Cumulative Live Birth Rates of Good and Low Prognosis Patients According to POSEIDON Criteria: A Single Center Analysis of 18,455 Treatment Cycles

Abstract

Objective: To investigate the characteristics and outcomes of low prognosis patients defined by POSEIDON criteria undergoing IVF treatment. Design: Retrospective cohort analysis. Setting: An IVF clinic in a public hospital. Patients: 18,455 fresh aspirated IVF cycles with subsequently frozen embryo transfer from Jan 2014 to Jan 2017 in a single IVF clinic were included in the analysis. The low prognosis patients were categorized into 4 groups based on POSEIDON criteria: group 1: age < 35, antral follicle count (AFC) ≥ 5, number of oocytes retrieved ≤ 9 in the previous cycle; group 2: age ≥ 35, AFC≥5, number of oocytes retrieved ≤ 9 in the previous cycle; group 3: age < 35, AFC < 5; group 4: age ≥ 35, AFC < 5. The non-low prognosis patients: group 5: AFC ≥ 5, previous number of oocytes retrieved > 9 oocytes; group 6: AFC ≥ 5, no previous ovarian stimulation. Intervention(s): None. Main Outcome Measure: The primary outcome was cumulative live birth rate (CLBR). Result(s): Taking group 1 as reference, the CLBR from young women in group 3 (35.5%, OR 0.9, 95% CI 0.7-1.2) was slightly lower than that in group 1 (44.6%, p = 0.615). The CLBR in group 2 (24.5%, OR 0.6, 95% CI 0.4-0.8, p = 0.004) and group 4 (12.7%, OR 0.4, 95% CI 0.3-0.6, p < 0.001) was significant lower than that in group 1. In non-poor prognosis patients, the CLBR from young women in group 5 (53.5% OR 1.3 95% CI 0.9, 1.7, p = 0.111) was a slight higher than the reference group 1 while the highest CLBR was originated from the first IVF patients with good ovarian reserve in group 6 (66.9%, OR 2.0, 95% CI 1.6, 2.4). Conclusion(s): The CLBRs and implantation rates in the young women (group 3) with diminished ovarian reserve was similar in those young women (group 1), and was significantly higher than in advanced age women with a fair ovarian reserve (group 2). Though patients in group 2 had better ovarian reserve, more oocytes and more embryos, the pregnancy outcome was inferior to that of group 3 patients with poorer ovarian reserve, fewer oocytes and fewer embryos.

Keywords: POSEIDON; cumulative live birth; implantation rate; low prognosis patient; miscarriage rate.

Figure 1

Flow chart and data processing.

Figure 2

Trend chart of key events in low prognosis patients. There was a crossing of trend lines between group 2 (red) and group 3 (blue) after embryo transfer. X axis represents the average number of AFC, number of oocytes, number embryos, number of good quality embryos, rate of implantation and rate of cumulative live birth. The Y axis on the left represents the number of the first four variables (n) and the Y axis on the right represents the rate of last two variables (%).

Figure 3

SWOT analysis of 4 groups of low prognosis patients defined by POSEIDON criteria.