Zayıf Over Yanıtına Sahıp Hastaların Bologna Kriterlerine ve Poseıdon Alt Gruplarına Göre Taze Embriyo Transferi veya Donmuş Embriyo Transferi Yapılanların Kümülatif Canlı Doğum Oranlarının Retrospektif Olarak Karşılaştırılması
Özet
TEMİZ.B.E., Retrospective Comparison of the Effects of Fresh and Frozen Embryo
Transfers on Cumulative Live Birth Rates in Patients with Poor Ovarian Response
According to Bologna Criteria and POSEIDON Subgroups. Hacettepe University Faculty
of Medicine, Department of Gynecology and Obstetrics, Ankara, 2024 This thesis study
retrospectively compared the cumulative live birth rates of patients with poor ovarian response
according to Bologna and POSEIDON criteria. Patients who initiated their first IVF cycle at
Hacettepe University Faculty of Medicine Hospital between January 2017 and October 2023
were eligible for this study. Those who underwent oocyte retrieval and received treatment
through IVF/Intracytoplasmic Sperm Injection (IVF/ICSI) following a standard ovarian
stimulation protocol were included. The study encompassed patients who underwent either a
fresh embryo transfer or a frozen-thawed embryo transfer (FET), with outcomes measured as
either live births or the absence of live births despite the transfer of all embryos. Cycles where
oocyte retrieval was not feasible due to inaccessible ovaries, patients with azoospermic partners,
those undergoing fertility preservation, individuals with a BMI ≥ 35 kg/m2
, patients younger
than 18 or older than 45 years, those classified within WHO Group 1 (hypogonadotropic
hypogonadal anovulatory), patients undergoing preimplantation genetic testing (PGT-M and
PGT-SR) cycles, those receiving dual stimulation treatments, and patients diagnosed with
premature ovarian insufficiency (POI) were excluded from the study. A total of 1250 patients
experiencing their first aspiration cyle at the Hacettepe University IVF Center were included in
the final analysis. The Bologna patients have at least two of the following three features; female-
age ≥40 or prior ovarian surgery, AMH<1.1ng/ml or antral-follicle-count (AFC)<5-7, and
obtaining ≤3 oocytes in prior conventional stimulation. POSEIDON patients were categorized
into four groups; younger(<35) and older(≥35) women with AMH≥1.2/AFC≥5 experiencing an
unexpected poor(<4 oocytes-retrieved) or suboptimal(4–9 oocytes-retrieved) response, along
with respective younger and older counterparts with AMH<1.1/AFC<5. Non-POSEIDON
patients were those with AMH≥1.2/AFC≥5 and >9 oocytes-retrieved. Each patient was
classified according to both the Bologna and POSEIDON criteria, and Generalized Estimating
Equations (GEE) analysis was used to compare the categories. The primary outcome measure
was defined as the cumulative live birth rate. Out of 1250 patients, 79.6% (995 patients) were
classified as POSEIDON, with sub-groups as follows: 5.28% (66 patients) Group 1a, 23.4%
(293 patients) Group 1b, 3.6% (45 patients) Group 2a, 10.1% (126 patients) Group 2b, 14.64%
(183 patients) Group 3, and 22.48% (281 patients) Group 4. The number of patients meeting
v
Bologna criteria was 17.4% (218 patients). For POSEIDON patients, median[IQR] values were:
age 34 [30-38], AMH 1.33 [0.65-2.69], oocytes retrieved 4 [2-6], and embryo transfers 1 [1-2].
For non-POSEIDON patients: age 30 [27-33], AMH 4.63 [2.93-7.07], oocytes retrieved 13 [11-
15], and embryo transfers 2 [1-3]. In Bologna patients: age 40 [36-42], AMH 0.46 [0.20-0.76],
oocytes retrieved 2 [1-3], and embryo transfers 1 [0-1]. For non-Bologna patients: age 31 [28-
36], AMH 2.30 [1.17-4.29], oocytes retrieved 6 [3-9], and embryo transfers 1 [1-2]. CDR for
non-POSEIDON: 49.8%; Group 1a, 24.2%; Group 1b, 34.1%; Group 2a, 15.6%; Group 2b,
27.6%; Group 3, 20.8%; Group 4, 10.7%. In clustered-GEE analysis, using non-POSEIDON as
reference, odds ratios (ORs) for live birth were: Group 1a OR 0.32 [0.18 - 0.60]; Group 1b OR
0.52 [0.37-0.74]; Group 2a OR 0.19 [0.08-0.43]; Group 2b OR 0.38 [0.24-0.61]; Group 3 OR
0.26 [0.17-0.41]; Group 4 OR 0.12 [0.08-0.19]. CDR for the Bologna group: 8.7% (OR: 0.10,
0.06-0.16); non-Bologna patients: 32.4% [OR: 0.48, 0.39-0.60]. The odds of achieving live-
birth were ~3-fold higher in POSEIDON than in the Bologna group. Patients in the POSEIDON
group have a cumulative live birth rate approximately two times lower than normal responders,
while those in the Bologna group have a rate four times lower than patients in the Non-Bologna
group. . Poseidon criteria cover a broader range of low-prognosis patients, while meeting
Bologna criteria indicates a narrower, more specific group with poorer outcomes.
Keywords: Poor ovarian response, cumulative live birth rate, POSEIDON classification,
Bologna criteria
