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Abstract SUMMARY he etiology of infertility is diverse. Despite the improvement in ovarian stimulation protocols and techniques, results of in vitro fertilization (IVF) has unfortunately reached a plateau. Diverse and unexplained factors affecting implantation rates have become a major limiting factor. Therefore, more attention needs to be focused on implantation and endometrial receptivity. Good embryo quality, appropriately timed and arranged endometrial receptivity, and efficient crosstalk between the embryo and the receptive endometrium are required for successful implantation. Impairment of any one of these factors may result in implantation failure. Clomiphene has been used to induce ovulation in patients suffering from chronic oligo-anovulation and ovulatory dysfunction. Anti-estrogenic effects of clomiphene on the endometrium are likely to be one of the causes of suboptimal pregnancy rates in spite of good ovulation rates. To improve poor endometrial response, several regimens have been put forward, including treatment with estrogens and low dose aspirin. Sildenafil citrate improves the uterine artery blood flow and the endometrial thickness in women diagnosed as unexplained infertility. Sildenafil citrate can be used orally or vaginally to improve endometrial receptivity. T Summary ¨ 67 To evaluate the efficacy of the orally administered sildenafil citrate on the endometrial thickness and pattern, uterine artery blood flow and pregnancy rate in infertility patients undergoing induction of ovulation. This study was conducted at the infertility outpatient clinic in Ain Shams University Maternity Hospital during the period from October 2017 to May 2018. Ninety patients were involved in the current study. Patients incorporated in the study were randomly allocated to 2 equal groups using a randomized computer number generation by the closed envelope method. According to inclusion and exclusion criteria of the study, they were divided into two equal groups, Study group received clomiphene citrate, estradiol valerate and sildenafil and control group received clomiphene citrate and estradiol valerate with no difference as regard demographic basal maternal hormonal profile and basal partner’s semen analysis. 2-D Doppler transvaginal ultrasound was done, Endometrial thickness, pattern and vascularity of all groups from the day 10th day of the cycle every 48 hour till the dominant follicle reach 18mm were assessed, Triggering of ovulation was done by hCG IM injection single dose and the patient was asked to have a coitus from 34-36 hours after triggering of ovulation, then progesterone support was prescribed to every patient form the day of ovulation for 14 days. Summary ¨ 68 Result The current study showed that uterine artery resistive indices (RI) after intervention was non-significantly lower among study group than among control group (P= 0.078), Endometrial blood flow RI after intervention was highly significantly lower (P<0.001) among study group compared to control group. Ovarian volume on the day of trigger was significantly higher among study group compared to control group. There was no statistically significant difference between study and control groups regarding basal endometrial thickness (P>0.05). On the day of trigger, Study group had highly significantly increase in endometrial thickness (P<0.001) compared to control group. Trilaminar pattern of endometrium was present more in the study group than the control group with the difference being highly statistically significant. The present study depicted that chemical pregnancy occurred more in the study group than control group, yet the difference was not statistically different (P>0.05 |