Exploring determinants of cumulative live birth rates in IVF

Infertility affects a significant proportion of couples worldwide, yet data from low- and middle-income countries, including Lebanon, remain limited. Cumulative live birth rates (CLBR) are a key indicator of assisted reproductive technology (ART) success. This study aimed to assess the demographic and clinical predictors of CLBR among Lebanese patients undergoing ART, focusing on maternal age, oocyte yield, embryo transfer stage and strategy. Anonymous medical record of 1,243 patients undergoing their first ART cycles at a fertility center in Beirut, Lebanon, between June 16, 2020 and June 30, 2024 was retrieved. Data on demographic characteristics, infertility indications, ovarian stimulation outcomes, and transfer strategy (first fresh cycles vs. freeze-all) were collected. CLBRs were calculated using both conservative and optimistic approaches across up to four embryo transfers. Logistic regression models were applied to identify predictors of live birth. The overall live birth rate was 46.3%, with higher CLBRs observed in patients undergoing freeze-all compared to First Fresh cycles (51.4% vs. 41.7% by the fourth transfer). Maternal age was inversely associated with success, with women ≥ 35 years showing significantly reduced odds of live birth. Oocyte yield was a strong predictor, with > 15 oocytes retrieved resulting in a CLBR exceeding 60%. Blastocyst-stage (Day 5) transfers were associated with markedly higher odds of live birth compared to cleavage-stage (Day 3) transfers (aOR = 3.89, p < 0.001). This is the first comprehensive study of its kind in Lebanon, demonstrating that ART outcomes are significantly influenced by maternal age, oocyte yield, and embryo transfer stage. Despite the country’s recent political, economic, and health crises, ART success rates remain promising. Future studies should explore additional variables, such as environmental exposures and dietary patterns, to enhance CLBR predictive models for In vitro-fertilization (IVF) success ultimately improving patient counseling and personalized care. Numerous couples suffer from infertility around the globe. Limited information is available regarding infertility in low to middle income nations such as Lebanon. To address this gap, the present study examined the key factors influencing the success of in vitro fertilization procedures among Lebanese patients. Medical records from 1243 couples that underwent their first IVF cycle at the Saint Joseph Fertility Center in Beirut were analyzed. The CLBR was assessed according to female age, the quantity of eggs retrieved, and the timing and method of embryo transfer. Findings indicated that younger women and patients with greater number of collected eggs enhanced the probability of success. Moreover, transferring embryos at a more advanced developmental stage yielded superior outcomes for couples compared to earlier transfers. Cryopreserving embryos and subsequently transferring them may show higher pregnancy rates compared to freshly transferred embryos. This represents the first extensive study of its nature in Lebanon. Despite the persistent political, economic, and health challenges, fertility treatments continue to provide promising results for numerous Lebanese couples. Well-designed future research is needed to determine how other factors such as lifestyle, environmental exposures, and nutrition may affect the likelihood of IVF success, thereby improving patient counseling and personalized care.

Assisted reproductive technology · Embryo transfer · Fertility · Infertility · Live birth · Logistic regression · Odds · Odds ratio · Assisted Reproductive Technology and Twin Pregnancy · Ovarian function and disorders · Reproductive Health and Technologies · Reproductive Medicine