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Morphokinetic embryo behaviour in low-prognosis patients according to the POSEIDON criteria: an analysis of 3326 injected oocytes

Published online by Cambridge University Press:  13 March 2025

Edson Borges Jr ,
Daniela Paes Almeida Ferreira Braga ,
Patricia Guilherme ,
Assumpto Iaconelli Jr  and
Amanda Sousa Setti Open the ORCID record for Amanda Sousa Setti [Opens in a new window]
Edson Borges Jr
Affiliation:
Fertility Medical Group / FERTGROUP Medicina Reprodutiva, São Paulo – SP, Brazil Sapientiae Institute – Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo – SP, Brazil
Daniela Paes Almeida Ferreira Braga
Affiliation:
Fertility Medical Group, São Paulo, Brazil Sapientiae Institute – Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo – SP, Brazil
Patricia Guilherme
Affiliation:
Fertility Medical Group / FERTGROUP Medicina Reprodutiva, São Paulo – SP, Brazil
Assumpto Iaconelli Jr
Affiliation:
Fertility Medical Group / FERTGROUP Medicina Reprodutiva, São Paulo – SP, Brazil Sapientiae Institute – Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo – SP, Brazil
Amanda Sousa Setti*
Affiliation:
Fertility Medical Group, São Paulo, Brazil Sapientiae Institute – Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo – SP, Brazil
*
Corresponding author: Amanda Sousa Setti; Email: amanda@sapientiae.org.br
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Abstract

The objective of this cohort study was to investigate whether embryo quality and morphokinetic behaviour differ in the four groups of low-prognosis women as stratified by the POSEIDON criteria. The study was performed in a private university-affiliated in vitro fertilization (IVF) centre, and included 3326 injected oocytes from 846 women undergoing ICSI cycles between March 2019 and April 2022. Kinetic markers from the point of insemination were recorded in the EmbryoScope incubator. Generalized mixed models followed by Bonferroni post hoc were used to compare morphokinetics among the POSEIDON groups. Embryos derived from patients in the POSEIDON groups 2, 3 and 4 showed significantly slower divisions compared to those from POSEIDON 1 group. The KIDScore rank was significantly lower for embryos deriving from POSEIDON groups 2, 3 and 4 (2: 4.4 ± 0.7 vs. 3: 4.2 ± 0.2 vs. 4: 3.0 ± 0.4) compared to those deriving from POSEIDON 1 group (4.8 ± 0.1, p < 0.001). Group POSEIDON 1 showed improved implantation (26.9% vs. 2: 22.4% vs. 3: 20.0% vs. 4: 14.0, p < 0.001) and miscarriage rates (5.6% vs. 2: 31.2% vs. 4: 50.0%, p = 0.013). Embryo quality and morphokinetic behaviour differ across the POSEIDON groups, being more favourable in POSEIDON group 1, as well as implantation and miscarriage rates. Embryo development was more favourable in POSEIDON group 1 (young age and adequate ovarian reserve), suggesting that oocyte quality is determinant of embryo developmental potential. These findings show the reasonability of classifying POR by the POSEIDON criteria and provide information for counselling of POR regarding their possible prognosis.

Keywords

Controlled ovarian stimulationintracytoplasmic sperm injectionlow prognosispoor ovarian responsePOSEIDON criteria

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Type
Research Article
Information
Zygote , Volume 33 , Issue 1 , February 2025 , pp. 56 - 61
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Copyright
© The Author(s), 2025. Published by Cambridge University Press

