Management Strategies for POSEIDON Group 2

Sunkara, Sesh Kamal; Raju, Gottumukkala Achyuta Rama; Kamath, Mohan S

doi:10.3389/fendo.2020.00105

Cited by 10 publications

(5 citation statements)

References 42 publications

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“…According to a study by Genro et al (2012) , starting with a higher gonadotrophin dose would overcome the FSH receptor gene polymorphism-induced ovarian resistance, which would explain the reasonable LBR reported in the current study ( Behre et al , 2005 ; Genro et al , 2012 ). The counter-intuitive approach of increasing the starting gonadotrophin dose, which is recommended by the POSEIDON group as well, appears to be beneficial with LBRs in groups 1 and 2 that were comparable to women with good prognosis as shown in the current study ( Polyzos and Drakopoulos, 2019 ; Sunkara et al , 2020 ). There is a lack of high-quality evidence which indicates a higher prevalence of FSH/LH polymorphism among women categorized under POSEIDON groups 1 and 2.…”

Section: Discussionsupporting

confidence: 56%

“…Recently, various treatment modalities have been proposed for women belonging to different POSEIDON groups but most of these options are hypothetical in nature and need validation. The proposed treatment options in groups 1 and 2 include increasing the starting dose of gonadotrophin and/or the addition of recombinant LH as well as the use of dual stimulation (duostim) to increase the oocyte yield ( Sunkara et al , 2020 ). For POSEIDON groups 3 and 4, additional options of adding adjuvants and the use of dual triggers have been suggested ( Haahr et al , 2019 ; Polyzos and Drakopoulos, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

POSEIDON classification and the proposed treatment options for groups 1 and 2: time to revisit? A retrospective analysis of 1425 ART cycles

Chinta

Antonisamy

Mangalaraj

et al. 2021

Human Reproduction Open

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STUDY QUESTION Do live birth outcomes differ when Patient-Oriented Strategy Encompassing IndividualizeD Oocyte Number (POSEIDON) stratified groups are compared with women with good prognosis (non-POSEIDON group) undergoing ART? SUMMARY ANSWER The current study showed no significant difference in the live birth rates (LBRs) per embryo transfer between POSEIDON groups 1 and 2 when compared with women in the non-POSEIDON group undergoing ART. WHAT IS KNOWN ALREADY Recently, there has been a lot of focus on the POSEIDON classification for low prognosis women undergoing ART and various management options have been advocated. For POSEIDON groups 1 and 2, low starting dose and gonadotrophin receptor polymorphism have been suggested as possible reasons for a hyporesponse, and increasing the starting gonadotrophin dose, the addition of recombinant LH and dual stimulation have been suggested as treatment options. Most of these treatment options are hypothetical in nature and need validation. STUDY DESIGN, SIZE, DURATION In the current cohort study, a total of 1425 cycles were analyzed retrospectively following a single cycle fresh embryo transfer. The study period was from January 2013 to June 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS Women undergoing ART at a tertiary level infertility clinic were included. Clinical and treatment-related details were obtained from the hospital’s electronic medical records. The ART outcomes in a non-POSEIDON group (women with an adequate ovarian reserve and/or optimal ovarian response i.e. >9 oocytes retrieved in the previous ART cycle) and a low prognosis group stratified by POSEIDON criteria were compared. We also examined the effectiveness of the modifications made in the current ART treatment protocols among women with an adequate ovarian reserve who had a history of poor/suboptimal response (POSEIDON 1 and 2). MAIN RESULTS AND THE ROLE OF CHANCE There was no statistically significant difference in the LBR per embryo transfer in POSEIDON group 1 (32/109, 29%) and group 2 (17/58, 29%) when compared with the non-POSEIDON group (340/1041, 33%) (adjusted odds ratio (aOR) 0.69; 95% CI 0.37–1.27 and aOR 0.93, 95% CI 0.43–1.97, respectively), while significantly lower LBR were observed in POSEIDON groups 3 (17/97, 17.5%) and 4 (12/120, 10%) (aOR 0.49; 95% CI 0.28–0.89 and aOR 0.38, 95% CI 0.19–0.74, respectively). The gonadotrophin dose alone was increased in one-quarter of the cycles and in another 27% the dose was increased along with the protocol change among POSEIDON group 1. In POSEIDON group 2, a change in the dose alone and in combination with protocol change was performed in 5 and 41% of cycles, respectively. LIMITATIONS, REASONS FOR CAUTION A limitation of our study is the retrospective nature of the study with an inherent risk of unknown confounders influencing the outcomes. Other limitations are the lack of cumulative live birth data and the relatively small sample within POSEIDON group 2, which could lead to a type II error. WIDER IMPLICATIONS OF THE FINDINGS The current study showed no significant difference in the LBR between the POSEIDON groups 1 and 2 when compared with the non-POSEIDON group of women, while groups 3 and 4 had significantly lower LBR. The simple gonadotrophin/protocol changes in groups 1 and 2 resulted in LBRs comparable to women with good prognosis. These findings call for revisiting the proposed treatment strategies for POSEIDON groups 1 and 2. STUDY FUNDING/COMPETING INTEREST(S) No funding was obtained. There are no competing interests to declare.

