Analysis of Risk Factors Affecting Cumulative Live Birth in Couples With Unexplained Infertility Undergoing IVF/ICSI

To identify the specific risk factors associated with unexplained infertility (UI) among infertile couples.

We conducted a retrospective cohort study analyzing UI risk factors, focusing on 5465 infertile couples who completed their first full in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycle out of a total cohort of 62201 infertile couples.

Among 5465 UI couples, 3400 achieved a live birth (cumulative live birth rate = 62.2%). Multivariate logistic regression indicated the key negative predictors included: female age ≥ 35 years (odds ratio [OR]: 0.63; 95% confidence interval [CI]: 0.51-0.78; p < 0.001), male age (OR: 0.98; 95% CI: 0.96-0.99; p = 0.015), Female body mass index ≥ 27.5 kg/m² (OR: 0.78; 95% CI: 0.62-0.97; p = 0.028), low anti-Müllerian hormone (AMH) (AMH < 1.2 ng/mL) (OR: 0.64; 95% CI: 0.52-0.77; p < 0.001), and a mid-range endometrial thickness (EMT) (EMT 0.7-1.0 cm) (OR: 0.77; 95% CI: 0.66-0.89; p < 0.001). A higher number of retrieved oocytes positively correlated with cumulative live birth (CLB) (OR: 1.02; 95% CI: 1.01-1.04; p = 0.039).

The prevalence of UI was 8.8% in our population, with 62.2% achieving CLB after one complete IVF/ICSI cycle. Female age and ovarian reserve indicators emerged as the main factors influencing oocyte yield, embryo acquisition, and CLB outcomes in UI patients.