Blastocyst Aneuploidy Rates In Poor Ovarian Response Patients According To The POSEIDON Criteria

Background Poor ovarian response(POR),which is associated with both high cancelation rates and low live birth rates,represents one of the most important challenges in IVF-ET(in vitro fertilization and embryo transfer).The Patient-Oriented Strategies Encompassing Individualized Oocyte Number(POSEIDON)criteria based on quantitative and qualitative parameters of the oocytes,is an important criterion for the evaluation of patients with low prognosis.Age is a key determination on blastocyst aneuploidy.However,it remains unclear whether the ovarian reserve tests(Orts),such as antral follicle count(AFC)and anti-Müllerian hormone(AMH)could predict the embryo aneuploidy in patients with POR.Objective To investigate the prediction of AMH and AFC on the blastocyst aneuploidy,this study analyzed the blastocyst aneuploidy rate between POR groups according to the POSEIDON classification and age-matched control groups.The results provided clinical evidence for the individualized treatment strategy of POR patients participating in preimplantation genetic testing for aneuploidies(PGT-A).Methods This was a retrospective cohort study of patients who underwent PGT-A at the Center for Reproductive Medicine,Shandong University,China from January 2017 to December 2020.POR patients were stratified into four groups using the POSEIDON criteria.The aneuploidy rate and euploidy rate of the blastocysts and secondary outcomes such as the ability of obtaining at least one euploid embryo in a cycle was compared with age-matched control women with normal ovarian reserve respectively(POR 1,2,3,4 groups correspond to control group a,b,c,d respectively).The generalized estimating equations(GEE)combined with binary Logistics regression were performed adjusting confounding factors,at the same time,the pregnancy outcomes were analyzed for the groups with statistically different aneuploidy rates.Results A total of 8269 blastocysts from 2619 PGT-A cycles were included.The number of oocytes retrieved and embryos in POR patients was significantly decreased(P<0.01).No differences were identified in embryo euploidy rate(G1 53.06%vs.56.59%;G2 34.39%vs.36.02%;G3 48.17%vs.54.13%),aneuploidy rate(G1 27.18%vs.25.46%;G2 52.80%vs.50.27%;G3 32.85%vs.28.33%),and chimerism rate(G1 19.76%vs.17.94%;G2 12.80%vs.13.72%;G3 18.98%vs.17.55%)between POR patients in groups 1,2,3 and corresponding controls,respectively.However,the embryo euploidy rate in Group 4 POR patients was significantly lower than that in age-matched controls(30.30%vs.34.51%,P=0.042);the embryo aneuploidy rate was significantly higher than controls(55.79%vs.51,13%;P=0.034);there was no statistically different observed in the chimerism rate(13.92%vs.14.37%,P>0.05).After adjusting for multiple cycles of PGT-A and PGT-A indications by generalized estimating equation(GEE),the embryo aneuploidy rate in the POR4 group was still significantly higher than that in the control group(OR:1.246,95%CI:1.014-1.532,P=0.037).However,there were no statistically significant differences in clinical pregnancy rate,live birth rate,and abortion rate between the POR4 group and the control group(P>0.05).The probability of obtaining at least one euploid embryo in a single cycle was significantly lower in each group of POR than in the control group(G1 78.29%vs.93.44%;G2 55.67%vs.69.52%;G3 77.78%vs.91.92%;G4 46.42%vs.68.17%;P<0.001 respectively),and the probability of all embryos obtained during the cycle being aneuploid was significantly higher than in the control group(G1 9.69%vs.2.46%;G2 30.48%vs.17.38%;G3 10.10%vs.2.02%;G4 40.58%vs.18.83%;P<0.001 respectively).Conclusion The ovarian reserve adversely affects the quantity and quality of oocytes in advanced age POR women,however,live birth rates after transfer of euploid blastocysts were similar to the controls.Decreased ovarian reserve in young women mainly affects the number of oocytes retrieved and the outcome of assisted reproductive technology(ART).