Abstract

INTRAVAGINAL SILDENAFIL AND ORAL SILYMARIN AS A NOVEL TREATMENT FOR PATIENTS WITH POLYCYSTIC OVARIAN SYNDROME UNDERGOING IN VITRO FERTILIZATION: FIRST BIOPHARMACEUTICAL CLINICAL APPLICATION FROM EGYPT

Mohamed El-Far*, Maher Shams and Esraa Abdel-Mohsen

ABSTRACT

Background: Reactive oxygen species likely affect folliculogenesis, oocyte maturation, fertilization and embryo quality in polycystic ovarian syndrome (PCOS) patients undergoing in vitro fertilization (IVF). We aimed to evaluate the effect of vaginal sildenafil citrate (SC), oral silymarin (SM) or SC and SM combined on the antioxidant defense system and lipid peroxidation in PCOS. Methods: This study include healthy women (n=10), untreated PCOS women (n=10), women with PCOS self-administrated intravaginal SC (n=8), with PCOS received oral SM (n=7) and with PCOS received both vaginal SC and oral SM (n=9). Total antioxidant capacity (TAC), glutathione reductase (GSH), superoxide dismutase (SOD), malondialdehyde (MDA) and nitric oxide (NO) were assessed. Results: Both SC and SM significantly increase TAC, SOD and GSH and significantly decrease NO and MDA. The combination of SC and SM caused the most effect. Furthermore, combination of SC and SM improve abnormalities in oocytes and embryos. In almost all cases treated with SC+SM together, oocytes were normal with regular shape and normal polar body, perivitelline space and homogenous cytoplasm without granulation and the zona pellucida was dense and homogenous. Most of embryos were very good, 8-cell stage embryos with equal sized blastomeres, no fragmentation and no cytoplasmic granulation. There was also a sign of compaction in higher numbers of embryos. Conclusion: Combinatorial treatment of sildenafil and silymarin significantly improve abnormalities in oocytes and embryos and pregnancy outcomes with no miscarriage in PCOS women. This effect is likely because of their powerful antioxidant capacity that regulates the follicular fluid (FF) environments.

Keywords: PCOS, IVF, Sildenafil, Silymarin, Pregnancy, Abortion.