Live birth rate after ART with donor semen in single women, lesbian couples and heterosexual couples: a systematic review and meta-analysis.

This systematic review and meta-analysis compared the live birth rate (LBR) after assisted reproductive technology (ART) with donor semen among single women, lesbian couples and heterosexual couples. Searches of PubMed, EMBASE and the Cochrane Library up to September 2025 identified seven eligible studies including 19,457 women. Separate analyses were performed for intrauterine insemination (IUI) and IVF. For IUI, single women had a significantly lower LBR than heterosexual couples [risk ratio (RR) = 0.70, 95% CI 0.66-0.74] and lesbian couples (RR = 0.67, 95% CI 0.63-0.72), whereas no significant difference was observed between heterosexual couples and lesbian couples. The clinical pregnancy rate was lower in single women compared with lesbian couples, but the pregnancy loss rate was similar across both groups. Sensitivity analyses confirmed these findings. Importantly, meta-regressions indicated that differences in LBR were no longer significant after adjusting for female age. Results from IVF studies were consistent with those from IUI analyses. Overall, single women using donor semen for ART showed lower success rates, largely explained by older maternal age. These findings highlight the importance of age adjustment, and provide evidence-based data for counselling individuals and couples considering ART with donor semen.