Redefining success in assisted reproductive technologies: the Embryo-Maternal-Offspring Continuum Framework

Assisted reproductive technologies (ART) have significantly improved infertility treatment outcomes, with success traditionally defined by pregnancy and live birth rates. However, this endpoint-driven definition provides a limited perspective on reproductive success and does not fully capture the biological complexity underlying maternal and offspring health. Emerging evidence indicates that ART procedures may induce subtle molecular, cellular, and epigenetic alterations during early developmental stages, which may influence both short-term clinical outcomes and long-term health trajectories. In addition to embryonic factors, maternal physiology, including hormonal stimulation, metabolic status, and endometrial receptivity, plays a critical role in shaping pregnancy outcomes and fetal development. Furthermore, paternal and broader parental contributions, such as sperm DNA integrity and epigenetic factors, add another layer of complexity to ART outcomes. These interconnected determinants highlight the need for a more comprehensive approach to evaluating ART success. This review proposes the Embryo-Maternal-Offspring Continuum Framework, a conceptual model that redefines ART outcomes as a dynamic and integrated process spanning early embryonic events, maternal adaptation, and long-term offspring health. By linking subclinical biological changes with clinical endpoints, this framework emphasizes the importance of multidimensional outcome assessment and longitudinal evaluation. Adopting this continuum-based perspective may improve both clinical decision-making and research strategies by promoting individualized treatment approaches, identifying early biomarkers of developmental competence, and addressing long-term health implications. Ultimately, redefining ART success beyond live birth is essential to ensure optimal and sustainable reproductive outcomes for both mothers and their children.