الفهرس 
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Abstract
Although ED incidence increases with age, younger men are also affected. Phosphodiesterase enzyme 5 inhibitors are considered as the first-line treatment for ED because of easy accessibility and efficacy with no serious side effects.
A significant number of individuals use PDE5Is for procreation as the percentage of patients having a temporary ED during semen collection in the IVF centers is high. This occur as well when the male is asked to do sex by order at the time of ovulation. Phosphodiesterase enzyme 5 inhibitors are very helpful in such situations. Sildenafil is the most commonly used PDE5Is.
In this context the effects of these drugs on semen parameters and fertility are asked for by many of those who use PDE5Is.
Studies in this regard are relatively few and the results are still contradictory.
So, we aimed by this study to evaluate the effects of long-term use of the most commonly used PDE5Is -sildenafil citrate- on the testicular function both spermatogenesis through following the changes in semen parameters & inhibin-b level and hormonal function through measuring total testosterone level, and INSL3 level.
To approach our goal, we selected 40 males complaining of ED aging 24-64 years who are in a stable marriage and have children (last < 2 years old).
All individuals were subjected to full history, thorough examination -both general and local- and evaluation of IIEF, basal
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seminogram, total testosterone, INSL3 and inhibin-b. Then were classified into two groups.
group I: included 20 individuals received oral 100 mg of sildenafil citrate on-demand twice weekly for 3 months.
group II: included another 20 individuals received oral 50 mg sildenafil citrate daily for 3 months.
The previously mentioned parameters were re-evaluated at the end of the treatment course.
The results were compared before and after treatment in each group and in between both groups. Statistical analysis of the results showed that:
1- Both groups are matched with no significant differences regarding; age, residence, co-morbidity and smoking.
2- No significant differences between both groups regarding the duration of ED and its severity before treatment.
3- On demand dose of sildenafil citrate is more beneficial than the chronic daily dose in treatment of ED, as the IIEF showed significant improvement in group I after treatment and when both groups were compared together.
4- No significant changes in semen volume, sperm density, total motility percentage, progressive motility percentage, and normal forms when comparing the values after 3 months treatment to the basal values, neither in group I nor in group II.
5- Sildenafil citrate showed significant improvement in inhibin-b and INSL3 but not in total testosterone level in both groups with no
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preference on any of both dosage used i.e on demand 100 mg is the same as chronic daily dosage 50 mg.
6- No significant differences in the side effects reported in both groups. Headache, GIT upset, and palpitation were the most common side effects reported. These side effects were mostly transient and disappeared on continuation. None of the patients stopped the drug for any of these side effects.