Clinical outcomes in POSEIDON low-prognosis patients receiving IVF/ICSI treatment: a multi-centered retrospective cohort study

Yixuan Zou; Cheng Wang; Lei Jin; Juanzi Shi; Yundong Mao; Cuilian Zhang; Xing Yang; Xiaoyan Liang; Rui Huang

doi:10.1016/j.fertnstert.2025.06.037

Clinical outcomes in POSEIDON low-prognosis patients receiving IVF/ICSI treatment: a multi-centered retrospective cohort study

Fertil Steril. 2025 Jun 28:S0015-0282(25)00542-4. doi: 10.1016/j.fertnstert.2025.06.037. Online ahead of print.

Authors

Yixuan Zou¹, Cheng Wang¹, Lei Jin², Juanzi Shi³, Yundong Mao⁴, Cuilian Zhang⁵, Xing Yang¹, Xiaoyan Liang¹, Rui Huang⁶

Affiliations

¹ Reproductive Medicine Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Engineering Technology Research Center of Fertility Preservation, Guangzhou, China.
² Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
³ Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China.
⁴ Reproductive Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
⁵ Reproductive Medicine Center, Henan Provincial People's Hospital, Zhengzhou, China.
⁶ Reproductive Medicine Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Engineering Technology Research Center of Fertility Preservation, Guangzhou, China. Electronic address: huangr57@mail.sysu.edu.cn.

PMID: 40588148
DOI: 10.1016/j.fertnstert.2025.06.037

Abstract

Objective: To evaluate cumulative live birth rates (CLBRs) across different POSEIDON groups undergoing IVF treatment.

Design: Multi-centered retrospective cohort study.

Patient(s): A total of 100,821 female patients undergoing IVF/ICSI treatments from January 2013 to December 2017 in five cities across China (Guangzhou, Wuhan, Xi'an, Nanjing, Zhengzhou) were included in this study.

Exposure: None.

Main outcome measure(s): CLBRs were the primary outcome, estimated using the Kaplan-Meier method, and analyzed through pairwise log-rank tests and a Cox regression model.

Results: The CLBRs across POSEIDON groups were ranked from high to low as follows: POSEIDON Groups 1b, 1a, 2b, 3, 2a, and 4. Notably, the CLBRs in POSEIDON Groups 1a and 3 demonstrated a consistent increase of over 5% with each added cycle, and the CLBRs in POSEIDON Group 1b reached that of young non-POSEIDON patients. The CLBRs in POSEIDON Groups 2a and 2b reached a plateau after the third cycle, and POSEIDON Group 4 plateaued earlier after the second cycle. Age stratification revealed a clear decline in CLBRs with age's increasing. CLBRs significantly improved by more than 5% with each added cycle in patients aged 35-37 and 38-39, but those aged ≥ 40 benefited less from additional cycles.

Conclusions: Young low-prognosis patients in POSEIDON Groups could achieve CLBRs comparable to age-matched normal responders through multiple ovarian stimulation cycles. However, advanced-age low-prognosis patients, particularly those over 40, benefited less from additional cycles. Repeated ovarian stimulation did not compensate for reduced oocyte quantity and quality in advanced-age groups. The study underscores the importance of tailored clinical approaches based on age and prognostic factors in fertility treatments.

Keywords: POSEIDON criteria; cumulative live birth rate; low-prognosis patients.