Influential factors on the pregnancy outcome of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer in patients classified by Poseidon criteria

Objective To investigate the influential factors on the pregnancy outcome of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) in patients classified by Poseidon criteria. Methods The 1058 patients who underwent IVF/ICSI-ET in Peking Union Medical Hospital from June 2015 to June 2017 were collected. Ovulation induction protocol was decided according to the age, sex hormone levels and antral follicle count (AFC). Four groups for the patients had been defined by the Poseidon criteria. These cases were analyzed retrospectively to study the relative factors of the pregnancy outcome of IVF/ICSI-ET. Results The patients were divided into four groups according to the Poseidon criteria, age < 35 years and AFC≥5 group (n=467), the data revealed that No. of oocytes retrieved, live birth rate and clinical pregnancy rate were 8.22±3.63, 42.0%, 55.0%, respectively; age≥35 years and AFC≥5 group (n=401), the data revealed that No. of oocytes retrieved, live birth rate and clinical pregnancy rate were 6.28±3.19, 22.4%, 30.7%, respectively; age < 35 years and AFC < 5 group (n=20), the data revealed that No. of oocytes retrieved, live birth rate and clinical pregnancy rate were 3.05±1.5, 35.0%, 45.0%, respectively; age≥35 years and AFC < 5 group (n=44), the data revealed that No. of oocytes retrieved, live birth rate and clinical pregnancy rate were 3.20±1.79, 15.9%, 20.5%, respectively. Comparison of retrieved oocytes, live birth rate and clinical pregnancy rate among the groups showed a statistically significant difference (all P<0.001). The univariate and multivariate analysis of factors influencing pregnancy outcome in age < 35 years and AFC≥5 group showed that antagonist program vs. dual down-regulation: OR=0.522, 95% CI=0.305-0.894, P=0.018; OR=0.568, 95% CI=0.329-0.983, P=0.043, respectively. The univariate and multivariate analysis of factors influencing pregnancy outcome in age≥35 years and AFC≥5 group showed that long-acting-agonists modified program vs. dual down-regulation program was OR=0.385, 95% CI=0.163-0.907, P=0.029; OR=0.396, 95% CI=0.167-0.938, P=0.035; antagonist program vs. dual down-regulation program was OR=0.217, 95% CI=0.087-0.544, P=0.001; OR=0.229, 95% CI=0.091-0.576, P=0.002, respectively. Conclusion Age is an important factor to affect the gravida and newborn outcome. The pregnancy outcome of the double down-regulation protocol was better than the improved gonadotropin-releasing hormone agonist (GnRH-a) downregulation and antagonist protocols. Further research is required to investigate this in larger and longer-term studies. Key words: Fertilization in vitro; Embryo transfer; Poor ovarian response; Bologna criteria; Poseidon criteria