Humaidan Peter, Alviggi Carlo, Fischer Robert, Esteves Sandro C
Fertility Clinic, Skive Regional Hospital, Skive, Denmark; Faculty of Health, Aarhus University, Skive, Denmark.
Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy.
F1000Res. 2016 Dec 23;5:2911. doi: 10.12688/f1000research.10382.1. eCollection 2016.
In reproductive medicine little progress has been achieved regarding the clinical management of patients with a reduced ovarian reserve or poor ovarian response (POR) to stimulation with exogenous gonadotropins -a frustrating experience for clinicians as well as patients. Despite the efforts to optimize the definition of this subgroup of patients, the existing POR criteria unfortunately comprise a heterogeneous population and, importantly, do not offer any recommendations for clinical handling. Recently, the POSEIDON group ( atient- riented trategies ncompassing ndividualize ocyte umber) proposed a new stratification of assisted reproductive technology (ART) in patients with a reduced ovarian reserve or unexpected inappropriate ovarian response to exogenous gonadotropins. In brief, four subgroups have been suggested based on quantitative and qualitative parameters, namely, i. Age and the expected aneuploidy rate; ii. Ovarian biomarkers (i.e. antral follicle count [AFC] and anti-Müllerian hormone [AMH]), and iii. Ovarian response - provided a previous stimulation cycle was performed. The new classification introduces a more nuanced picture of the "low prognosis patient" in ART, using clinically relevant criteria to guide the physician to most optimally manage this group of patients. The POSEIDON group also introduced a new measure for successful ART treatment, namely, the ability to retrieve the number of oocytes needed for the specific patient to obtain at least one euploid embryo for transfer. This feature represents a pragmatic endpoint to clinicians and enables the development of prediction models aiming to reduce the time-to-pregnancy (TTP). Consequently, the POSEIDON stratification should not be applied for retrospective analyses having live birth rate (LBR) as endpoint. Such an approach would fail as the attribution of patients to each Poseidon group is related to specific requirements and could only be made prospectively. On the other hand, any prospective approach (i.e. RCT) should be performed separately in each specific group.
在生殖医学领域，对于卵巢储备功能减退或对外源性促性腺激素刺激反应不良（POR）的患者，临床管理方面进展甚微，这对临床医生和患者来说都是令人沮丧的经历。尽管人们努力优化这一患者亚组的定义，但现有的POR标准不幸涵盖了一个异质性群体，重要的是，没有提供任何临床处理建议。最近，POSEIDON小组（以患者为导向的策略，包括个体化卵子数量）提出了一种新的辅助生殖技术（ART）分层方法，用于卵巢储备功能减退或对外源性促性腺激素意外出现不适当反应的患者。简而言之，根据定量和定性参数提出了四个亚组，即：i. 年龄和预期非整倍体率；ii. 卵巢生物标志物（即窦卵泡计数[AFC]和抗苗勒管激素[AMH]），以及iii. 卵巢反应——前提是之前进行过刺激周期。新的分类使用临床相关标准，为ART中“低预后患者”描绘了一幅更细致入微的图景，以指导医生最优化地管理这组患者。POSEIDON小组还引入了一种ART治疗成功的新衡量标准，即获取特定患者获得至少一个可移植整倍体胚胎所需卵子数量的能力。这一特征对临床医生来说是一个务实的终点，并有助于开发旨在缩短妊娠时间（TTP）的预测模型。因此，POSEIDON分层不应应用于以活产率（LBR）为终点的回顾性分析。这样的方法会失败，因为将患者归入每个POSEIDON组与特定要求相关，只能前瞻性地进行。另一方面，任何前瞻性方法（即随机对照试验）都应在每个特定组中单独进行。
