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Year : 2019  |  Volume : 2  |  Issue : 1  |  Page : 27-34

Assisted reproductive technology outcome in poor responders classified by patient-oriented strategies encompassing individualized oocyte number stratification

Dr. Patil's Fertility and Endoscopy Clinic, Bengaluru, Karnataka, India

Correspondence Address:
Dr. Madhuri Patil
No. 1, Uma Admirality, Bannerghatta Road, Bengaluru - 560 029, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tofj.tofj_8_19

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Aim: This study aims to evaluate the assisted reproductive technology (ART) outcome among various subgroups of poor responders classified by Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) criteria. Successful end point of any ART treatment is live birth, which depends on various factors including adequate number of follicles being stimulated, adequate number of oocytes retrieved, and quality of oocytes, which in turn depends on ovarian response. Usually, success rate is low in women who respond poorly to controlled ovarian stimulation. Bologna criteria have been used in the past to identify poor responders. Heterogeneity of subgroups using the Bologna criteria makes it difficult to manage the poor ovarian responder group. Moreover, specific profiles of abnormal ovarian response like hypo and suboptimal and the age-related embryo/blastocyst aneuploidy rate, which could dramatically change the prognosis in women that have the same oocyte yield were not included in Bologna criteria. The main goal of this study was to evaluate the ART outcome among various subgroups of poor responders defined by the POSEIDON stratification. Materials and Methods: In this retrospective cohort study, the clinical and laboratory records of 260 poor responder women undergoing their first ovarian stimulation and fresh embryo transfer cycle were reviewed. Patients were categorized into 4 groups according to the POSEIDON classification. Results: There was no difference in the fertilization and cleavage rate across the groups, but the blastocyst formation rate was higher in younger patients and reached statistical significance (P < 0.001). Implantation rate is significantly high in women <35 years (P < 0.001). Clinical pregnancy rate (CPR) was statistically higher in Group 1b and Group 2b where ovarian reserve was adequate and more than 5 oocytes were retrieved irrespective of the age (P < 0.001). In those with low ovarian reserve, CPR was statistically higher in the women <35 years (P < 0.001). Live birth rate (LBR) is high in Group 1b and Group 2b where more than 5 oocytes were retrieved irrespective of the age (P = 0.029). In patients with low ovarian reserve though the LBR was more in women <35 years it did not reach statistical significance. Conclusions: Poor responders are a heterogeneous group and not homogenous for pregnancy prospects. Apart from oocytes retrieved, age and ovarian reserve will also modulate the chance of pregnancy which is higher in women <35 years and those with adequate ovarian reserve. Poor responders still represent a therapeutic challenge to the clinician, and future studies should explore the most optimal treatment strategy for management of poor responders according to the POSEIDON stratification.

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