Management Strategies for POSEIDON Groups 3 and 4

Thor Haahr; Carlos Dosouto; Carlo Alviggi; Sandro C Esteves; Peter Humaidan

doi:10.3389/fendo.2019.00614

Management Strategies for POSEIDON Groups 3 and 4

Front Endocrinol (Lausanne). 2019 Sep 11:10:614. doi: 10.3389/fendo.2019.00614. eCollection 2019.

Authors

Thor Haahr^{1

2}, Carlos Dosouto^{3

4}, Carlo Alviggi^{5

6}, Sandro C Esteves^{1

2

7

8}, Peter Humaidan^{1

2}

Affiliations

¹ Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
² The Fertility Clinic Skive, Skive Regional Hospital, Skive, Denmark.
³ Hospital de la Santa Creu i Sant Pau- Fundació Puigvert, Obstetrics, Gynecology and Reproductive Medicine, Barcelona, Spain.
⁴ Faculty of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
⁵ Department of Neuroscience, Reproductive Science, and Odontostomatology, University of Naples Federico II, Naples, Italy.
⁶ Consiglio Nazionale Delle Ricerche, Istituto per L'Endocrinologia e L'Oncologia Sperimentale, Naples, Italy.
⁷ ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil.
⁸ Department of Surgery, University of Campinas, Campinas, Brazil.

Abstract

In the POSEIDON classification, patients belonging to groups 3 and 4 share the same common feature of a poor ovarian reserve which independently of age renders them at high risk of a poor reproductive outcome. Overall, POSEIDON groups 1-4 constitute approximately 47% of patients attending assisted reproductive technology (ART) treatment. With the increasing delay in childbearing, POSEIDON group 4 seems to increase in numbers now in some centers constituting more than 50% of the total POSEIDON population, whereas group 3 patients constitute approximately 10%. Both POSEIDON groups 3 and 4 patients require special attention as regards pre-treatment strategy, ovarian stimulation, adjuvant treatment, and ovulation trigger strategy in order to optimize the probability of having at least one euploid blastocyst for transfer. Although more evidence is needed, recent advances seem to have increased the reproductive outcomes in the poor prognosis patient. The key to success is individualization in all steps of ART treatment. Herein, we review the recent evidence for the management of POSEIDON groups 3 and 4.

Keywords: ART calculator; Bologna criteria; POSEIDON criteria; blastocyst; controlled ovarian stimulation; poor ovarian response; pregnancy.

Publication types

Review