Clinical outcomes in Patient-Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) low-prognosis patients receiving in vitro fertilization/intracytoplasmic sperm injection treatment: a multicentered retrospective cohort study.

OBJECTIVE

To evaluate cumulative live birth rates (CLBRs) across different Patient-Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) groups undergoing in vitro fertilization treatment.

DESIGN

Multicentered retrospective cohort study.

SUBJECT(S): A total of 100,821 female patients undergoing in vitro fertilization/intracytoplasmic sperm injection treatments from January 2013 to December 2017 in 5 cities across China (Guangzhou, Wuhan, Xi'an, Nanjing, and Zhengzhou) were included in this study.

EXPOSURE: None.

MAIN OUTCOME MEASURE(S): Cumulative live birth rates were the primary outcome, estimated using the Kaplan-Meier method, and analyzed through a Cox regression model.

RESULTS

The CLBRs across POSEIDON groups were ranked from high to low as follows: POSEIDON groups 1b, 1a, 2b, 3, 2a, and 4. Notably, the CLBRs in POSEIDON groups 1a and 3 demonstrated a consistent increase of >5% with each added cycle, and the CLBRs in POSEIDON group 1b reached that of young non-POSEIDON patients. The CLBRs in POSEIDON groups 2a and 2b reached a plateau after the third cycle, and POSEIDON group 4 plateaued earlier after the second cycle. Age stratification revealed a clear decline in CLBRs with age, which is increasing. Cumulative live birth rates significantly improved by >5% with each added cycle in patients aged 35-37 and 38-39 years, but those aged ≥40 years benefited less from additional cycles.

CONCLUSIONS

Young low-prognosis patients in POSEIDON groups could achieve CLBRs comparable with age-matched normal responders through multiple ovarian stimulation cycles. However, advanced-age low-prognosis patients, particularly those aged ≥40 years, benefited less from additional cycles. Repeated ovarian stimulation did not compensate for reduced oocyte quantity and quality in advanced-age groups. The study underscores the importance of tailored clinical approaches based on age and prognostic factors in fertility treatments.