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References

Agarwal, A., Gupta, S. and Sharma, R. (2005) Oxidative stress and its implications in female infertility–a clinician’s perspective. Reproductive Biomedicine Online 11, 641–650.CrossRefGoogle Scholar
Akarsu, S., Gode, F., Isik, A.Z., Celenk, H., Tamer, F.B. and Erkilinc, S. (2017) Comparison of the morphokinetic parameters of embryos according to ovarian reserve in IVF cycles. Gynecological Endocrinology 33, 733–736.CrossRefGoogle ScholarPubMed
Alviggi, C., Andersen, C.Y., Buehler, K., Conforti, A., De Placido, G., Esteves, S.C., Fischer, R., Galliano, D., Polyzos, N.P. and Sunkara, S.K. (2016) A new more detailed stratification of low responders to ovarian stimulation: from a poor ovarian response to a low prognosis concept. Fertility and Sterility 105, 1452–1453.CrossRefGoogle ScholarPubMed
Alviggi, C., Conforti, A., Santi, D., Esteves, S.C., Andersen, C.Y., Humaidan, P., Chiodini, P., De Placido, G. and Simoni, M. (2018) Clinical relevance of genetic variants of gonadotrophins and their receptors in controlled ovarian stimulation: a systematic review and meta-analysis. Human Reproduction Update 24, 599–614.CrossRefGoogle ScholarPubMed
Alviggi, C., Pettersson, K., Longobardi, S., Andersen, C.Y., Conforti, A., De Rosa, P., Clarizia, R., Strina, I., Mollo, A., De Placido, G. and Humaidan, P. (2013) A common polymorphic allele of the LH beta-subunit gene is associated with higher exogenous FSH consumption during controlled ovarian stimulation for assisted reproductive technology. Reproductive Biology and Endocrinology : RB&E 11, 51.CrossRefGoogle ScholarPubMed
Borges, E., Braga, D.P., Setti, A., de Cássia Figueira, R. and Iaconelli, A. Jr (2017) The predictive value of serum concentrations of anti-Müllerian hormone for oocyte quality, fertilization, and implantation. JBRA Assisted Reproduction 21, 176.CrossRefGoogle ScholarPubMed
Braga, D.P.d.A.F., Setti, A.S., Guilherme, P., Vingris, L.S., Provenza, R.R., Iaconelli, A. and Borges, E. (2021) Serum anti-müllerian hormone concentrations impacts not only the quantity, but also the quality of the ovarian reserve: the importance of time-lapse imaging system. Fertility and Sterility 116, e243.Google Scholar
Casarini, L., Moriondo, V., Marino, M., Adversi, F., Capodanno, F., Grisolia, C., La Marca, A., La Sala, G.B. and Simoni, M.(2014) FSHR polymorphism p. N680S mediates different responses to FSH in vitro. Molecular and Cellular Endocrinology 393, 83–91.CrossRefGoogle ScholarPubMed
Casarini, L., Santi, D. and Marino, M. (2015) Impact of gene polymorphisms of gonadotropins and their receptors on human reproductive success. Reproduction 150, R175–R184.CrossRefGoogle ScholarPubMed
Chinta, P., Antonisamy, B., Mangalaraj, A.M., Kunjummen, A.T. and Kamath, M.S.(2021) POSEIDON classification and the proposed treatment options for groups 1 and 2: time to revisit? A retrospective analysis of 1425 ART cycles. Human Reproduction Open 2021, hoaa070.CrossRefGoogle ScholarPubMed
Cimadomo, D., Fabozzi, G., Vaiarelli, A., Ubaldi, N., Ubaldi, F.M. and Rienzi, L. (2018). Impact of Maternal Age on Oocyte and Embryo Competence. Frontiers in Endocrinology 9, 327.CrossRefGoogle ScholarPubMed
Conforti, A., Cariati, F., Vallone, R., Alviggi, C. and de Placido, G. (2017) Individualization of treatment in controlled ovarian stimulation: myth or reality. Biochimica Clinica 41, 294–305.Google Scholar
