Objectives: Nowadays, phosphodiestrase type5 (PDE5) inhibitors are the most prescribed oral agents in medical treatment of erectile dysfunction in men. They are sought to affect human spermatozoa, since 2 isoforms of phosphodiestrase (PDE1, PDE4) are present in human sperm cells and there is cross-reaction between phosphodiestrase family. So in this study we are going to evaluate the acute effect of sildenafil administration on semen parameters in a group of infertile men .
Material and methods: A prospective randomized study was conducted on 60 male patients attending the urology departments of Ahmed Maher Teaching Hospital &Faculty of Medicine,Banha University H0spitals, for infertility counseling with male infertility factor. After clinical examination, laboratory studies and basal semen analysis according to WHO protocol, all patients were asked not to ejaculate for 3-5 days, then they were given on empty stomach 50mg sildenafil orally and then they were asked to give semen sample after one hour. We compare the changes in semen parameters before and after sildenafil administration.
Results: The mean age of the study group is 37 + 3.4ys with range between 30-46 years. The mean duration of infertility was 4.2 + 2.7ys, with 36 men having primary infertility (60%) and 24 men having secondary infertility (40%), 11 patients (18.3%) reported side effects after sildenafil administration, but all were minor and self limited. Regarding semen analysis parameters, there was significant increase in percentage of total sperm motility after sildenafil administration (28.6% + 5.4 versus 40.5% + 7.2) and also highly significant increase in sperm rapid progressive motility i.e. grade 3 (13.1% + 2.3 versus 20.4% + 3.6) after sildenafil administration. However no significant differences were observed in other semen parameters.
Conclusion: The acute oral administration of sildenafil 50mg significantly affect increased percentage of total sperm motility and rapid progressive motility in infertile men, and we recommended its use one hour before any assisted reproductive technology procedures as intrauterine insemination (IUI) and intracytoplasmic sperm injection(ICSI), even if men have normal erectile function to enhance the fertilizing potential of poor quality spermatozoa as well as to alleviate the stress experienced by men in semen collection room.