Department of Public Health, University of Naples Federico II, Via Sergio Pansini, Naples, 80131, Italy.
The Fertility Clinic, Faculty of Health, Skive Regional Hospital, Aarhus University, Aarhus C, Denmark.
Reprod Biol Endocrinol. 2024 Oct 10;22(1):122. doi: 10.1186/s12958-024-01291-x.
Currently, there is no consensus on the optimal management of women with low prognosis in ART. In this Delphi consensus, a panel of international experts provided real-world clinical perspectives on a series of literature-supported consensus statements regarding the overall relevance of the POSEIDON criteria for women with low prognosis in ART.
Using a Delphi-consensus framework, twelve experts plus two Scientific Coordinators discussed and amended statements and supporting references proposed by the Scientific Coordinators (Round 1). Statements were distributed via an online survey to an extended panel of 53 experts, of whom 36 who voted anonymously on their level of agreement or disagreement with each statement using a six-point Likert-type scale (1 = Absolutely agree; 2 = More than agree; 3 = Agree; 4 = Disagree; 5 = More than disagree; 6 = Absolutely disagree) (Round 2). Consensus was reached if > 66% of participants agreed or disagreed.
The extended panel voted on seventeen statements and subcategorized them according to relevance. All but one statement reached consensus during the first round; the remaining statement reached consensus after rewording. Statements were categorized according to impact, low-prognosis validation, outcomes and patient management. The POSEIDON criteria are timely and clinically sound. The preferred success measure is cumulative live birth and key management strategies include the use of recombinant FSH preparations, supplementation with r-hLH, dose increases and oocyte/embryo accumulation through vitrification. Tools such as the ART Calculator and Follicle-to-Oocyte Index may be considered. Validation data from large, prospective studies in each POSEIDON group are now needed to corroborate existing retrospective data.
This Delphi consensus provides an overview of expert opinion on the clinical implications of the POSEIDON criteria for women with low prognosis to ovarian stimulation.
目前，ART 中低预后女性的最佳管理方法尚无共识。在本次德尔菲共识中，一组国际专家就一系列基于文献的共识声明提供了真实世界的临床观点，这些声明涉及 POSEIDON 标准对 ART 中低预后女性的整体相关性。
使用德尔菲共识框架，十二位专家加两位科学协调员讨论并修订了科学协调员提出的声明和支持性参考文献（第一轮）。通过在线调查向 53 位专家的扩展小组分发声明，其中 36 位匿名专家使用六点李克特量表对每项声明的同意或不同意程度进行投票（1=完全同意；2=非常同意；3=同意；4=不同意；5=非常不同意；6=完全不同意）（第二轮）。如果超过 66%的参与者同意或不同意，则达成共识。
扩展小组对十七项声明进行了投票，并根据相关性对其进行了分类。第一轮中有一项声明未达成共识，其余的在重新措辞后达成共识。声明根据影响、低预后验证、结局和患者管理进行了分类。POSEIDON 标准具有及时性和临床合理性。首选的成功衡量标准是累积活产，关键管理策略包括使用重组 FSH 制剂、r-hLH 补充、剂量增加和通过玻璃化冷冻保存卵母细胞/胚胎积累。ART 计算器和卵泡-卵母细胞指数等工具可以考虑使用。现在需要在每个 POSEIDON 组中进行大型前瞻性研究的验证数据来证实现有的回顾性数据。
本德尔菲共识提供了专家对 POSEIDON 标准对卵巢刺激中低预后女性临床影响的意见概述。
