الفهرس 
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Abstract
Summary
Infertility affects up to one in seven couples nowadays, a proportion of these couples may be able to ultimately conceive but for the majority ,conception is unlikely without some form of medical intervention.
Clomiphene citrate is the traditional first line treatment of anovulation, but only 75% of patients responds positively. Clomiphene citrate resistance was defined as failure to ovulate to a dose schedule of 200 mg / day for five days or failure of follicular maturation after receiving a dose of CC 100mg/day for 5 days for three consecutive cycles.
Sildenafil citrate is a phosphodiasterase inhibitor type 5 which increases level of nitric oxide leading to relaxation of vascular and non-vascular smooth tissue, increasing pelvic blood flow. So increase number of follicles and endometrial thickness which lead to increasing receptivity and implantation.
The aim of this study is to determine the effect of sildenafil citrate 20 mg on pregnancy rates in females undergoing induction of ovulation by clomiphene citrate 50mg.
The study included 100 patients who were randomized into two groups. group 1 included 50patients who were given clomiphene citrate 50 mg twice times per day orally sildenafil citrate 20 mg of the same cycle three times per day orally and. group 2 included 50 patients who were given clomiphene citrate 50 mg twice times per day orally and placebo tablets from cycle
Transvaginal u/s was done to detect endometrial thickness and number of follicles on day 13 or 14 of the cycle Finally, pregnancy was detected chemically by measuring B-HCG.
Measuring percentage in change in primary outcome in both groups we found that percentage change in follicular number in both groups was statistically significant with p -value 0.239.
endometrial thickness in both groups was statistically significant between two groups with p- value 0.001
Increase pregnancy rate to be 32% with sildenafil citrate versus 18% with placebo. Pregnancy rate was statistically significant between both group with p-value 0.035.
It could be concluded from this study that oral use of sildenafil citrate 20 mg in females under going induction of ovulation lead to increase number of follicles, endometrial thickness and so increase pregnancy rate. We recommend from this study to detect effect of oral sildenafil citrate on fetal outcome in pregnant women.