Novel Physiology and Definition of Poor Ovarian Response; Clinical Recommendations

Abu-Musa, Antoine; Haahr, Thor; Humaıdan, Peter

doi:10.3390/ijms21062110

Cited by 40 publications

(27 citation statements)

References 104 publications

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“…Poor ovarian response (POR) affects between 9% and 24% ( 1 , 2 ) of women undergoing assisted reproduction and is characterized by a failure to respond adequately to standard protocols and to recruit adequate follicles, resulting in reduced oocyte production and a diminished probability of pregnancy ( 3 ). POR is a therapeutic challenge that is amplified by a lack of consensus on the definition of POR and on the appropriate therapeutic approach for women with previous POR ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Cumulative Live Birth Rates Between GnRH-A and PPOS in Low-Prognosis Patients According to POSEIDON Criteria: A Cohort Study

Zhang

Yin

et al. 2021

Front. Endocrinol.

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ObjectiveTo compare the cumulative live birth rate (CLBR) of a gonadotropin-releasing hormone (GnRH) antagonist regimen and a progestin-primed ovarian stimulation (PPOS) regimen in low-prognosis patients according to POSEIDON criteria.DesignSingle-center, retrospective, observational study.SettingHenan Provincial People’s Hospital, Zhengzhou, ChinaPatientsWomen aged ≤40 years, with a body mass index <25 kg/m2, who underwent in vitro fertilization (IVF) or intracytoplasmic sperm microinjection (ICSI) and met POSEIDON low-prognosis criteria.InterventionGnRH or PPOS regimen with IVF or ICSI.Main Outcome MeasureCLBR per oocyte retrieval cycle.ResultsPer oocyte retrieval cycle, CLBR was significantly higher with GnRH antagonist versus PPOS (35.3% vs 25.2%; P<0.001). In multivariable logistic regression analysis, CLBR per oocyte retrieval cycle was significantly lower with PPOS versus GnRH antagonist before (OR 0.62 [95% confidence intervals (CI): 0.46, 0.82; P=0.009]) and after (OR 0.66 [95% CI: 0.47, 0.93; P=0.0172]) adjustment for age, body mass index, infertility type, infertility duration, baseline follicle stimulating hormone, anti-Müllerian hormone (AMH), antral follicle count (AFC), and insemination method. CLBR was numerically higher with the GnRH antagonist regimen than with PPOS, across all of the POSEIDON groups, and was significantly higher in patients aged ≥35 years with poor ovarian reserve [AFC <5, AMH <1.2 ng/mL] (unadjusted, P=0.0108; adjusted, P=0.0243).ConclusionIn this single-center, retrospective, cohort study, patients had a higher CLBR with a GnRH antagonist versus PPOS regimen, regardless of other attributes.

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Section: Introductionmentioning

confidence: 99%

Comparison of Cumulative Live Birth Rates Between GnRH-A and PPOS in Low-Prognosis Patients According to POSEIDON Criteria: A Cohort Study

Zhang

Yin

et al. 2021

Front. Endocrinol.

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“…The threshold effect of female age showed that the inflection point was 34 years old, which means that when age is > 34 years old, the probability of live birth in POR patients drops sharply; when age ≤ 34 years of age, the probability of spontaneous miscarriage and female age were not significantly related. A large number of studies have shown that female age is very important in the quality of embryos and endometrial receptivity (10,23). With increasing age, the number and quality of oocytes are significantly reduced, the number of mitochondria and the ATP content in the cytoplasm significantly decrease, the proportion of abnormal embryo chromosome structure increases, and live birth is closely related to embryo chromosomal abnormalities (24,25).…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Live Birth in Fresh In Vitro Fertilization/Intracytoplasmic Sperm Injection Treatment in Poor Ovarian Reserve Patients Classified by the POSEIDON Criteria

Tian

Kong

et al. 2021

Front. Endocrinol.

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The mechanisms underlying poor ovarian response (POR) in assisted reproductive technology remain unclear, there is no consensus on the management of poor responders, the POSEIDON stratification classifies infertility patients into “expected” or “unexpected” groups to provide a more nuanced picture of POR, but few researchers have discussed the independent predictive factors (smoothed plots and the threshold effect) for live birth in POR patients classified by the new criteria. We conducted a retrospective cohort study using clinical data from 6,580 POR patients classified by the POSEIDON criteria in the First Affiliated Hospital of Zhengzhou University, and explored the live birth based on the results before and after the threshold inflection point of each independent influencing factor. Among 6,580 poor ovarian reserve patients classified by the POSEIDON criteria, 1,549 (23.54%) had live births, and 5,031 (76.46%) did not have live births. Multivariate logistic regression analysis showed that female age (OR 0.901; 95% CI 0.887~0.916; P < 0.001), body mass index (OR 0.963; 95% CI 0.951~0.982; P < 0.001), antral follicle counting (OR 1.049; 95% CI 1.009~1.042; P < 0.001) and controlled ovarian hyperstimulation protocol were independent factors predicting live birth in patients with POR. The threshold effect analysis found that the inflection point of female age was 34 years old, and when age was > 34 years old, the probability of live birth in POR patients dropped sharply (OR 0.7; 95% CI 0.7~0.8; P < 0.001). The inflection point of BMI was 23.4 kg/m2, and BMI had a negative correlation with live birth (OR 0.963; 95% CI 0.951~0.982; P < 0.001). The threshold inflection point of AFC was 8n. Female age, BMI, AFC and COH protocol were independent predictive factors associated with live birth in POR patients classified by the POSEIDON criteria. The smooth curve fit and threshold effect analyses provide clinical management strategies for these patients. In addition, the early-follicular-phase long-acting GnRH-agonist long protocol seems to have a higher live birth rates than other protocols. It is worth highlighting that BMI should be considered as well in the POSEIDON criteria.

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“…This distribution is different than the numbers reported in other studies and depends on the characteristics of the population seen at each center (Table 3). According to Abu-Musa, group 4 tends to be the group with the highest number of patients, accounting for about 55% of the patients, while group 3 amounts to about 10% (Abu-Musa et al, 2020). The study by Levi-Setti et al (2019) included IVF/ICSI patients in whom 1-9 oocytes had been retrieved, instead of selecting patients who had had ≤ 9 oocytes in a previous cycle of ovarian stimulation and aspiration, as described in the POSEIDON criteria.…”

Section: Discussionmentioning

confidence: 99%

Cumulative live birth rates of patients in the Peruvian Andes according to the POSEIDON criteria: a single-center retrospective analysis

Vargas-Tominaga¹,

Vargas²,

Alarcón³

et al. 2021

JBRA

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Novel Physiology and Definition of Poor Ovarian Response; Clinical Recommendations

Cited by 40 publications

References 104 publications

Comparison of Cumulative Live Birth Rates Between GnRH-A and PPOS in Low-Prognosis Patients According to POSEIDON Criteria: A Cohort Study

Comparison of Cumulative Live Birth Rates Between GnRH-A and PPOS in Low-Prognosis Patients According to POSEIDON Criteria: A Cohort Study

Predictive Factors for Live Birth in Fresh In Vitro Fertilization/Intracytoplasmic Sperm Injection Treatment in Poor Ovarian Reserve Patients Classified by the POSEIDON Criteria

Cumulative live birth rates of patients in the Peruvian Andes according to the POSEIDON criteria: a single-center retrospective analysis

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