In vitro fertilization outcomes of POSEIDON group 1b and 2b patients with suboptimal ovarian response: Retrospective analysis

Öz

Objective: Based on the ovarian reserve tests, patients’ expected response to ovarian stimulation (OS) can be classified into three groups as poor, normal and high response. The adequacy of dividing patients into three categories as poor (PR), normo (NR) and high responders (HR) is questioned and including suboptimal responders (SR) as a separate group is recommended. SRs are between PRs with less than 4 oocytes retrieved and NRs with 10-15 oocytes retrieved after OS. SRs wih 4-9 oocytes retrieved are classified as group 1b-2b (PG 1b-2b) according to POSEIDON classification. The aim of our study is to compare IVF (in vitro fertilization) outcomes of PG 1b-2b patients with NRs. Material and Method: This was a retrospective data analysis of patients presenting at an IVF clinic. NRs were compared to and PG 1b-2b patients (4-9 oocytes retrieved after OS with adequate ovarian reserve, <35 years and ≥35 years, respectively) in terms of pregnancy rates and live birth rates (LBR). Results: Pregnancy and miscarriage rates were comparable between PG 1b-2b PRs and NRs. LBRs were significantly higher in NRs compared to PG 1b-2b PRs (29.8% vs 6.3%, p:0.02). Conclusion: Higher LBRs were observed in NRs compared to the PG 1b-2b PRs. Despite the four times higher pregnancy rates in NRs, lack of a significant difference in pregnancy rates between groups may be due to the small number of patients. Lower LBRs in PG 1b -2b PRs suggest that new treatment options are required to improve prognosis in SRs. Keywords: Ovulation induction; in vitro fertilization, pregnancy rate

Anahtar Kelimeler

• pregnancy rate,
• in vitro fertilization,
• ovulation induction

Proje Numarası

yok

Suboptimal ovaryen yanıtta POSEIDON grup 1b ve 2b hastaların in vitro fertilizasyon sonuçları: Retrospektif analiz

Öz

Amaç: Hastalar, over rezerv testlerinde yola çıkarak; ovaryen stimülasyona (OS) zayıf, normal veya aşırı yanıt vermesi beklenenler olarak sınıflandırılır. Hastaları zayıf, normal ve aşırı yanıt verenler olarak üç kategoriye ayırmanın, yeterliliği sorgulanmaktadır ve suboptimal (beklenenin altında) yanıt verenlerin ayrı bir grup olarak dahil edilmesi önerilmektedir. Suboptimal yanıt verenler, OS sonrası 4’ten az oosit toplanan zayıf ve 10-15 arası oosit toplanan normal yanıt verenler arasındaki gruptur. Bu hastalardan 4-9 arası oosit toplanır ve POSEIDON sınıflamasına göre grup 1b-2b’yi (PG 1b-2b) oluşturur. Çalışmamızın amacı PG 1b-2b hastaların IVF (in vitro fertilzasyon) sonuçlarını normal yanıt verenlerle karşılaştırmaktır. Gereç Yöntem: Bu çalışmada, bir IVF kliniğinde retrospektif data analizi yapıldı. Normal yanıt verenlerle (yeterli over rezervine sahip ve ≥9 oosit toplanan) ve PG 1b-2b kadınların (yeterli over rezervine sahip standart OS sonrası 4-9 arası oosit toplanan, sırasıyla <35 yaş ve ≥35 yaş) embriyo transferi (ET) başına canlı doğum ve gebelik oranları karşılaştırıldı. Bulgular: PG 1b ve 2b ile normal yanıt verenler arasında gebelik ve düşük oranlar benzerdi. Canlı doğum oranları, normal yanıt verenlerde PG 1b-2b hastalara göre anlamlı olarak yüksekti (%29.8 vs %6.3, p:0.02). Sonuç: Bu çalışmada normal yanıt veren kadınlarda, PG 1b-2b grubuna kıyasla artmış canlı doğum oranları gösterildi. Normal yanıt verenlerin gebelik sayısı, PG 1b-2b’dekinin yaklaşık dört katı olmasına rağmen iki grup arasında gebelik oranları açısından anlamlı fark gösterilememesi gruplardaki hasta sayısının az olmasıyla açıklanabilir. PG 1b ve 2b grubundaki azalmış canlı doğum oranları yeni tanımlanan bu hasta grubunda prognozu iyileştirecek ek yaklaşımlar gerektiğini düşündürmektedir. Anahtar Kelimeler: Ovulasyon indüksiyonu; in vitro fertilizasyon, gebelik oranı

