Overview and Aims:

In vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) show discouraging results in poor ovarian responders. We aim to characterize low prognosis women, stratifying them according to POSEIDON criteria -based on ovarian reserve markers and response in previous cycles.

Study Design:

data base retrospective study

Population:

women undertaking an IVF/ICSI cycle between May/2012 and December/2017 in our public centre.

Methods:

all women undertaking IVF/ICSI cycles with registered antimullerian hormone levels and antral follicule count (the ovarian reserve markers considered in POSEIDON criteria) were divided in 4 groups -women with normal ovarian reserve markers but low response in previous cycle (<35 years-G1; ≥35 years-G2) and women with at least one low ovarian reserve marker (<35 years-G3; ≥35years-G4). Ovarian reserve markers, previous ovarian response, socio-demographic features, type/etiology of infertility, number of oocytes collected, clinical pregnancy and delivery rates per cycle/ovarian puncture(OP)/transfer were determined. Ovarian response (categorized into optimal/non-optimal based on the number of oocytes collected), clinical pregnancy and delivery rates of the 4 groups were compared to population non-POSEIDON(PNP). X 2 test was used. Significance was set at p-value<0.05.

Results:

1789 cycles were analysed; 49.6%(887/1789) of them met POSEIDON criteria - n=86(G1), n=129(G2); n=180(G3); n=492(G4). 85.7% of those reaching OP had a non-optimal response. G4 showed the worse pregnancy and delivery rates, significantly lower than PNP. The highest rates of pregnancy and delivery were verified in a subgroup of G2, except for delivery/cycle; no difference was observed between G1/G2 and PNP. Most women were Portuguese, Caucasian, normal weighted, non-smokers and presented primary infertility. Male factor was the most frequently identified cause.

Conclusion:

POSEIDON criteria showed high positive predictive value of having a non-optimal response. Results may help managing expectations of women undergoing IVF/ICSI with similar characteristics. Exclusion from POSEIDON group should not be considered reassuring due to low negative predictive value.

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