| Background:A major problem with low-prognosis patients is a lack of consensus on the terminology related to diminished ovarian reserve and poor ovarian response(POR)to stimulation.As a systematical criterium to identify and classify women with poor ovarian response,the POSEIDON stratification is considered superior to previous definitions.Diverse pregnancy outcomes among different POSEIDON groups receiving in vitro fertilization treatment(IVF)have been reported,whereas the embryos euploidy rates among the four POSEIDON groups are still uncertain.Objective:This study aimed to explore whether the euploidy rates of embryos differs in four groups of women with low prognosis stratified by POSEIDON criteria.Methods:This was a retrospective cohort study of low-prognosis patients who met the POSEIDON criteria and underwent genetic testing for aneuploidy(PGT-A)from January 2013 to June 2020 in Center for Reproductive Medicine,Shandong University.According to the definition,it is divided into POSEIDON group and non-POR group,and low-prognosis women were categorized into four groups based on POSEIDON criteria,including age(≥or<35 years),anti-Mullerian hormone(AMH)level(≥ or<1.2 ng/ml),and the ovarian response(poor or suboptimal)after standard ovarian stimulation.The primary outcome was the euploidy rate of the blastocysts.Regression analysis was carried out in each group to quantitatively describe the relationship between maternal age and embryo euploidy rate.In addition,in order to isolate the effect of age on the final results,for each group,age was used as a univariate matching analysis to determine differences in euploidy rates between Poseidon groups and non-POR groups of the same ageResults:8,204 blastocysts from women between the ages of 20 and 46 underwent 2,570 PGT-A cycles were enrolled in the study.3,016 blastocysts were detected in POR patients totally,and the embryo euploidy rate was 39.1%.In the non-POR group,a total of 5188 blastocysts were detected,and the embryo euploidy rate was 52.8%.The numbers of blastocysts were 727,1052,275 and 962 in groups 1,2,3,and 4,respectively,and the euploidy rates of embryos were 57.2%,34.9%,52.4%,and 26.2%accordingly(p<0.001).Within each group,the euploidy rate decreased with age,especially in women aged≥35 years(i.e.groups 2 and 4).Besides,after controlling for age,except POSEIDON group 4(group 4:30.8%,control group 4:37.7%,P=0.002),the euploidy rate of other groups 1,2,and 3 was similar to that of non-POR population at the same age(group 1:57.2%,control group 1:59.8%,P=0.235;Group 2:36.4%,control group 2:39.0%,P=0.204;group 3:52.4%,control group 3:58.6%,P=0.078).Conclusion:The euploidy rates favored in group 1 and 3 with young age,which re-emphasized that oocyte quality was the primary determine factor for embryo euploidy rate.After controlling for the effect of age,only the elderly population with reduced ovarian reserve(POSEIDON group 4)showed a difference in the rate of euploidy compared with the non-POR population,suggesting that low AMH levels are associated with an increased risk of fetal aneuploidy in older women.Diminished ovarian reserve and aging of oocytes in patients may result in impaired chromosomal euploidy in embryos.Our findings demonstrated the reasonability of the categorization of patients with POR by POSEIDON criteria depending on the female ages and ovarian reserve biomarkers.These results also provide clues for POR patients in different subgroups with proper counselling on the possible prognosis. |
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