Gonadotropin dose selection for repeat IVF cycles in POSEIDON Groups 1 and 2

Area of Science:

• Reproductive Medicine
• Infertility Treatment
• Assisted Reproductive Technology

Background:

• The POSEIDON classification stratifies patients undergoing in vitro fertilization (IVF) based on age and ovarian reserve.
• POSEIDON Groups 1 and 2 represent patients with poor ovarian response (POR) or expected POR.
• Optimizing ovarian stimulation protocols is crucial for improving IVF outcomes in these patient groups.

Purpose of the Study:

• To investigate if increasing gonadotropin (Gn) dosage in the second IVF cycle improves cumulative live birth rate (CLBR) for POSEIDON Groups 1 and 2 patients.
• To evaluate the impact of Gn dose escalation on oocyte yield, fertilization, and blastocyst formation rates.
• To determine the cost-effectiveness of escalating Gn dosage in subsequent IVF cycles.

Main Methods:

• Retrospective study of 343 patients in POSEIDON Groups 1 and 2 undergoing two consecutive IVF cycles with an antagonist protocol.
• Patients were categorized into an 'Additive' group (increased Gn dose in the second cycle) and a 'Control' group (maintained or decreased Gn dose).
• Propensity score matching (1:2 ratio) was used to balance baseline characteristics; CLBR was the primary outcome.

Main Results:

• The Additive group received higher initial and total Gn doses in the second cycle, but differences in retrieved oocytes, MII oocytes, and 2PN fertilization rates were not statistically significant.
• Blastocyst formation rates were similar between groups (44.9% vs 44.2%, P=0.937).
• The Control group showed a slightly higher, though not statistically significant, CLBR (31.5% vs 28.9%, P=0.8).

Conclusions:

• Increasing Gn dosage in the second IVF cycle for POSEIDON Groups 1 and 2 using the antagonist protocol does not enhance CLBR.
• Escalating Gn dosage leads to increased treatment costs without a demonstrable improvement in live birth rates.
• Routine dose escalation of Gn in subsequent cycles is not recommended for these patient groups.