Abstract
ObjectiveTo estimate the prevalence of low-prognosis patients according to the POSEIDON criteria using real-world data.DesignMulticenter population-based cohort study.SettingsFertility clinics in Brazil, Turkey, and Vietnam.PatientsInfertile women undergoing assisted reproductive technology using standard ovarian stimulation with exogenous gonadotropins.InterventionsNone.Main outcome measuresPer-period prevalence rates of POSEIDON patients (overall, stratified by POSEIDON groups and by study center) and the effect of covariates on the probability that a patient be classified as “POSEIDON”.ResultsA total of 13,146 patients were included. POSEIDON patients represented 43.0% (95% confidence interval [CI] 42.0–43.7) of the studied population, and the prevalence rates varied across study centers (range: 38.6–55.7%). The overall prevalence rates by POSEIDON groups were 44.2% (group 1; 95% CI 42.6–45.9), 36.1% (group 2; 95% CI 34.6–37.7), 5.2% (group 3; 95% CI 4.5–6.0), and 14.4% (group 4; 95% CI: 13.3–15.6). In general, POSEIDON patients were older, had a higher body mass index (BMI), lower ovarian reserve markers, and a higher frequency of female factor as the primary treatment indication than non-POSEIDON patients. The former required larger doses of gonadotropin for ovarian stimulation, despite achieving a 2.5 times lower number of retrieved oocytes than non-POSEIDON patients. Logistic regression analyses revealed that female age, BMI, ovarian reserve, and a female infertility factor were relevant predictors of the POSEIDON condition.ConclusionsThe estimated prevalence of POSEIDON patients in the general population undergoing ART is significant. These patients differ in clinical characteristics compared with non-POSEIDON patients. The POSEIDON condition is associated with female age, ovarian reserve, BMI, and female infertility. Efforts in terms of diagnosis, counseling, and treatment are needed to reduce the prevalence of low-prognosis patients.
Highlights
The POSEIDON (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number) criteria were developed to help clinicians identify and classify ‘low-prognosis’ patients undergoing assisted reproductive technology (ART) [1, 2]
Cycle cancellation before oocyte pick-up was reported in 30 patients (0.23%), all of whom were “POSEIDON”
We found that advanced female age, decreased ovarian reserve, increased body mass index (BMI) and the presence of a female infertility factor were the POSEIDON population’s main traits
Summary
The POSEIDON (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number) criteria were developed to help clinicians identify and classify ‘low-prognosis’ patients undergoing assisted reproductive technology (ART) [1, 2]. The novel classification aims to capture subtle differences related to a poor treatment outcome, thereby creating homogenous patient groups, helping clinicians tailor ovarian stimulation strategies for these challenging patients [3]. The number of clinical studies using the POSEIDON criteria has steadily increased [4,5,6,7,8,9]. Prevalence studies assess the burden of a disease or condition in a population and guide clinical practice, research, and resource allocation [10, 11]. The accurate interpretation of prevalence studies requires an understanding of the input data on which estimates were based, including quality information, and an explanation of the methods used to derive the health estimates [12]
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