Dal Canto, M., Bartolacci, A., Turchi, D., Pignataro, D., Lain, M., De Ponti, E., Brigante, C., Mignini Renzini, M. and Buratini, J. (2021) Faster fertilization and cleavage kinetics reflect competence to achieve a live birth after intracytoplasmic sperm injection, but this association fades with maternal age. Fertility and Sterility 115, 665–672.CrossRefGoogle ScholarPubMed
Dal Canto, M., Coticchio, G., Mignini Renzini, M., De Ponti, E., Novara, P.V., Brambillasca, F., Comi, R. and Fadini, R. (2012) Cleavage kinetics analysis of human embryos predicts development to blastocyst and implantation. Reproduction Biomedicine Online 25, 474–480.CrossRefGoogle ScholarPubMed
De Geyter, C., Fehr, P., Moffat, R., Gruber, I.M. and von Wolff, M. (2015) Twenty years’ experience with the Swiss data registry for assisted reproductive medicine: outcomes, key trends and recommendations for improved practice. Swiss Medical Weekly 145, w14087.Google Scholar
Drakopoulos, P., Bardhi, E., Boudry, L., Vaiarelli, A., Makrigiannakis, A., Esteves, S.C., Tournaye, H. and Blockeel, C. (2020) Update on the management of poor ovarian response in IVF: the shift from Bologna criteria to the Poseidon concept. Therapeutic Advances in Reproductive Health 14, 2633494120941480.CrossRefGoogle Scholar
Drakopoulos, P., Blockeel, C., Stoop, D., Camus, M., de Vos, M., Tournaye, H. and Polyzos, N.P. (2016) Conventional ovarian stimulation and single embryo transfer for IVF/ICSI. How many oocytes do we need to maximize cumulative live birth rates after utilization of all fresh and frozen embryos? Human Reproduction (Oxford, England) 31, 370–376.Google ScholarPubMed
Dumesic, D.A., Meldrum, D.R., Katz-Jaffe, M.G., Krisher, R.L. and Schoolcraft, W.B. (2015) Oocyte environment: follicular fluid and cumulus cells are critical for oocyte health. Fertility and Sterility 103, 303–316.CrossRefGoogle ScholarPubMed
Fanchin, R., Mendez Lozano, D.H., Frydman, N., Gougeon, A., di Clemente, N., Frydman, R. and Taieb, J. (2007) Anti-Mullerian hormone concentrations in the follicular fluid of the preovulatory follicle are predictive of the implantation potential of the ensuing embryo obtained by in vitro fertilization. The Journal of Clinical Endocrinology and Metabolism 92, 1796–1802.CrossRefGoogle ScholarPubMed
Gardner, D.K., Lane, M.W. and Lane, M. (2000) EDTA stimulates cleavage stage bovine embryo development in culture but inhibits blastocyst development and differentiation. Molecular Reproduction and Development: Incorporating Gamete Research 57, 256–261.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
Gryshchenko, M.G., Pravdyuk, A.I. and Parashchyuk, V.Y. (2014) Analysis of factors influencing morphokinetic characteristics of embryos in ART cycles. Gynecological Endocrinology 30, 6–8.CrossRefGoogle ScholarPubMed
Haahr, T., Esteves, S.C. and Humaidan, P. (2018a) Individualized controlled ovarian stimulation in expected poor-responders: an update. Reproductive Biology and Endocrinology : RB&E 16, 20.CrossRefGoogle ScholarPubMed
Haahr, T., Esteves, S.C. and Humaidan, P. (2018b) Poor definition of poor-ovarian response results in misleading clinical recommendations. Human Reproduction (Oxford, England) 33, 979–980.CrossRefGoogle ScholarPubMed
Jiao, X., Meng, T., Zhai, Y., Zhao, L., Luo, W., Liu, P. and Qin, Y. (2021) Ovarian reserve markers in premature ovarian insufficiency: within different clinical stages and different etiologies. Frontiers in Endocrinology 12, 1–9.CrossRefGoogle ScholarPubMed
Kirkegaard, K., Kesmodel, U.S., Hindkjær, J.J. and Ingerslev, H.J. (2013) Time-lapse parameters as predictors of blastocyst development and pregnancy outcome in embryos from good prognosis patients: a prospective cohort study. Human Reproduction (Oxford, England) 28, 2643–2651.CrossRefGoogle ScholarPubMed
