Achieving two live births from one ovarian stimulation cycle: the one-and-done approach revisited

To identify the proportion of patients who would achieve ≥2 live births after a single in vitro fertilization (IVF) stimulation/embryo creation cycle.

Retrospective cohort study at a university-affiliated infertility practice.

Patients undergoing their first IVF cycle between January 1, 2014, and December 31, 2022.

Index oocyte retrieval cycle and subsequent autologous embryo transfer cycles.

Live births after autologous embryo transfer cycles from the index oocyte retrieval were analyzed, with additional live birth potential estimates extrapolated using age and oocyte number for those who had remaining frozen high-quality embryos. Univariable and multivariable logistic regression models were used to evaluate the association of known fertility factors with the outcome.

A total of 16,474 patients were included who underwent 20,710 total transfers during the study period. A total of 8,223 patients (49.9%) achieved ≥1 live birth, and 1,857 patients (11.3%) achieved ≥2 live births. Of note, 6,662 patients (40.4%) had a total of 24,067 remaining frozen high-quality embryos. Including estimates of additional live births resulting from use of remaining frozen embryos, 9,599 patients (58.3%; 95% confidence interval, 57.6%-59.1%) would achieve ≥1 live birth and 4,511 patients (27.3%; 95% confidence interval, 26.8%-28.0%) would achieve ≥2 live births. The proportion of patients achieving ≥2 live births progressively increased across groups of increasing oocyte yield and decreased with advancing age. Predictors of the odds of achieving ≥2 live births included age and number of oocytes retrieved. A total of 5,105 patients (31.0%) used preimplantation genetic testing for aneuploidy. Those who used preimplantation genetic testing for aneuploidy had a lower odds of achieving ≥2 live births.

With current IVF practices, over one fourth of patients could complete their families by achieving ≥2 live births from a single IVF stimulation cycle. The increasing number of oocytes retrieved and age of <35 years increased the odds of achieving this result. Providers can use these values as a counseling tool to guide shared decision-making to avoid additional stimulation cycles.