Impact of infertility etiology on clinical pregnancy, cumulative live birth rate, and time to live birth after IVF/ICSI: a retrospective cohort study

Abstract Purpose This study aimed to evaluate the association between infertility etiology and first transfer clinical pregnancy, cumulative live birth rate (CLBR), and time to live birth (TTLB) in couples undergoing their first assisted reproductive technology (ART) cycle. Methods A total of 2,444 infertile couples undergoing their first IVF/ICSI treatment were included in this single-center retrospective cohort study. Participants were categorized into nine etiological groups. Baseline characteristics, pregnancy outcomes, and cumulative live birth outcomes were compared across groups. Kaplan–Meier analysis was used to evaluate TTLB, and intergroup differences were assessed using appropriate statistical tests. Results Tubal factor infertility was the most common etiology (39.57%). Significant differences were observed among etiological groups in first-cycle clinical pregnancy rate (P < 0.001), cumulative live birth rate (CLBR) (P < 0.001), and time to live birth (TTLB) (log-rank P < 0.001). Patients with ovulatory dysfunction had the highest CLBR (76.8%) and shortest median TTLB (11 months), whereas those with diminished ovarian reserve had the lowest CLBR (37.6%) and prolonged TTLB. First-cycle clinical pregnancy rates ranged from 32.9% in diminished ovarian reserve to 63.7% in ovulatory dysfunction. Conclusion Infertility etiology was significantly associated with ART outcomes, including first-transfer clinical pregnancy, cumulative live birth, and time to live birth. These findings support individualized etiology-based counseling and treatment planning to improve reproductive efficiency.