Effect of sildenafil citrate on treatment of infertility in women with a thin endometrium: a systematic review and meta-analysis

Objective Endometrial thickness is a prognostic factor for successful pregnancy. This meta-analysis aimed to examine the role of sildenafil citrate on infertile women with a thin endometrium. Methods Two investigators independently searched the literature on sildenafil citrate and infertile women with a thin endometrium from PubMed, EMBASE, and the Cochrane Controlled Trials Register Database from inception to January 2019. Results Nine studies involving 1452 patients were included for analysis in our study. We found that endometrial thickness in patients who received sildenafil citrate was significantly higher than that in the control group (placebo or no treatment) (weighted mean difference: 1.22; 95% confidence interval [CI]: 1.07-1.38). The radial artery resistance index was significantly lower (weighted mean difference: -0.12; 95% CI: -0.17 to -0.06), and the clinical pregnancy rate (risk ratio: 1.31; 95% CI: 1.11-1.53) and biochemical pregnancy rate (risk ratio: 1.45; 95% CI: 1.11-1.89) were significantly higher in the sildenafil citrate group compared with the control group. Conclusion Sildenafil citrate is effective in improving endometrial thickness, the clinical pregnancy rate, and the biochemical pregnancy rate in women who have a thin endometrium. This treatment is a potential therapeutic intervention for a thin endometrium.