The novel POSEIDON stratification of ‘Low prognosis patients in Assisted Reproductive Technology’ and its proposed marker of successful outcome [version 1; referees: 2 approved, 1 approved with reservations]
In reproductive medicine little progress has been achieved regarding the clinical management of patients with a reduced ovarian reserve or poor ovarian response (POR) to stimulation with exogenous gonadotropins -a frustrating experience for clinicians as well as patients. Despite the efforts to opti...
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| Format: | Article |
| Language: | English |
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F1000 Research Ltd
2016-12-01
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| Series: | F1000Research |
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| Online Access: | https://f1000research.com/articles/5-2911/v1 |
| _version_ | 1818851435047026688 |
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| author | Peter Humaidan Carlo Alviggi Robert Fischer Sandro C. Esteves |
| author_facet | Peter Humaidan Carlo Alviggi Robert Fischer Sandro C. Esteves |
| author_sort | Peter Humaidan |
| collection | DOAJ |
| description | In reproductive medicine little progress has been achieved regarding the clinical management of patients with a reduced ovarian reserve or poor ovarian response (POR) to stimulation with exogenous gonadotropins -a frustrating experience for clinicians as well as patients. Despite the efforts to optimize the definition of this subgroup of patients, the existing POR criteria unfortunately comprise a heterogeneous population and, importantly, do not offer any recommendations for clinical handling. Recently, the POSEIDON group (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number) proposed a new stratification of assisted reproductive technology (ART) in patients with a reduced ovarian reserve or unexpected inappropriate ovarian response to exogenous gonadotropins. In brief, four subgroups have been suggested based on quantitative and qualitative parameters, namely, i. Age and the expected aneuploidy rate; ii. Ovarian biomarkers (i.e. antral follicle count [AFC] and anti-Müllerian hormone [AMH]), and iii. Ovarian response - provided a previous stimulation cycle was performed. The new classification introduces a more nuanced picture of the “low prognosis patient” in ART, using clinically relevant criteria to guide the physician to most optimally manage this group of patients. The POSEIDON group also introduced a new measure for successful ART treatment, namely, the ability to retrieve the number of oocytes needed for the specific patient to obtain at least one euploid embryo for transfer. This feature represents a pragmatic endpoint to clinicians and enables the development of prediction models aiming to reduce the time-to-pregnancy (TTP). Consequently, the POSEIDON stratification should not be applied for retrospective analyses having live birth rate (LBR) as endpoint. Such an approach would fail as the attribution of patients to each Poseidon group is related to specific requirements and could only be made prospectively. On the other hand, any prospective approach (i.e. RCT) should be performed separately in each specific group. |
| first_indexed | 2024-12-19T07:04:58Z |
| format | Article |
| id | doaj.art-a55351bcd37f497683b33b5d3a88da79 |
| institution | Directory Open Access Journal |
| issn | 2046-1402 |
| language | English |
| last_indexed | 2024-12-19T07:04:58Z |
| publishDate | 2016-12-01 |
| publisher | F1000 Research Ltd |
| record_format | Article |
| series | F1000Research |
| spelling | doaj.art-a55351bcd37f497683b33b5d3a88da792022-12-21T20:31:19ZengF1000 Research LtdF1000Research2046-14022016-12-01510.12688/f1000research.10382.111186The novel POSEIDON stratification of ‘Low prognosis patients in Assisted Reproductive Technology’ and its proposed marker of successful outcome [version 1; referees: 2 approved, 1 approved with reservations]Peter Humaidan0Carlo Alviggi1Robert Fischer2Sandro C. Esteves3Faculty of Health, Aarhus University, Skive, DenmarkDepartment of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, ItalyFertility Center Hamburg, Hamburg, GermanyANDROFERT, Andrology & Human Reproduction Clinic, Campinas, BrazilIn reproductive medicine little progress has been achieved regarding the clinical management of patients with a reduced ovarian reserve or poor ovarian response (POR) to stimulation with exogenous gonadotropins -a frustrating experience for clinicians as well as patients. Despite the efforts to optimize the definition of this subgroup of patients, the existing POR criteria unfortunately comprise a heterogeneous population and, importantly, do not offer any recommendations for clinical handling. Recently, the POSEIDON group (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number) proposed a new stratification of assisted reproductive technology (ART) in patients with a reduced ovarian reserve or unexpected inappropriate ovarian response to exogenous gonadotropins. In brief, four subgroups have been suggested based on quantitative and qualitative parameters, namely, i. Age and the expected aneuploidy rate; ii. Ovarian biomarkers (i.e. antral follicle count [AFC] and anti-Müllerian hormone [AMH]), and iii. Ovarian response - provided a previous stimulation cycle was performed. The new classification introduces a more nuanced picture of the “low prognosis patient” in ART, using clinically relevant criteria to guide the physician to most optimally manage this group of patients. The POSEIDON group also introduced a new measure for successful ART treatment, namely, the ability to retrieve the number of oocytes needed for the specific patient to obtain at least one euploid embryo for transfer. This feature represents a pragmatic endpoint to clinicians and enables the development of prediction models aiming to reduce the time-to-pregnancy (TTP). Consequently, the POSEIDON stratification should not be applied for retrospective analyses having live birth rate (LBR) as endpoint. Such an approach would fail as the attribution of patients to each Poseidon group is related to specific requirements and could only be made prospectively. On the other hand, any prospective approach (i.e. RCT) should be performed separately in each specific group.https://f1000research.com/articles/5-2911/v1Female Fertility RegulationPregnancy, Labor, Delivery & Postpartum Care |
| spellingShingle | Peter Humaidan Carlo Alviggi Robert Fischer Sandro C. Esteves The novel POSEIDON stratification of ‘Low prognosis patients in Assisted Reproductive Technology’ and its proposed marker of successful outcome [version 1; referees: 2 approved, 1 approved with reservations] F1000Research Female Fertility Regulation Pregnancy, Labor, Delivery & Postpartum Care |
| title | The novel POSEIDON stratification of ‘Low prognosis patients in Assisted Reproductive Technology’ and its proposed marker of successful outcome [version 1; referees: 2 approved, 1 approved with reservations] |
| title_full | The novel POSEIDON stratification of ‘Low prognosis patients in Assisted Reproductive Technology’ and its proposed marker of successful outcome [version 1; referees: 2 approved, 1 approved with reservations] |
| title_fullStr | The novel POSEIDON stratification of ‘Low prognosis patients in Assisted Reproductive Technology’ and its proposed marker of successful outcome [version 1; referees: 2 approved, 1 approved with reservations] |
| title_full_unstemmed | The novel POSEIDON stratification of ‘Low prognosis patients in Assisted Reproductive Technology’ and its proposed marker of successful outcome [version 1; referees: 2 approved, 1 approved with reservations] |
| title_short | The novel POSEIDON stratification of ‘Low prognosis patients in Assisted Reproductive Technology’ and its proposed marker of successful outcome [version 1; referees: 2 approved, 1 approved with reservations] |
| title_sort | novel poseidon stratification of low prognosis patients in assisted reproductive technology and its proposed marker of successful outcome version 1 referees 2 approved 1 approved with reservations |
| topic | Female Fertility Regulation Pregnancy, Labor, Delivery & Postpartum Care |
| url | https://f1000research.com/articles/5-2911/v1 |
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