Live birth outcomes after first donor oocyte embryo transfer: a comparison by treatment pathways in poor prognosis patients.

PURPOSE: To compare live birth rates after the first donor oocyte embryo transfer between patients who began treatment as donor oocyte recipients and those who transitioned to donor oocyte following unsuccessful autologous in vitro fertilization (IVF). METHODS: This retrospective cohort study included patients who underwent their first donor oocyte embryo transfer between 2012 and 2024 at a single academic-affiliated fertility clinic. Patients were grouped by treatment pathway: immediate use of donor oocytes ("DONOR-1st") or secondary use following unsuccessful autologous IVF attempts ("IVF-1st"). The primary outcome was live birth after the first donor oocyte embryo transfer. Secondary outcomes included live birth per all donor oocyte embryo transfers and time from initial consultation to live birth. RESULTS: One-hundred fifty-seven DONOR-1st and 196 IVF-1st patients were included. The live birth rate after the first donor oocyte embryo transfer was similar between groups (DONOR-1st: 59.2% vs. IVF-1st: 53.1%, p = 0.24). Live birth rates across all donor transfers were comparable (DONOR-1st: 50.4% (250 transfers) vs. IVF-1st: 49.2% (327 transfers), p = 0.82). DONOR-1st patients reached the transfer that resulted in a live birth significantly faster than IVF-1st patients (13.2 ± 9.9 vs. 21.0 ± 13.7 months, p < 0.01). CONCLUSION: Live birth rate after the first donor oocyte embryo transfer was comparable between patients who initially attempted autologous IVF without success and those who initiated treatment as donor recipients. Prior autologous IVF does not appear to negatively associate with reproductive potential, evidenced by successful outcomes with subsequent donor oocyte use. However, for patients with poor prognosis, donor oocyte use may provide a more efficient treatment pathway.