CLINICAL AND LABORATORY FACTORS AFFECTING THE EFFECTIVENESS OF ASSISTED REPRODUCTIVE TECHNOLOGIES IN INFERTILITY TREATMENT
Keywords:
Infertility, assisted reproductive technologies, in vitro fertilization, intracytoplasmic sperm injection, ovarian reserve, anti-Müllerian hormone, antral follicle count, oocyte quality, sperm quality, embryo development, endometrial receptivity, ovarian stimulation, embryology laboratory, cumulative live birth rate, reproductive medicine.Abstract
Infertility is a major reproductive health concern that affects individuals and couples worldwide and may result from female, male, combined, or unexplained reproductive disorders. Assisted reproductive technologies (ART), particularly in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), have significantly expanded the possibilities of achieving pregnancy in patients with different causes of infertility. However, treatment outcomes vary considerably, even among patients receiving similar treatment protocols. This variability reflects the interaction of clinical characteristics, endocrine function, ovarian reserve, gamete quality, embryo developmental competence, endometrial conditions, and laboratory performance. Understanding these determinants is essential for improving treatment selection, optimizing safety, and establishing realistic expectations regarding reproductive outcomes. The aim of this article is to analyze the clinical and laboratory factors influencing the effectiveness of assisted reproductive technologies and to identify evidence-based approaches for improving infertility management. The study was designed as a narrative review of international clinical guidelines, scientific publications, and relevant regulatory documents from Uzbekistan. The analysis focused on female age, anti-Müllerian hormone (AMH), antral follicle count (AFC), endocrine and metabolic disorders, uterine and tubal abnormalities, male reproductive characteristics, semen parameters, oocyte competence, embryo morphology, blastocyst development, cryopreservation, and embryology laboratory quality indicators. The reviewed evidence indicates that female age is a major determinant of reproductive prognosis because of its association with oocyte competence and embryo chromosomal abnormalities. AMH and AFC are valuable predictors of ovarian response to stimulation, but they should not be interpreted as independent predictors of live birth. Male reproductive factors influence fertilization and may affect subsequent embryo development, while uterine and tubal abnormalities can compromise implantation or pregnancy maintenance. Laboratory conditions, including temperature and pH stability, culture media, equipment performance, gamete handling, and cryopreservation procedures, are also important components of treatment quality. The analysis supports an individualized approach integrating comprehensive clinical assessment, appropriate ovarian stimulation, targeted investigation of male and female reproductive factors, standardized embryological procedures, and continuous laboratory quality assurance. Treatment effectiveness should be evaluated using clearly defined outcomes, particularly cumulative live birth rate, while considering safety and patient-centered outcomes. In conclusion, the optimization of ART requires coordinated clinical and laboratory management rather than reliance on a single biomarker or procedural technique
References
1. World Health Organization. Guideline for the Prevention, Diagnosis and Treatment of Infertility. Geneva: World Health Organization; 2025. 262 p.
2. ESHRE Guideline Group on Ovarian Stimulation, Ata B., Bosch E., Broer S., Griesinger G., Grynberg M., et al. ESHRE guideline: ovarian stimulation for IVF/ICSI: an update in 2025. Human Reproduction. 2026;41(4):498–514. Oxford University Press.
3. Practice Committee of the American Society for Reproductive Medicine. Fertility evaluation of infertile women: a committee opinion. Fertility and Sterility. 2021;116(5):1255–1265. Elsevier.
4. Broer S.L., Broekmans F.J.M., Laven J.S.E., Fauser B.C.J.M. Anti-Müllerian hormone: ovarian reserve testing and its potential clinical implications. Human Reproduction Update. 2014;20(5):688–701. Oxford University Press.
5. Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile male: a committee opinion. Fertility and Sterility. 2021;115(1):54–61. Elsevier.
6. Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology. The Vienna consensus: report of an expert meeting on the development of ART laboratory performance indicators. Human Reproduction Open. 2017;2017(2). Oxford University Press.
7. Zegers-Hochschild F., Adamson G.D., Dyer S., Racowsky C., de Mouzon J., Sokol R., et al. The International Glossary on Infertility and Fertility Care, 2017. Fertility and Sterility. 2017;108(3):393–406. Elsevier.
8. Ministry of Health of the Republic of Uzbekistan. Order No. 106 of 14 January 2020 approving the Regulation on the Procedure for Using Assisted Reproductive Technologies. Registered by the Ministry of Justice on 6 February 2020, registration No. 3217. Tashkent: Ministry of Health of the Republic of Uzbekistan; 2020.
9. President of the Republic of Uzbekistan. Resolution No. PQ-296 of 8 September 2023 on measures to protect maternal and child health and strengthen reproductive health. Tashkent: Government of the Republic of Uzbekistan; 2023.
10. Sunkara S.K., Rittenberg V., Raine-Fenning N., Bhattacharya S., Zamora J., Coomarasamy A. Association between the number of eggs and live birth in IVF treatment: an analysis of 400,135 treatment cycles. Human Reproduction. 2011;26(7):1768–1774. Oxford University Press.