taking the medicine.
The patient started receiving sildenafil citrate oral solution at a dose of 50 mg, three times daily, on the fifth day of the menstrual cycle. This time aligns with the endometrium’s proliferative phase to maximize endometrial development and receptivity during the IVF treatment cycle.
While receiving treatment, the patient's endometrial thickness was often measured. It was observed that the endometrial thickness grew, indicating improved endometrial receptivity. This result is consistent with earlier studies that demonstrate sildenafil citrate enhances endometrial blood flow, resulting in improved endometrial growth.
Additionally, the patient became clinically pregnant. These encouraging results imply that sildenafil citrate therapy may have contributed to the success of IVF in this cervical TB patient. Sildenafil citrate may have aided in successful implantation and subsequent clinical pregnancy by increasing endometrial receptivity. The results of this case report are in line with earlier research on the use of sildenafil citrate to enhance IVF outcomes.
It should be stressed that this case report only covers one patient, and that additional research with greater patient populations and controlled trials is required to verify these results. Future studies should also establish the best sildenafil citrate dosage, course, and timing for cervical TB patients seeking IVF therapy.
In conclusion, sildenafil citrate administration as an additional therapy in a cervical TB patient seeking IVF treatment has promise for enhancing therapeutic outcomes. According to this case report, sildenafil citrate improved endometrial receptivity as shown by an increase in endometrial thickness. Inferring that sildenafil citrate may increase the likelihood of successful implantation and pregnancy in cervical TB patients having IVF treatment, the patient was able to get pregnant. Further research is warranted to validate these findings in larger studies and to determine the optimal dosage and duration of sildenafil citrate therapy in this specific patient population. Nonetheless, these preliminary results suggest that sildenafil citrate could be a valuable addition to the management of cervical TB patients seeking IVF treatment, potentially improving their chances of successful outcomes.
Written informed consent has been obtained from patient and her husband for the publication of this manuscript.