title: Cervical mucus removal before embryo transfer in women undergoing in vitro fertilization/intracytoplasmic sperm injection: a systematic review and meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To appraise critically the published randomized controlled trials (RCTs) reporting on the effectiveness of cervical mucus removal before embryo transfer.
  
  
  METHODS
  Systematic review and meta-analysis of RCTs.
  
  
  METHODS
  Assisted reproduction technology (ART) units.
  
  
  METHODS
  Women undergoing embryo transfer after in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI).
  
  
  METHODS
  Cervical mucus removal followed or not by cervical irrigation immediately before embryo transfer.
  
  
  METHODS
  Clinical pregnancy, implantation and live-birth rates.
  
  
  RESULTS
  Eight RCTs involving 1,715 women were systematically analyzed. There was substantial heterogeneity among the included trials. There was no statistically significant difference in terms of pregnancy, implantation, or live-birth rates.
  
  
  CONCLUSIONS
  A meta-analysis from the available moderate to low quality trials provides very little evidence of an overall benefit of cervical mucus removal before embryo transfer for women undergoing IVF/ICSI. Due to problems of clinical diversity, statistical heterogeneity, and risk of bias, additional pragmatic multicenter RCTs are needed to evaluate the possible small benefit of cervical mucus removal before embryo transfer.
authors.affiliation: Department of Reproductive Medicine, St. Mary's Hospital, Central Manchester University Hospitals Foundation Trust, Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom. Electronic address: lcraciunas@doctors.org.uk.
authors.forename: Laurentiu
authors.initials: L
authors.lastname: Craciunas
authors.affiliation: Department of Reproductive Medicine, St. Mary's Hospital, Central Manchester University Hospitals Foundation Trust, Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tsampras
authors.affiliation: Department of Reproductive Medicine, St. Mary's Hospital, Central Manchester University Hospitals Foundation Trust, Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Fitzgerald
mesh_terms: D002582:Cervix Mucus / Q000737:chemistry / Q000378:metabolism; D004624:Embryo Transfer / Q000379:methods / Q000639:trends*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods / Q000639:trends; D006801:Humans; D007247:Infertility, Female / Q000196:embryology / Q000628:therapy*; D015337:Multicenter Studies as Topic / Q000379:methods / Q000639:trends; D011247:Pregnancy; D018873:Pregnancy Rate / Q000639:trends; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000639:trends*; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods / Q000639:trends*
keywords: Cervical mucus; embryo transfer; live birth rate; pregnancy rate