Anahtar Kelimeler

• gebelik oranı
• ovulasyon indüksiyonu
• in vitro fertilizasyon

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

yok

Kaynakça

1. 1. La Marca A, Sunkara SK. Individualization of controlled ovarian stimulation in IVF using ovarian reserve markers: from theory to practice. Hum Reprod Update. 2014;20:124–140. doi:10.1093/humupd/dmt037
2. 2. Broer S, Madeleine D, Disseldorp J, Broeze, et al. Prediction of an excessive response in in vitro fertilization from patient characteristics and ovarian reserve tests and comparison in subgroups: an individual patient data meta-analysis. Fertil Steril. 2013;100:420–429. doi:10.1016/j.fertnstert.2013.04.024
3. 3. Broer SL, vanDisseldorp J, Broeze KA, et al. Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach. Hum Reprod Update. 2013;19:26–36. doi:10.1093/humupd/dms041
4. 4. Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update. 2006;12:685–718. doi:10.1093/humupd/dml034
5. 5. Polyzos NP, SunkaraSK. Sub-optimal respondersfollowingcontrolledovarianstimulation: an overlookedgroup? Hum Reprod. 2015;30:2005–2008. doi:10.1093/humrep/dev149
6. 6. Esteves SC, Roque M, Bedoschi GM, Conforti A, Humaidan P, Alviggi C. Defining low prognosis patients undergoing assisted reproductive technology: POSEIDON criteria—the why. Front Endocrinol(Lausanne) .2018;9:461. PMID:30174650. doi:10.3389/fendo. 2018.00461
7. 7. Humaidan P, Alviggi C, Fischer R, Esteves SC. The novel POSEIDON stratification of ‘low prognosis patients in assisted reproductive technology’ and its proposed marker of successful outcome. F1000Res. 2016;23(5)2911. doi:10.12688/f1000research.10382.1. PMID:28232864. doi:10.12688/f1000research.10382.1
8. 8. Conforti A, Esteves SC, Cimadomo D, et al. Management of women with an unexpected low ovarian response to gonadotropin. Front Endocrinol. 2019;10:387. doi:10.3389/fendo. 2019.00387

9. 9. Gardner DK, Schoolcraft WB. In Vitro Culture of Human Blastocyst. In: Jansen R and Mortimer D, ed. Towards Reproductive Certainty: Infertility and Genetics Beyond, Carnforth, UK: ParthenonPress; 1999:377-388.
10. 10. Cedars MI. Evaluation of Female Fertility-AMH and Ovarian Reserve Testing. J ClinEndocr. 2022;107:1510-1519.
11. 11. Neves AN, Montoya-Botero P, Sachs-Guedj N, Polyzos NP. Association between the number of oocytes and cumulative live birth rate: A systematic review cumulative live birth rate: A systematic review. Best Pract Res Clin Obstet Gynaecol. 2023;87(102307). https://doi.org/10.1016/j.bpobgyn.2022.102307
12. 12. Perez Mayorga M, Gromoll J, Behre HM, Gassner C, Nieschlag E, Simoni M. Ovarian response to follicle-stimulating hormone (FSH) stimulation depends on the FSH receptor genotype. J ClinEndocrinolMetab. 2000;85:3365–3369.
13. 13. Drakopoulos P, Santos-Ribeiro S, Bosch E, et al. The effect of dose adjustments in a subsequent cycle of women with suboptimal response following conventional ovarian stimulation. Front Endocrinol (Lausanne). 2018;9:361.PMID:30083131. doi:10.3389/fendo. 2018.00361
14. 14. Alviggi C, Andersen CY, Buehler K, et al. A new more detailed stratification of low responders to ovarian stimulation: from a poor ovarian response to a low prognosis concept. Fertil Steril. 2016;105:1452–1453.
15. 15. Conforti A, EstevesSC, DiRella F, et al. The role of recombinant LH in women with hypo-response to controlled ovarian stimulation: a systematic review and meta-analysis. ReprodBiolEndocrinol. 2019;17(1):18.PMID:30728019.doi:10.1186/s12958-019-0460-4.
16. 16. Shi W, Zhou H, Tian L, Zhao Z, Zhang W, Shi J. Cumulative live birth rates of good and low prognosis patients according to POSEIDON criteria: a single center analysis of 18,455 treatment cycles. Front Endocrinol (Lausanne). 2019;10:409.PMID:31293519.doi: 10.3389/ fendo.2019.00409
17. 17. Chinta P, Antonisamy B, Manglarj AM, Kunjummen AT, Kamath MS. POSEIDON classification and the proposed treatment options for groups 1 and 2: time to revisit? A retrospective analysis of 1425 ART cycles. Hum Reprod Open. 2021;00(0):1–10. doi:10.1093/ hropen/hoaa070