Purpose <p>To assess if 1PN-derived embryos are diploid/euploid and suitable for embryo transfer.</p> Methods <p>This systematic review and meta-analysis were conducted according to the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. PubMed, Embase, and SCOPUS were systematically searched for peer-reviewed original papers using relevant keywords and Medical Subject Heading (MeSH) terms: “1PN” OR “monopronucleated” OR “single pronucleus” AND “cleavage” OR “embryo quality” OR “blastocyst quality” OR “blastulation” OR “embryo development” OR “euploidy” OR “ploidy” OR “pregnancy” OR “live birth” OR “miscarriage” OR “clinical outcomes” OR “malformation.”</p> Results <p>A total of 21 studies met the inclusion criteria. Compared to 2PN-derived embryos, 1PN-derived embryos exhibited a lower blastulation rate and clinical outcomes when transferred without prior genetic testing. However, 1PN-derived embryos demonstrated similar euploidy and live birth rates following euploid blastocyst transfer, as well as comparable malformation rates to their 2PN counterparts. A non-significant trend toward a higher risk of abnormal ploidy constitution was observed in 1PN-derived embryos. Notably, pregnancy and live birth rates were significantly lower for 1PN-derived embryos from ICSI compared to those from conventional IVF.</p> Conclusions <p>1PN-derived embryos, though less competent than 2PNs, can lead to healthy live births. They may be cautiously utilized in clinical practice, particularly when biparental diploidy has been confirmed.</p> <p>Clinical trial registration.</p> <p>CRD42024605305.</p>