Cumulative live-birth, perinatal and obstetric outcomes for POSEIDON groups after IVF/ICSI cycles: a single-center retrospective study

Abstract

Recently, perinatal outcomes and cumulative live birth rate (cLBR) have widely been utilized to assess the fertility outcomes and safety of assisted reproductive technology (ARt), but more robust research is needed to address the success rates of live-healthy births resulting from this procedure, particularly for patients with low prognosis. this study aims to assess and comparative perinatal outcomes and cLBR per cycle of in vitro fertilization/intracytoplasmic sperm injection (iVf/icSi) between four groups of low prognosis characterized by poSeiDon criteria. A retrospective assessment was done among infertile women with a low prognosis undergoing iVf/icSi at a reproductive center in china. Data were collected between January 2011 and December 2015 with a follow-up of at least two years, and censoring was defined by three-cycle completion, discontinuation, or having a live birth. Participants were grouped into 4 groups according to the POSEIDON classification (POSEIDON1, POSEIDON2, POSEIDON3, and POSEIDON4). The main outcomes were perinatal and obstetric outcomes with cLBR per cycle after iVf/icSi procedure. And iVf/icSi-technique outcomes as a secondary outcome. Statistical analyses were performed by SpSS, and a p value of < 0.05 was considered significant. A total of 461 eligible participants underwent a total of 825 IVF/ICSI cycles. POSEIDON1 had the best perinatal outcomes in terms of live births (≥ 28w) (54.8%). POSEIDON4 had a higher risk for perinatal and obstetric complications with abortion rate (9.8%); LBW (11.7%), PTD (23.5%), PROM (11.7%), and gestational diabetes (17.6%). POSEIDON2 had a high rate for malpresentation (14.2%), and cesarean delivery(57.2%), while POSEIDON3 was much associated with the occurrences of placenta previa (9.3%) compared to other groups (p value = 0.001). After adjusting odds ratio by age and BMI, POSEIDON4 had the least odds for biochemical pregnancy (p value = 0.019); and the least odds for clinical pregnancy (p value = 0.001) of the four groups. CLBR per cycle was better in POSEIDON1 and increased with an increasing number of cycles in all groups during the three cycles. conservative cLBR after three complete cycles were 77.27%, 42.52%, 51.4% and 22.34%, while optimistic CLBR were 79.01%, 51.19%, 58.59% and 34.46% in POSEIDON1 to POSEIDON4, respectively. Younger women with low prognosis and normal ovarian reserve have a higher probability for live births and better perinatal outcomes compared with older women with poor or normal ovarian reserve. Besides, young women with low prognosis, despite ovarian reserve status, can increase their probability of conception and get relatively higher cLBR by undergoing multiple cycles of iVf/icSi. Age is therefore considered as a critical parameter in predicting the perinatal outcome and cLBR.

Clinical Application of AMH Measurement in Assisted Reproduction

“…As for women with predicted poor ovarian reserve, a recent retrospective analysis on 825 IVF cycles showed that the live birth rate decreased through Poseidon groups 1, 3, 2, and 4 in order ( 48 ). It implies that both AMH or AFC as well as age have an impact on the prediction of live birth.…”

Improving Reporting of Clinical Studies Using the POSEIDON Criteria: POSORT Guidelines

“…Among different study designs, it is widely recognized that RCTs represent the optimal way to verify the clinical efficacy of specific interventions ( 59 , 60 ). In RCTs, participants are prospectively and randomly allocated to either intervention or another, following strict inclusion and exclusion criteria.…”

Safety and effectiveness of acupuncture for POSEIDON patients in IVF/ICSI

“…[ 3 , 38 ] For better clinical decisions of these patents, POSEIDON criteria were carried out in 2016, [ 4 , 5 ] dividing low prognosis patients into 4 groups with their age, AMH, AFC, and retrieved oocytes number of previous cycle. Retrospective studies suggested significant differences on CPR and LBR among 4 groups [ 6 , 7 ] ; these results might be adequate references for building a predicting model in managing POR patients.…”

“…[ 4 , 5 ] With this classification, studies analyzed the results of completed IVF/ICSI cycles of POR patients, showing that in cumulative live birth rates (CLBR), optimistic outcomes were observed in group 1, 2, and 3. [ 6 , 7 ] Thus, POSEIDON criteria might provide a more detailed and precise model in predicting IVF/ICSI prognosis on POR women. [ 8 ]…”