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

Abstract

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.

Effect of medroxyprogesterone acetate dose in progestin-primed ovarian stimulation on pregnancy outcomes in poor ovarian response patients with different body mass index levels

“…To better manage POR patients, the 2016 POSEIDON criteria classified POR patients into POSEIDON groups 1 and 2 due to abnormal ovarian response to exogenous gonadotropin and POSEIDON groups 3 and 4 due to decreased ovarian reserve based on age and the ovarian reserve parameters AFC and AMH, which improved the homogeneity and comparability of clinical studies and was conducive to providing more accurate assisted pregnancy strategies for POR patients ( 10 , 25 ). Female age, BMI, AFC, and COH protocols were independent predictors of live birth in POR patients according to the POSEIDON criteria ( 26 , 27 ). The previous retrospective analysis on the impact of BMI on the pregnancy outcome of FET showed that low BMI had no significant impact on the live birth rate, while obesity was closely associated with decreased clinical pregnancy rate and live birth rate ( 28 , 29 ).…”

Development and validation of a live birth prediction model for expected poor ovarian response patients during IVF/ICSI

“…In a clinical pregnancy failure prediction model based on 281 POR patients, is still conducted according to the Bologna criteria, cannot be distinguished the biological heterogeneity of patients with POR (18,19). Another study found independent predictors of live birth in POR patients based on the POSEIDON criteria, but failed to develop a complete live birth predictive model (20). Conforti et al found that, with the increasing age of the first delivery in recent years, the proportion of patients in group 4 under POSEIDON criteria is as high as 55%, and the proportion of patients in group 3 is about 10% (21).…”

“…In a clinical pregnancy failure prediction model based on 281 POR patients, is still conducted according to the Bologna criteria, cannot be distinguished the biological heterogeneity of patients with POR ( 18 , 19 ). Another study found independent predictors of live birth in POR patients based on the POSEIDON criteria, but failed to develop a complete live birth predictive model ( 20 ). Conforti et al.…”