Cervical mucus removal prior to intrauterine insemination: a randomized trial.

<bold>Objective: </bold>To detect if removing the cervical mucus before performing intrauterine insemination (IUI) could improve pregnancy outcomes in patients with unexplained infertility.<bold>Design: </bold>Prospective randomized study.<bold>Setting: </bold>An Egyptian University Hospital.<bold>Population: </bold>Seven hundred and fourteen couples with unexplained infertility who underwent intrauterine insemination (IUI) with or without cervical mucus removal.<bold>Methods: </bold>Using computer-generated numbers, patients were randomly allocated to cervical-mucus-removal (removed from both internal and external os) or non-mucus-removal groups. Only participants were blinded as to group assignment.<bold>Main Outcome Measures: </bold>The clinical pregnancy rate.<bold>Results: </bold>Of 714 IUI patients between November 2014 and March 2017, 361 were in the mucus removal group, and 353 in the non-mucus-removal group. Difficult catheterization was encountered in 17 cases out of 666 (2.6%) 12 in the cervical-mucus-removal group and five in the non-mucus-removal group). A total of 666 IUI cycles were completed while 48 were either cancelled or lost in their follow-up. The clinical pregnancy rate was significantly higher in the mucus-removal group [31.0% (n = 112)] than in the non-mucus-removal group [21.8% (n = 77); P = 0.005]. Ovarian hyperstimulation developed in 33 (4.6%) cases: 18 cervical mucus-removal and 15 non-mucus-removal. All except one were mild and managed with outpatient care.<bold>Conclusions: </bold>Cervical mucus removal before IUI could improve pregnancy outcomes in women with unexplained infertility.<bold>Tweetable Abstract: </bold>Cervical mucus removal before IUI can improve pregnancy outcomes. [ABSTRACT FROM AUTHOR]