Pregnancy and live birth rates in ART cycles and their determinants: A retrospective cohort study

Objective: To identify predictors of pregnancy and live birth outcomes in assisted reproductive technology (ART) cycles based on patient characteristics, hormonal profile, and embryo transfer variables. Methods: This retrospective cohort study included 50 fresh in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles selected from ART participants at a single tertiary ART center. Controlled ovarian stimulation was performed using recombinant follicle stimulating hormone (rFSH), gonadotropin-releasing hormone (GnRH) antagonist, and menotropins; oocyte retrieval occurred 36 h after trigger and embryo transfer was performed on day 3 or 5. Outcomes (chemical pregnancy, ongoing pregnancy, abortion, live birth) were compared across groups stratified by maternal age, antral follicle count (AFC), anti-Müllerian hormone (AMH), baseline luteinizing hormone (LH), estradiol (E 2 ) at trigger, and endometrial thickness. Multivariate regression was used to identify independent predictors of live birth. Results: A total of 124 ART patients were screened during the study period, of whom 50 participants meeting the eligibility criteria were included in the final analysis. The median age of the participants was 35.8 years [interquartile range (IQR) 32.5–39.6]. The median AFC was 8 (IQR 4–14), AMH level was 1.4 ng/mL (IQR 0.7–2.9), and the median endometrial thickness at embryo transfer was 10.2 mm (IQR 9.0-11.3). Chemical, ongoing, abortion, and live birth rates were 62%, 32%, 12%, and 16%, respectively. Younger maternal age (<35 years), higher AFC (>12), AMH 1–4 ng/mL, and endometrial thickness >10 mm were associated with more favorable pregnancy outcomes. In multivariate analysis, higher baseline LH (β=0.089; 95% CI 0.017–0.162; P =0.02) and greater endometrial thickness (β=0.145; 95% CI 0.011–0.278; P =0.04) independently predicted live birth, whereas age, AFC, AMH, and E 2 did not. Conclusions: Maternal age, ovarian reserve markers, LH levels, and endometrial thickness collectively influence ART outcomes. Baseline LH and endometrial receptivity are key independent predictors of live birth and may guide individualized treatment strategies.