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Abnormal Cervical Mucus

By Robert W. Rebar, MD, Professor and Chair, Department of Obstetrics and Gynecology, Western Michigan University Homer Stryker M.D. School of Medicine

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Abnormal cervical mucus may impair fertility by inhibiting penetration or increasing destruction of sperm.

Normally, cervical mucus is stimulated to change from thick and impenetrable to thin and stretchable by an increase in estradiol levels during the follicular phase of the menstrual cycle. Abnormal cervical mucus may

  • Remain impenetrable to sperm around the time of ovulation

  • Promote sperm destruction by facilitating influx of vaginal bacteria (eg, due to cervicitis)

  • Contain antibodies to sperm (rarely)

Abnormal mucus rarely impairs fertility significantly, except in women with chronic cervicitis or cervical stenosis due to prior treatment for cervical intraepithelial neoplasia.


  • Examination to check for cervicitis and cervical stenosis

A pelvic examination is done to check for cervicitis and cervical stenosis. Cervicitis is diagnosed if women have cervical exudate (purulent or mucopurulent) or cervical friability. Complete cervical stenosis is diagnosed if a 1- to 2-mm diameter probe cannot be passed into the uterine cavity.

Postcoital testing of cervical mucus to determine whether viable sperm are present (which used to be routine during infertility evaluation) is no longer considered useful.


  • Assisted reproductive techniques (intrauterine insemination or in vitro fertilization)

Treatment may include intrauterine insemination and in vitro fertilization. However, whether either treatment is effective is unproved.

There is no evidence that using drugs to thin the mucus (eg, guaifenesin) improves fertility.

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