A higher number of oocytes retrieved is associated with an increase in fertilized oocytes, blastocysts, and cumulative live birth rates.

Objective: To investigate the association between the number of oocytes retrieved and the numbers of fertilized oocytes and blastocysts and cumulative and primary transfer live birth rates (LBRs).

Design: Retrospective study.

Setting: Retrieval cycles and linked embryo transfers from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System.

Patient(s): Patients in the United States undergoing autologous in vitro fertilization cycles from 2014 to 2019 (n = 402,411 cycles).

Intervention(s): None.

Main Outcome Measure(s): Normally fertilized oocytes, blastocysts, and cumulative and primary transfer LBRs.

Result(s): There was a strong positive linear correlation between oocytes and fertilized oocytes and between oocytes and blastocysts. The cumulative LBR increased rapidly with the number of oocytes retrieved to approximately 16-20 oocytes, at which point it continued to increase but with diminishing returns. The increasing trend of the cumulative LBR was observed when stratifying patients by age and antimüllerian hormone and after controlling for confounding variables using multivariate logistic regression. The primary transfer LBR also increased with the number of oocytes to approximately 16-20 oocytes, at which point it plateaued but did not decline.

Conclusion(s): A higher number of oocytes retrieved improves the cumulative LBR without impairing the primary transfer LBR. This suggests that ovarian stimulation strategies should aim to safely maximize the number of oocytes retrieved.