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Section: Discussionsupporting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

POSEIDON classification and the proposed treatment options for groups 1 and 2: time to revisit? A retrospective analysis of 1425 ART cycles

Chinta

Antonisamy

Mangalaraj

et al. 2021

Human Reproduction Open

View full text Add to dashboard Cite

show abstract

“…This was anticipated to some extent, since important factors (e.g., adenomyosis, junctional zone thickness, endometrium markers of chronic endometritis) were not addressed in this study. Our results are consistent with those reported by experts in this field (members of the ESHRE board who elaborated the most recent ESHRE guidelines for best clinical practice in ovarian stimulation) who recommend the use of GH therapy in certain groups of patients, based on small sample size studies, where not all the major outcomes turned out to be statistically significant (live birth rate, in particular) [ 42 , 43 ].…”

Section: Discussionsupporting

confidence: 90%

Impact of Follicle Stimulating Hormone Receptor (FSHR) Polymorphism on the Efficiency of Co-Treatment with Growth Hormone in a Group of Infertile Women from Romania

et al. 2022

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“Poor responders” (PR) are an important category of infertile women who experience a modest response to controlled ovarian stimulation. In this study, we evaluated response to growth hormone (GH) administration among PR patient subtypes stratified by follicle stimulation hormone receptor (FSHR) polymorphism (c.2039A > G p.Asn680Ser). We conducted a cohort study of 125 women with poor ovarian response, 58 of whom received GH in addition to the standard treatment, and 67 of whom received the standard treatment only. The Ala307Thr polymorphism genotypes were analyzed using a polymerase chain reaction-restriction fragment length polymorphism method, and the FSHR gene polymorphism was analyzed using a predesigned TaqMan SNP Genotyping Assay (rs6166). A comparative analysis detected statistically significant differences in mean mature follicles (p = 0.0002), metaphase-II oocytes (p = 0.0005), progesterone levels (p = 0.0036), and IGF levels (follicle IGF1, p = 0.0004) between GH-treated and non-GH-treated participants with the FSHR (Ser/Ser) polymorphism. However, the differences were modest among participants with the other two FSHR polymorphisms (Ser/Asn and Asn/Asn). The subcategory of patients with the FSHR Asn680Ser (Ser/Ser) polymorphism showed a stronger response when GH was added to the IVF protocol.

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“…The existing evidence, albeit limited, collectively suggest that the POSEIDON criteria are overall useful to prognosticate reproductive outcomes among women undergoing ART, in which each group might demand specific treatment strategies ( 4 , 5 , 21 , 31 – 35 , 38 , 39 , 45 , 54 – 57 , 60 ). Thus, besides providing a counseling tool, the POSEIDON criteria may guide clinical management to optimize the FOI.…”

Section: Discussionmentioning

confidence: 99%

“…The FOI may be informative, especially in patients with unexpected suboptimal or poor responses to ovarian stimulation (i.e., POSEIDON groups 1 and 2). In these patients, the primary aim of interventional trials would be to identify strategies to overcome suboptimal response to ovarian stimulation, like personalizing FSH starting dosage based on specific genotype characteristics, supplementing with recombinant luteinizing hormone, or modifying the trigger strategy ( 21 , 22 , 31 , 34 , 47 , 54 , 60 ). On this basis, the FOI may serve as a marker to identify patients with a relative FSH/LH deficiency who could benefit from individualized ovarian stimulation.…”

Section: Discussionmentioning

confidence: 99%

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

Esteves¹,

Conforti

Sunkara

et al. 2021

Front. Endocrinol.

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The POSEIDON (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number) criteria were developed to help clinicians identify and classify low-prognosis patients undergoing assisted reproductive technology (ART) and provide guidance for possible therapeutic strategies to overcome infertility. Since its introduction, the number of published studies using the POSEIDON criteria has increased steadily. However, a critical analysis of existing evidence indicates inconsistent and incomplete reporting of critical outcomes. Therefore, we developed guidelines to help researchers improve the quality of reporting in studies applying the POSEIDON criteria. We also discuss the advantages of using the POSEIDON criteria in ART clinical studies and elaborate on possible study designs and critical endpoints. Our ultimate goal is to advance the knowledge concerning the clinical use of the POSEIDON criteria to patients, clinicians, and the infertility community.

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Management Strategies for POSEIDON Group 2

Cited by 10 publications

References 42 publications

POSEIDON classification and the proposed treatment options for groups 1 and 2: time to revisit? A retrospective analysis of 1425 ART cycles

POSEIDON classification and the proposed treatment options for groups 1 and 2: time to revisit? A retrospective analysis of 1425 ART cycles

Impact of Follicle Stimulating Hormone Receptor (FSHR) Polymorphism on the Efficiency of Co-Treatment with Growth Hormone in a Group of Infertile Women from Romania

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

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