The prognosis of sub group of unexpected poor responders (POSEIDON group 1) in a cohort of normal responder women; is it really poor?

Ahmed Shoukry Rageh; Emad ElDin Abd El Rahman Khalifa; Ashraf Hany Abd El Rahman; Mohamed El Mahdy

Ahmed Shoukry Rageh Faculty of medicine Alexandria university
Emad ElDin Abd El Rahman Khalifa
Ashraf Hany Abd El Rahman
Mohamed El Mahdy

Keywords: poor responders, POSEIDON, antagonist protocol, clinical pregnancy rate, ongoing pregnancy rate

Abstract

Background: Poor responders still represent one of the most challenging patients in fertility practice. Recently "Patient Oriented Strategies Encompassing IndividualizeD Oocyte Number" classification of suboptimal/poor responders, considering essential characteristics of infertile women, which could have a pivotal impact on the outcome of ICSI cycles in those women.

Methods: observational prospective cohort study conducted for 350 women with normal ovarian reserve and aged < 35 years; GnRH antagonist protocol was used for all women. The primary outcomes were clinical and ongoing pregnancy rate.

Results: out of 350 women in the study, 42 women (12 %) were found to be unexpected suboptimal/poor response. there was a statistically significant difference regarding age, body mass index, antral follicles count, anti-mullerian hormone level, total FSH dose and number of follicles >11 mm on day of ovulation trigger. Group of normal responders (308/350) have more oocytes retrieved than POSEIDON group 1 however, there was no statistically significant difference in clinical pregnancy (36.1 % vs. 51.2 %, p = 0.087) and ongoing pregnancy (36.1 % vs. 43.6 %, p = 0.392) rates between normal responders and POSEIDON group 1 respectively. There were no women with miscarriages in POSEIDON group (all the clinically pregnant women continued their pregnancy beyond 12 weeks).

Conclusion: it was concluded that poor responder women with good ovarian reserve and aged < 35 years would have a comparable pregnancy rates to normal responder women.