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Study quality was appraised using Joanna Briggs Institute (JBI) Checklists. Meta\u2010analyses employed a random\u2010effects model, and evidence was classified using a comprehensive numerical framework.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Results<\/jats:title><jats:p>We included 45 studies covering 56\u2009787 mature oocytes, 7463 women for clinical pregnancies, and 7063 women for live births. AOA showed potential in increasing fertilisation rates in patients with a history of low or absent fertilisation but did not enhance embryo development or clinical outcomes. This effect diminished when excluding low\u2010quality studies or focusing solely on RCTs. In other patient groups, AOA showed limited or nonsignificant benefits.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Applying comprehensive evidence assessment, AOA showed potential in improving fertilisation rates in patients with fertilisation problems but no benefits for embryo development or live birth rates. 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