Bologna vs. POSEIDON criteria as predictors of the likelihood of obtaining at least one euploid embryo in poor ovarian response: an analysis of 6,889 cycles

Abstract

To study the likelihood of obtaining at least one euploid embryo for transfer in poor ovarian response (POR) diagnosed per Bologna and POSEIDON criteria, and compare it between groups and with patients without POR. Retrospective cohort study. Women undergoing an ovarian stimulation cycle with intention to pursue preimplantation genetic testing for aneuploidy. Bologna criteria and POSEIDON classification system were applied to characterize each stimulation cycle as POR or not. Cycles identified as POR by POSEIDON were sub-divided into groups I, II, III, and IV as defined by this classification system. The proportion of cycles resulting in at least one euploid blastocyst. Other outcome measures included cycle yields (metaphase II oocytes, fertilized oocytes, blastocysts, and euploid blastocysts), and euploidy rate per embryo cohort. 6,889 cycles were included, of which 3,653 (53.0%) were classified as POR per POSEIDON criteria: 1.5% (100/6,889) in group I, 3.2% (222/6,889) in II, 11.9% (817/6,889) in III, and 36.5% (2,514/6,889) in IV. Per Bologna criteria, 23.4% (1,612/6,889) of cycles were classified as POR. Group I had similar likelihood of obtaining at least one euploid embryo (97.0%, 95CI: 91.5-99.2%) as cycles not deemed POR (91.9%, 95CI: 90.9-92.8%, p = 0.09), while this decreased significantly with each subsequent POSEIDON group (II: 77.9%, 72.0-82.9%; III: 70.5%, 67.3-73.5%; IV: 44.8%, 42.9-46.7%; p < 0.0001) and those meeting Bologna criteria had the lowest rates (31.9%, 29.7-34.3%; p < 0.0001). Cycle yields were found to correlate with ovarian reserve testing results, whereas euploidy rates were associated with age. While younger POSEIDON groups (I and III) have higher euploidy rates than older groups (II and IV), each incremental POSEIDON group poses a higher risk of having no euploid blastocysts; with POSEIDON I being no different than non-POSEIDON, and Bologna having the worst prognosis. While ovarian reserve appears to have little impact on euploidy rates, it remains a key prognostic factor for having at least one euploid embryo available for transfer through its impact on oocyte yield. This is the first study to provide the odds ratio of this outcome depending on the degree of POR.