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What is known and was published by Sher et al in the early 1990s is that the uterine lining can be improved through increased estrogen in the woman's blood, which has been accomplished through upped dosages of fertility drugs, estrogen patches, pills, injections, or suppositories. These remedies still failed to assist a group of women.
Sher clarifies the extent of the situation by saying "This is not the kind of thing where we could say 20% or 30% of women who don't get pregnant" have this particular problem. Yet, he says, "In every OB/Gyn's or reproductive endocrinologist's practice, there will be a handful of patients who are spinning their wheels with no explanation, and this turns out to be the factor."
He also mentions the importance of reproductive immunology factors as compared to blood flow/endometrium issues; that is, women with certain immunological situations may have more than adequate endometrial health, yet will still be unable to conceive due to various antibodies. Sher believes that this controversial area warrants more study.
For that small group of women who were not helped by the addition of estrogen, Sher and others began in the mid-1990's looking at different substances to assist specifically with muscular blood flow. Nitroglycerin, commonly used for angina (heart pains), was used successfully (resulting in pregnancy) with "hundreds of women," but with the drug's usual side effect -- severe headaches. While pregnancies seemed to coincide with nitroglycerin's use, this was prior to the invention of doppler measurement of blood flow; therefore, no confirmed cause and effect relationship existed or was published.
Sher makes the point, "Almost nothing we do in the ART arena has ever been proven through random controlled studies. Everything we do today is the result of carefully moving forward and using cohort studies to explain why we do things." Whether it is GIFT, uterine insemination, or ICSI, none of these techniques have been "proven" in a randomly controlled fashion, says Sher, for the simple reason that there are not enough studiable cycles and far too many variables with each pregnancy. Not even cryopreservation, fraught with ethical dilemmas, has a basis on evidence-based indications.
Upon Viagra's release, Dr. Sher was ready to try its vasodilation properties on women with poor endometrial response to estrogen. To avoid nitroglycemic side effects, Sher had the new tablets formulated as vaginal suppositories which would theoretically deliver a concentrated dose locally to the uterine muscle yet avoid higher systemic levels.
"And I can tell you without any question of a doubt that there are zero side effects with this treatment to the woman herself," the doctor remarks.
© Tracy Morris
