Background

In order to classify poor responders, the following criteria (Bologna criteria) were introduced by the European Society of Human Reproduction and Embryology (ESHRE):

• Age at least 40 years old or other risk factors for poor ovarian response (POR)
• Previous POR episodes (3 or less oocytes collected with a standard stimulation protocol).
• Antral Follicle Count (AFC) less than 5-7 follicles or anti-Mullerian hormone (AMH) less than 0.5-1.1 ng/mL or an Ovarian Reserve Test with abnormal results.

POR has been defined as the presence of at least two of the above criteria. However, the diagnosis of POR entails a wide range of sub-populations due to different associated mechanisms. The ESHRE Bologna Criteria could therefore lead to heterogeneity in the attempt to identify POR patients. In an attempt to overcome these issues, the novel POSEIDON (Patient-Oriented Strategies Encompassing Individualized Oocyte Number) criteria were proposed for classification of ‘low prognosis’ patients.  The POSEIDON criteria include female age, ovarian reserve markers (AMH, AFC or both), as well as the number of oocytes retrieved in previous cycles. The use of this classification on our patient database, and associated research on patient pathways and treatment strategies, has not been carried out to date. Understanding these groups is critical for tailoring treatment strategies and improving patient care.

Aims

We will have to develop a systematic approach to accurately categorize patients into the four POSEIDON groups based on established criteria, ensuring consistency and reproducibility in classification in order to analyse treatment histories and outcomes for each POSEIDON group, and identifying patterns and unique characteristics that influence success rates.

Collaboration with both internal and external fertility specialists will be key to design and refine specific treatment protocols tailored to each POSEIDON group. This may include adjusting stimulation protocols, medication regimens, and adjunctive therapies based on group-specific characteristics. We will evaluate the efficacy of the newly developed treatment protocols, measuring key outcomes such as oocyte yield, embryo quality, and live birth rates; and establish a continuous feedback mechanism to collect data on patient responses to treatment, allowing for real-time adjustments to protocols and ensuring that strategies remain aligned with patient needs.