An Observational Retrospective Cohort Trial on 4,828 IVF Cycles Evaluating Different Low Prognosis Patients Following the POSEIDON Criteria

Abstract

Objective: To study the actual controlled ovarian stimulation (COS) management in women with suboptimal response, comparing clinical outcomes to the gonadotropins consume, considering potential role of luteinizing hormone (LH) addition to follicle-stimulating hormone (FSH). Design: Monocentric, observational, retrospective, real-world, clinical trial on fresh intra-cytoplasmic sperm injection (ICSI) cycles retrieving from 1 to 9 oocytes, performed at Humanitas Fertility Center from January 1st, 2012 to December 31st, 2015. Methods: COS protocols provided gonadotropin releasing-hormone (GnRH) agonist long, flare-up, short and antagonist. Both recombinant and urinary FSH were used for COS and LH was added according to the clinical practice. ICSI outcomes considered were: gonadotropins dosages; total, mature, injected and frozen oocytes; cumulative, transferred and frozen embryos; implantation rate; pregnancy, delivery and miscarriage rates. Outcomes were compared according to the gonadotropin regimen used during COS. Results: Our cohort showed 20.8% of low responders, defined as 1–3 oocytes retrieved and 79.2% of “suboptimal” responders, defined as 4–9 oocytes retrieved. According to recent POSEIDON stratification, cycles were divided in group 1 (6.9%), 2 (19.8%), 3 (11.7%), and 4 (61.5%). The cohort was divided in 3 groups, according to the gonadotropin's regimen. Women treated with FSH plus LH showed worst prognostic factors, in terms of age, basal FSH, AMH, and AFC. This difference was evident in suboptimal responders, whereas only AMH and AFC were different among treatment groups in low responders. Although a different result, in terms of oocytes and embryos detected, major ICSI outcomes (i.e., pregnancy and delivery rates) were similar among groups of COS treatment. Outcomes were significantly different among Poseidon groups. Implantation, pregnancy and delivery rates were significantly higher in Poseidon group 1 and progressively declined in other POSEIDON groups, reaching the worst percentage in group 4. Conclusions: In clinical practice, women with worst prognosis factors are generally treated with a combination of LH and FSH. Despite low prognosis women showed a reduced number of oocytes retrieved, the final ICSI outcome, in terms of pregnancy, is similarly among treatment group. This result suggests that the LH addition to FSH during COS could improve the quality of oocytes retrieved, balancing those differences that are evident at baseline. Clinical Trial Registration: www.ClinicalTrials.gov , identifier: NCT03290911

Cumulative live-birth, perinatal and obstetric outcomes for POSEIDON groups after IVF/ICSI cycles: a single-center retrospective study

“…Women with low prognosis after ART treatment can be stratified by using the POSEIDON criteria. Despite many studies have reported the CLBR among POSEIDON groups 19,22,23 , to our knowledge, the long term perinatal and obstetric outcome is still unexplored among women with low prognosis stratified by the POSEIDON criteria. From the demographic characteristics and obstetric history, the majority of participants were found to have regular menses with highest mean for POSEIDON1, with normal BMI or overweight.…”

“…This urges deep exploration and robust researches in the subject matter. It follows that, since POSEIDON criteria were introduced within the last decade, several publications have opted to assess different fertility outcomes among the four groups of low prognosis defined by the criteria 18,19 . With the majority assessing the cumulative probability of pregnancies 20,21 , a few assessed cumulative probabilities of pregnancy.…”

The Role of hCG Triggering Progesterone Levels: A Real-World Retrospective Cohort Study of More Than 8000 IVF/ICSI Cycles

“…The COS protocol was chosen based on patients' characteristics and gynecologists' judgment, according mainly to Poseidon criteria (16)(17)(18).…”

What Is the Best Regimen for Ovarian Stimulation of Poor Responders in ART/IVF?

“…More recently, a new classification of poor ovarian reserve patients in IVF/ART has been put forward by the POSEIDON (Patient Oriented Strategies Encompassing Individualized Oocyte Number) group (20)(21)(22). In this classification, four subgroups have been suggested according to qualitative and quantitative parameters, like the Bologna criteria, namely:…”