Factors associated with the absence of transferable cleavage-stage embryos in fresh IVF cycles with 10–20 retrieved oocytes: a retrospective analysis of 42,931 cycles

To investigate the incidence and factors associated with the absence of transferable cleavage-stage embryos in patients with 10–20 retrieved oocytes. This retrospective study included 42,931 fresh IVF cycles with 10–20 oocytes retrieved between January 2017 and December 2024. Cycles with no transferable cleavage‑stage embryo were defined as the no-transferable-embryo group while those with at least one transferable embryo (transferred or cryopreserved) served as controls. Univariate and multivariable logistic regression analyses were performed to identify factors independently associated with the outcome. The incidence of no transferable cleavage‑stage embryos was 1.47% (632/42,931). Multivariable regression analysis showed that secondary infertility (aOR 0.753, 95% CI 0.620–0.914), higher trigger-day estradiol (E 2 ) (aOR 0.662, 95% CI 0.467–0.937), and oocyte yield (aOR 0.888, 95% CI 0.858–0.919) were associated with lower odds of the outcome. Longer infertility duration (aOR 1.048, 95% CI 1.022–1.074), higher total gonadotropin (Gn) dosage (aOR 7.353, 95% CI 3.365–16.07), use of intracytoplasmic sperm injection (ICSI) (aOR 2.514, 95% CI 2.069–3.055), and rescue ICSI (aOR 6.393, 95% CI 3.642–11.22) were independently associated with higher odds of the outcome (all P < 0.05). Polycystic ovary syndrome (PCOS) was not significantly associated with the outcome in the overall population; in the ICSI subgroup, PCOS was associated with lower odds of the outcome (aOR 0.593, 95% CI 0.356–0.987). Surgically retrieved sperm was not independently associated with the outcome. Primary infertility, longer infertility duration, higher total Gn dosage, lower trigger-day E 2 level, lower oocyte yield, and the use of ICSI or rescue ICSI were associated with higher odds of having no transferable cleavage-stage embryos.