Live birth rates in different subgroups of poor ovarian responders according to Bologna and POSEIDON group classification criteria

Background: Live birth rates (LBRs) have been separately evaluated in two poor ovarian responder (POR) classification methods. We designed the present study to compare the LBRs according to Bologna criteria or Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) group classifications to determine the important predictive factors for LBR in patients with POR. Methods: In this cross-sectional study, we evaluated a database that contained clinical and laboratory information on infertility treatment cycles of all patients with at least one POR after standard controlled ovarian stimulation (COH) during in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles from December 2015 to December 2017. The eligible data were collected and the subjects divided into five groups according to Bologna criteria and four groups according to POSEIDON group classification. Results: We assessed 812 patients diagnosed with POR; overall, 517 underwent embryo transfer (ET) during the last treatment cycle (63.6%). The results indicated a total clinical pregnancy rate of 19.3% (100 cases) and LBR of 16.1% (86 cases). According to Bologna criteria, 41 patients were not included in any group. Analysis of treatment cycle outcome showed that patients classified as Bologna group II had a higher LBR than the other groups. In terms of POSEIDON classification, all of the patients could be classified into groups. Patients in POSEIDON group 3 had the highest LBR. According to multivariable regression analysis, the significant independent variables that remained in the model as important predictive factors for live births were the number and quality (good and excellent) of the embryos transferred, and POSEIDON group 3 classification. Conclusion: The results indicated that the POSEIDON group classification could be more comprehensive and practical than Bologna criteria for diagnosing and categorizing POR patients. In addition, we noted that the number and quality of transferred embryos were the most important prognostic factors for live births in POR patients. Therefore, we suggest that clinicians consider COH protocols that have a freezing embryo strategy and the collection of more good quality embryos to improve the probability of a live birth.