A Retrospective Clinical Study On The Classifications Of Patients With Low Prognosis Of Ovary Using The POSEIDON Criteria

Objective: Low-ovarian response can lead to the risk of fewer eggs,the rate of low clinical pregnancy and the rate of high cycle cancellation.The clinical management and treatment of people with low ovarian response are a severe challenge which were faced by reproductive doctors.In 2016,Alviggi and others proposed the POSEIDON criteria,tried to classify people with poor prognosis according to their specific characteristics as better guide clinical work.So far,according to POSEIDON criteria’s stratification,there are few relevant literatures to study on the clinical application of ovulation induction programs in different groups of patients.This study used a retrospective cohort study to compare the correlation with different ovulation induction programs(Gn RH-a protocol,Gn RH-ant protocol,and Mild stimulation protocol)and clinical outcomes in each group and explored the applicability of each promotion scheme in people with low ovarian prognosis.In general,the purpose of parper is to provide a basis for precise management guidance for low-prognosis populations.Methods: This study was a retrospective collection of patients with low ovarian prognosis who received IVF/ICSI at the Reproductive Center of Guilin Medical College Affiliated Hospital from January 2014 to December2019.According to POSEIDON criteria,patients with poor prognosis were divided into POSEIDON group 1,POSEIDON group 2,POSEIDON group 3,and POSEIDON group 4.Compare the correlation on different ovulation induction programs(Gn RH-a protocol,Gn RH-ant protocol,Mild stimulation protocol)and clinical outcomes in each group.Results: The cumulative live birth rate of the four groups of patients in descending order was group 1(52.4%),group 3(34.0%),group 2(33.9%),and group 4(17.9%).The POSEIDON group1 had the best clinical outcome.(1)POSEIDON group 1:The number of days of Gn use,the comsumption of Gn,intimal thickness in HCG day,number of eggs obtained,and cumulative live birth rate of the Gn RH-a protocol group were higher than the rest of the other two groups,with statistical significance(P<0.05).(2)POSEIDON group 2: The cumulative pregnancy rate of the Mild stimulation protocol group was lower than the rest of the other two groups(P<0.05).There was no significant difference in the cycle cancellation rate,embryo implantation rate,clinical pregnancy rate,and cumulative live birth rate between the Gn RH-a protocol group and the Gn RH-ant protocol group(P>0.05).The number of Gn days,the comsumption of Gn,intimal thickness in HCG day and number of eggs obtained in the Gn RH-a protocol group that one of the figure was higher than figure of the other two groups(P<0.05).(3)POSEIDON group 3: The Gn RH-ant protocol group and the Mild stimulation protocol group had lower intimal thickness in HCG day,and the number of eggs obtained than the Gn RH-a protocol group,with statistical differences(P<0.05).There was no statistical difference in cycle cancellation rate and cumulative live birth rate among the three groups(P>0.05).(4)POSEIDON group 4: The number of 2PN,number of high-quality embryos,cycle cancellation rate,embryo implantation rate,clinical pregnancy rate,and cumulative live birth rate were not statistically significant among the three groups(P>0.05).The Gn dosage and treatment time of the Gn RH-ant protocol group and the Mild stimulation protocol group were lower than the Gn RH-a protocol group.Conclusions: The POSEIDON standard can clearly distinguish patients with different characteristics and low prognosis,which is helpful for individualized treatment.(1)POSEIDON group 1: the clinical outcome of the Gn RH-a protocol was better than that of the Gn RH-ant protocol and the Mild stimulation protocol.The Gn RH-a protocol is recommended and sufficient starting amount is given.(2)POSEIDON group 2:the Gn RH-a protocol and the Gn RH-ant protocol all achieved similar pregnancy outcomes.It is recommended to use Gn RH-a protocol or Gn RH-ant protocol,and give enough starting amount,add LH as appropriate.(3)POSEIDON group3: although the highest cumulative live birth rate was observed in the Gn RH-a protocol group,the statistical difference was not significant.The number of eggs and intimal thickness in HCG day in the Gn RH-a protocol group were better than the other two.Recommend Gn RH-a protocol.(4)POSEIDON group 4: the clinical outcomes of the three groups of ovulation promotion programs were similar,while the Gn RH-ant protocol and the Mild stimulation protocol were more cost-effective.