Shi Wenhao, Zhou Hanying, Tian Li, Zhao Zhenghao, Zhang Wei, Shi Juanzi
The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China.
Department of Respiratory Medicine, Shaanxi Provincial People's Hospital, Xi'an, China.
Front Endocrinol (Lausanne). 2019 Jun 26;10:409. doi: 10.3389/fendo.2019.00409. eCollection 2019.
To investigate the characteristics and outcomes of low prognosis patients defined by POSEIDON criteria undergoing IVF treatment. Retrospective cohort analysis. An IVF clinic in a public hospital. 18,455 fresh aspirated IVF cycles with subsequently frozen embryo transfer from Jan 2014 to Jan 2017 in a single IVF clinic were included in the analysis. The low prognosis patients were categorized into 4 groups based on POSEIDON criteria: group 1: age < 35, antral follicle count (AFC) ≥ 5, number of oocytes retrieved ≤ 9 in the previous cycle; group 2: age ≥ 35, AFC≥5, number of oocytes retrieved ≤ 9 in the previous cycle; group 3: age < 35, AFC < 5; group 4: age ≥ 35, AFC < 5. The non-low prognosis patients: group 5: AFC ≥ 5, previous number of oocytes retrieved > 9 oocytes; group 6: AFC ≥ 5, no previous ovarian stimulation. None. The primary outcome was cumulative live birth rate (CLBR). Taking group 1 as reference, the CLBR from young women in group 3 (35.5%, OR 0.9, 95% CI 0.7-1.2) was slightly lower than that in group 1 (44.6%, = 0.615). The CLBR in group 2 (24.5%, OR 0.6, 95% CI 0.4-0.8, = 0.004) and group 4 (12.7%, OR 0.4, 95% CI 0.3-0.6, < 0.001) was significant lower than that in group 1. In non-poor prognosis patients, the CLBR from young women in group 5 (53.5% OR 1.3 95% CI 0.9, 1.7, = 0.111) was a slight higher than the reference group 1 while the highest CLBR was originated from the first IVF patients with good ovarian reserve in group 6 (66.9%, OR 2.0, 95% CI 1.6, 2.4). The CLBRs and implantation rates in the young women (group 3) with diminished ovarian reserve was similar in those young women (group 1), and was significantly higher than in advanced age women with a fair ovarian reserve (group 2). Though patients in group 2 had better ovarian reserve, more oocytes and more embryos, the pregnancy outcome was inferior to that of group 3 patients with poorer ovarian reserve, fewer oocytes and fewer embryos.
为研究符合POSEIDON标准的低预后患者接受体外受精（IVF）治疗的特征及结局。进行回顾性队列分析。研究地点为一家公立医院的IVF诊所。分析纳入了2014年1月至2017年1月在该单一IVF诊所进行的18455个新鲜取卵IVF周期及随后的冻融胚胎移植周期。根据POSEIDON标准，将低预后患者分为4组：第1组：年龄<35岁，窦卵泡计数（AFC）≥5，前一周期获卵数≤9个；第2组：年龄≥35岁，AFC≥5，前一周期获卵数≤9个；第3组：年龄<35岁，AFC<5；第4组：年龄≥35岁，AFC<5。非低预后患者：第5组：AFC≥5，既往获卵数>9个；第6组：AFC≥5，既往未接受过卵巢刺激。无。主要结局为累积活产率（CLBR）。以第1组为参照，第3组年轻女性的CLBR（35.5%，比值比[OR]0.9，95%可信区间[CI]0.7 - 1.2）略低于第1组（44.6%，P = 0.615）。第2组（24.5%，OR 0.6，95%CI 0.4 - 0.8，P = 0.004）和第4组（12.7%，OR 0.4，95%CI 0.3 - 0.6，P<0.001）的CLBR显著低于第1组。在非低预后患者中，第5组年轻女性的CLBR（53.5%，OR 1.3，95%CI 0.9，1.7，P = 0.111）略高于参照组第1组，而CLBR最高的是第6组首次接受IVF且卵巢储备良好的患者（66.9%，OR 2.0，95%CI 1.6，2.4）。卵巢储备功能减退的年轻女性（第3组）的CLBR和种植率与年轻女性（第1组）相似，且显著高于卵巢储备一般的高龄女性（第2组）。尽管第2组患者的卵巢储备更好，获卵数更多，胚胎更多，但其妊娠结局却不如卵巢储备较差、获卵数较少、胚胎较少的第3组患者。
