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Background: Unilateral oophorectomy (UO), the surgical removal of one ovary, remains a necessary intervention for various gynecologic conditions despite a general trend toward more conservative treatments. As increasing numbers of women with a single ovary participate in assisted reproductive technology (ART) programs, understanding the impact of UO on fertility outcomes is essential. Though ovarian reserve may be diminished, compensatory mechanisms may preserve reproductive potential. Clarifying this relationship can inform patient counseling and treatment planning. 

Aim: To evaluate whether unilateral oophorectomy significantly affects outcomes in assisted reproductive technologies (ART), particularly in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), through a systematic review of the literature. 

Methods: A literature review was conducted using PubMed and Google Scholar databases. The search included articles published in English from January 1987 to December 2024 using the keywords “unilateral oophorectomy” AND “assisted reproduction.” After removing duplicates and studies that did not meet inclusion criteria, 9 articles were included in the final analysis. These studies varied in design (prospective, retrospective, cohort studies, and systematic reviews) and sample size, but all focused on ART outcomes in women with one ovary compared to those with two.

Results: The selected studies demonstrated that women with a single ovary generally have a reduced ovarian response, including fewer follicles, lower peak estradiol levels, and fewer retrieved oocytes. However, in most studies, clinical pregnancy and live birth rates remained comparable to those of women with two ovaries. Some studies even reported higher pregnancy rates in the UO group. Evidence of compensatory ovarian function in the remaining ovary was observed, including increased antral follicle count and follicular yield. Differences in ovarian stimulation protocols and patient characteristics influenced the magnitude of response, but ART success rates were not significantly compromised overall.

Conclusions: Despite reduced ovarian reserve and response in women with unilateral oophorectomy, ART outcomes—including pregnancy and live birth rates—are largely comparable to those in women with two ovaries. This suggests that the remaining ovary may compensate functionally, supporting satisfactory reproductive outcomes. Women who have undergone UO can be counseled with confidence regarding their fertility potential with ART. Further research is warranted to explore mechanisms of ovarian compensation and optimize treatment protocols for this population