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

Craciunas, Laurentiu; Tsampras, Nikolaos; Fitzgerald, Cheryl

doi:10.1016/j.fertnstert.2014.01.047

Cited by 24 publications

(18 citation statements)

References 35 publications

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“…Additionally, systematic reviews showed little evidence of an overall benefit of cervical mucus removal before ET for women undergoing IVF/ICSI. Similar outcomes were reported in terms of clinical pregnancy, implantation, and live-birth rates between groups with and without cervical mucus cleaning [31]. On the other hand, significantly increased pregnancy rates were reported in 2 retrospective studies [32, 33] with cervical mucus removal by cytobrush and vigorous irrigation of the cervical canal respectively.…”

Section: Discussionsupporting

confidence: 74%

Prospective Randomized Trial Comparing Embryo Transfers of Cases with and without Catheter Rotation during Its Withdrawal

Abide¹,

Özkaya²,

Sanverdi³

et al. 2018

Gynecol Obstet Invest

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Objective: To compare embryo transfer (ET) technique based on catheter rotation during its withdrawal in cases with unexplained infertility in a prospective, randomized trial (NCT03097042). Methods: Two hundred intracytoplasmic sperm injection (ICSI) patients undergoing ET with cleaving or blastocyst-stage fresh embryos were randomized into 2 groups: cases with (n = 100), and without (n = 100) catheter rotation during its withdrawal. Groups were matched for age and some clinical parameters. A soft catheter was used to transfer a single embryo with catheter rotation during its withdrawal in the study group and without rotation in the control. The use of a stiff catheter or tenaculum was not needed in any case. Groups were compared in terms of cycle characteristics and clinical pregnancy rates. Results: Pregnancy rate was significantly higher in the study group (41 vs. 26%, p = 0.04). Clinical pregnancy rate was also significantly higher in the study group (39 vs. 25%, OR 1.9 [1.1–3.5], p = 0.05). On the other hand, the ongoing pregnancy rate was similar between the 2 groups (33 vs. 23%, p = 0.2). Conclusion: Catheter rotation during its withdrawal may be associated with increased pregnancy and clinical pregnancy rates; however, the difference in ongoing pregnancy rates did not reach statistical significance.

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Section: Discussionsupporting

confidence: 74%

Prospective Randomized Trial Comparing Embryo Transfers of Cases with and without Catheter Rotation during Its Withdrawal

Abide¹,

Özkaya²,

Sanverdi³

et al. 2018

Gynecol Obstet Invest

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“…Studies included in the review were low to intermediate quality, and the researchers concluded that mucus removal done before the embryo transfer in IVF/ICSI patients had a very small benefit. The results also suggested that implantation, clinical pregnancy, and live birth rates were similar [4]. In another study, the authors stated that mucus remnants on the tip of embryo transfer catheter was associated with lower implantation and pregnancy rates [1,10,12].…”

Section: Discussionmentioning

confidence: 84%

“…The success of embryo transfer which is the final step in IVF/ ICSI treatments depends on additional factors other than endometrial receptivity and the quality of embryos. Ultrasound guidance, myometrial contractions, type of transfer catheter or the mode of loading, dummy transfer, the site that the embryos were placed, presence of cervical mucus and /or blood, a blood-stained catheter after transfer or an embryo stuck in the catheter are some such factors [4][5][6]. Sperms need to go through vagina and cervix and reach upper genital system for fertilization and to achieve this they have to penetrate into the cervical mucus (CM) which is a hydrolyzed gel containing various forms of mucin.…”

mentioning

confidence: 99%

“…Conversely, removing the mucus which acts as a natural lubricant might complicate transfer [10]. Additionally, poking the cervix or the endocervix during the mucus removal might trigger uterine contractions and lead to decreased pregnancy rates [4]. We anticipated that the mucus removal that would be done on the day of embryo transfer could be done on OPU day and this practice might be related with better pregnancy rates since it is unlikely to cause uterine contractions during the embryo transfer.…”

mentioning

confidence: 99%

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Oocyte pick up day mucus removal: Does it have a positive effect on pregnancy rates?

Kaleli¹

2018

Ann Clin Anal Med

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Aim: Mucus removal that would be done on the day of embryo transfer could be done on Oocyte pick up(OPU) day, and this practice might be related with better pregnancy rates since it is unlikely to cause uterine contractions during the embryo transfer. We compared the effects of mucus removal done on OPU day, transfer day or no removal at all on success rates of the treatment in three groups. Material and Method: We designed a prospective match control study.There were 131 cycles in which mucus removal was done on either OPU day or embryo transfer day (64 and 67 cycles respectively) and in 411 cycles mucus removal was not done, and these patients constituted the control group. Results: After mucus removal on OPU day, mucus removal on embryo transfer day and no mucus removal done at all, pregnancy rates were calculated as 40,6%, 29,9%, and 23,1% respectively and the difference among the groups was statistically significant (p=0,009). Discussion: Mucus removal on OPU day or on embryo transfer day improves pregnancy rates. It can be included in the routine practice, since it may potentially minimize cervical trauma and uterine contractions and thus improve success in IVF/ICSI treatments.

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“…Depending on the time relation with the ET, these can be divided in three main groups (Craciunas, Tsampras, & Fitzgerald, 2014): (i) pre ET (dummy ET, cervical and endometrial preparation), (ii) at the time of ET (catheter choice, site of embryo placement, ultrasound guidance) and (iii) post ET (fibrin sealant, mechanical closure of the cervix, bed rest).…”

Section: Introductionmentioning

confidence: 99%

Bed rest following embryo transfer might negatively affect the outcome of IVF/ICSI: a systematic review and meta-analysis

Craciunas

Tsampras

2016

Human Fertility

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The majority of patients undergoing in vitro fertilization (IVF) and intracytoplasmatic sperm injection (ICSI) treatment will reach the stage of embryo transfer (ET), but only a small proportion of transferred embryos implant. Bed rest following ET has been recommended as a way to prevent embryo expulsion by gravity. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) published prior to May 2014 reporting the effect of bed rest following ET, and irrespective of language, country of origin, blinding or sample size. Four RCTs, including 757 women met the inclusion criteria. Bed rest following ET did not improve clinical pregnancy and live birth rates, but reduced the implantation rate. The quality of the trials included was moderate because of attrition bias and possible reporting bias. The findings of this systematic review and meta-analysis are concordant with previously published literature and suggest that bed rest is not beneficial following ET. Moreover, it might negatively affect the outcome of IVF/ICSI cycles via stress/anxiety mechanisms.

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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

Cited by 24 publications

References 35 publications

Prospective Randomized Trial Comparing Embryo Transfers of Cases with and without Catheter Rotation during Its Withdrawal

Prospective Randomized Trial Comparing Embryo Transfers of Cases with and without Catheter Rotation during Its Withdrawal

Oocyte pick up day mucus removal: Does it have a positive effect on pregnancy rates?

Bed rest following embryo transfer might negatively affect the outcome of IVF/ICSI: a systematic review and meta-analysis

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