The POSEIDON Criteria and Its Measure of Success Through the Eyes of Clinicians and Embryologists

Abstract

This article represents a viewpoint on the POSEIDON criteria by a group of clinicians and embryologists. Its primary objective is to contextualize the Poseidon criteria and their metric of success for the relevant Frontiers Research Topic "POSEIDON's Stratification of Low Prognosis Patients in ART: The WHY, the WHAT, and the HOW". "Low prognosis" relates with reduced oocyte number, which can be associated with low or sometimes a normal ovarian reserve and is aggravated by advanced female age. These aspects will ultimately affect the number of embryos generated and consequently, the cumulative live birth rate. The novel system relies on female age, ovarian reserve markers, ovarian sensitivity to exogenous gonadotropin, and the number of oocytes retrieved, which will both identify the patients with low prognosis and stratify such patients into one of four groups of women with "expected" or "unexpected" impaired ovarian response to exogenous gonadotropin stimulation. Furthermore, the POSEIDON group introduced a new measure of clinical success in ART, namely, the ability to retrieve the number of oocytes needed to obtain at least one euploid blastocyst for transfer in each patient. Using the POSEIDON criteria, the clinician can firstly identify and classify patients who have low prognosis in ART, and secondly, aim at designing an individualized treatment plan to maximize the chances of achieving the POSEIDON measure of success in each of the four low prognosis groups. The novel POSEIDON classification system is anticipated to improve counseling and management of low prognosis patients undergoing ART, with an expected positive effect on reproductive success and a reduction in the time to live birth.

Keywords: ART calculator; POSEIDON criteria; assisted reproductive technology; blastocyst; low prognosis; oocyte; ovarian stimulation; poor ovarian response.

Figure 1

POSEIDON criteria of low prognosis patients in ART. The novel system relies on female age, ovarian reserve markers, ovarian sensitivity to exogenous gonadotropin, and the number of oocytes retrieved, which will both identify the patients with low prognosis and stratify such patients into one of four groups of women with “expected” or “unexpected” impaired ovarian response to exogenous gonadotropin stimulation. According to these criteria, four distinct groups of low prognosis patients can be established (left). Owing to low oocyte numbers and less embryos produced, POSEIDON patients have lower cumulative live birth rates per started cycle than non-POSEIDON counterparts. However, the prognosis is differentially affected by oocyte quantity and female age, as the latter relates to the risk of embryo aneuploidy (right). Art drawing by Chloé Xilinas. Modified from Esteves et al. (16). This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).

Figure 2

Logistic regression analysis of 1,220 trophectoderm biopsies from 436 patients undergoing ICSI and PGT-A by NGS. The plot depicts the fitted probabilities (with 95% confidence intervals) of blastocyst euploidy as a function of female age (left). The graph shows the percent decrease in the probability of a blastocyst being euploid, which increases progressively with every year of female age (right). Reprinted with permission of Edizioni Minerva Medica from Esteves et al. (21).