Comparison of ART outcome in patients with poor ovarian response according to POSEIDON criteria

Abstract

The aim of this study is to evaluate whether the patient-oriented strategies encompassing individualized oocyte number (POSEIDON) criteria can reflect the prognosis of controlled ovarian stimulation (COS) by comparing the results of assisted reproductive technologies (ART) between four POSEIDON and normal responder (NR) groups. In total, 225 patients were included in this retrospective observational study. The patients underwent various COS protocols and in vitro fertilization or intracytoplasmic sperm injection, followed by fresh or frozen embryo transfer. Based on their clinical and demographic data, patients were divided into four groups according to the POSEIDON classification, and their ART outcomes were evaluated. Statistical analyses were performed using R version 4.0.5, and a p-value of < 0.05 was considered significant. The NR group had the highest number of total oocytes retrieved and total embryos obtained, as well as the best ART outcome in terms of clinical pregnancy rate ([CPR], 47.6%). The POSEIDON groups 1 and 2 had better COS and ART outcomes than groups 3 and 4 (CPR, 22.6%, 22.1%, 16.7%, and 4.8% in groups 1–4, respectively); the patients in group 3 were younger than those in group 2 by definition, but their CPR was lower than that of patients in group 2. When comparing young and old women with low anti-Müllerian hormone (AMH) levels, the younger group (POSEIDON group 2) had better COS and ART outcomes than their older counterparts, especially POSEIDON group 4. A binary logistic regression adjusted for body mass index (BMI) comparing the ART outcomes of patients that did not get pregnant in the POSEIDON groups compared to the NR group showed odds ratios (ORs) (95% confidence interval) of 2.938 (1.496–5.768), 3.376 (1.848–6.167), 6.801 (2.740–16.881), and 20.497 (8.284–50.713) for groups 1, 2, 3, and 4, respectively. Ovarian reserve still seems to outweigh patients’ age when predicting the ART outcomes of low-responder infertile women, as suggested by the results of POSEIDON groups 2 and 3. However, when there are no differences in ovarian reserve, as in POSEIDON groups 2 and 4, younger women with low AMH have a higher probability of pregnancy than their AMH-matched older counterparts.

Comparison of ovarian induction outcome in Mongolian women classified by POSEIDON criteria

“…Lee et al compared ART outcome in patients with POR according to POSEIDON criteria and concluded that serum AMH level and patients' age had impacts on ART outcome, especially serum AMH level [31]. This nding is consistent with our study result, concluding that age is the most signi cant factor of predicting the outcome of ART treatment.…”

Evaluation of the Impact of Letrozole in Combination with the GnRH Antagonist Ovarian Stimulation Protocol in Patients Expected to Have a Poor Ovarian Response (POSEIDON Groups 3 and 4)

“…Previous studies have indicated that women in POSEIDON groups 3 and 4 typically experience lower LBR compared to normoresponders or those in POSEIDON group 1 and 2 [ 6 ]. Recommended strategies for achieving one euploid blastocyst in these expected POR patients include high-dose gonadotropin administration (300–450 IU/day), oocyte/embryo pooling, and duostim/luteal phase oocyte retrieval protocols [ 4 , 31 ].…”

“…In practice, the POSEIDON classification delineates patients with POR into two categories: ‘unexpected POR’ (groups 1 and 2) and ‘expected POR’ (groups 3 and 4) [ 5 ]. Upon comparing these groups in terms of cumulative live birth rates, the highest rate of 22.6% was recorded in group 1, with this rate progressively declining to 4.8% in group 4 [ 6 ]. Given the notably low live birth rates (LBRs) in POSEIDON groups 3 and 4, numerous treatment modalities are recommended for these patients [ 4 ], albeit some lacking approval from the US Food and Drug Administration (FDA) for use with POR patients.…”

Comparison between the modified long gonadotropin-releasing hormone agonist protocol and the non-downregulation protocol in POSEIDON groups: a propensity score matching retrospective cohort study

“…The assisted pregnancy strategies and clinical outcomes vary with different groups of POSEIDON patients. However, no definitive consensus has been reached r e g a r d i n g ho w t o f or m u l a t e in d i v i d u a l i z e d o va ri an hyperstimulation protocols for each POSEIDON group to attain maximal benefit (2)(3)(4). Some protocols do not require pituitary downregulation and these include the antagonist protocol, the non-downregulation protocol, and the progestin-primed ovarian stimulation protocol.…”