La Marca, A., Papaleo, E., Alviggi, C., Ruvolo, G., De Placido, G., Candiani, M., Cittadini, E., De Michele, F., Moriondo, V., Catellani, V. Volpe, A. and Simoni, M. (2013a) The combination of genetic variants of the FSHB and FSHR genes affects serum FSH in women of reproductive age. Human Reproduction (Oxford, England) 28, 1369–1374.CrossRefGoogle ScholarPubMed
La Marca, A., Sighinolfi, G., Argento, C., Grisendi, V., Casarini, L., Volpe, A. and Simoni, M. (2013b) Polymorphisms in gonadotropin and gonadotropin receptor genes as markers of ovarian reserve and response in in vitro fertilization. Fertility and Sterility 99, 970–978.e971.CrossRefGoogle ScholarPubMed
La Marca, A. and Sunkara, S.K. (2014) Individualization of controlled ovarian stimulation in IVF using ovarian reserve markers: from theory to practice. Human Reproduction Update 20, 124–140.CrossRefGoogle ScholarPubMed
Lebovitz, O., Michaeli, M., Aslih, N., Poltov, D., Estrada, D., Atzmon, Y. and Shalom-Paz, E. (2021) Embryonic development in relation to maternal age and conception probability. Reproductive Sciences 28, 2292–2300.CrossRefGoogle ScholarPubMed
Leijdekkers, J.A., Eijkemans, M.J.C., van Tilborg, T.C., Oudshoorn, S.C., van Golde, R.J.T., Hoek, A., Lambalk, C.B., de Bruin, J.P., Fleischer, K., Mochtar, M.H., Kuchenbecker, W.K.H., Laven, J.S.E., Mol, B.W.J., Torrance, H.L. and Broekmans, F.J.M. (2019) Cumulative live birth rates in low-prognosis women. Human Reproduction (Oxford, England) 34, 1030–1041.CrossRefGoogle ScholarPubMed
Lin, J. and Wang, L. (2021) Oxidative stress in oocytes and embryo development: implications for In vitro systems. Antioxidants & Redox Signaling 34, 1394–1406.CrossRefGoogle Scholar
Mailloux, R.J. and Harper, M.-E. (2012) Mitochondrial proticity and ROS signaling: lessons from the uncoupling proteins. Trends in Endocrinology & Metabolism 23, 451–458.CrossRefGoogle ScholarPubMed
May-Panloup, P., Boucret, L., Chao de la Barca, J.M., Desquiret-Dumas, V., Ferré-L’Hotellier, V., Morinière, C., Descamps, P., Procaccio, V. and Reynier, P. (2016) Ovarian ageing: the role of mitochondria in oocytes and follicles. Human Reproduction Update 22, 725–743.CrossRefGoogle ScholarPubMed
Meseguer, M., Herrero, J., Tejera, A., Hilligsoe, K.M., Ramsing, N.B. and Remohi, J. (2011) The use of morphokinetics as a predictor of embryo implantation. Human Reproduction (Oxford, England) 26, 2658–2671.CrossRefGoogle ScholarPubMed
Minasi, M.G., Colasante, A., Riccio, T., Ruberti, A., Casciani, V., Scarselli, F., Spinella, F., Fiorentino, F., Varricchio, M. T. and Greco, E. (2016) Correlation between aneuploidy, standard morphology evaluation and morphokinetic development in 1730 biopsied blastocysts: a consecutive case series study. Human Reproduction (Oxford, England) 31, 2245–2254.CrossRefGoogle ScholarPubMed
Oudendijk, J.F., Yarde, F., Eijkemans, M.J., Broekmans, F.J. and Broer, S.L. (2012) The poor responder in IVF: is the prognosis always poor?: a systematic review. Human Reproduction Update 18, 1–11.CrossRefGoogle Scholar
Palermo, G., Joris, H., Devroey, P. and Van Steirteghem, A.C. (1992) Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet 340, 17–18.CrossRefGoogle ScholarPubMed
Roy, S., Gandra, D., Seger, C., Biswas, A., Kushnir, V.A., Gleicher, N., Kumar, T.R. and Sen, A. (2018). Oocyte-derived factors (GDF9 and BMP15) and FSH regulate AMH expression via modulation of H3K27AC in granulosa cells. Endocrinology 159, 3433–3445.CrossRefGoogle ScholarPubMed
Sampo, A.V., Palena, C., Ganzer, L., Maccari, V., Estofán, G. and Hernández, M. (2017) The adverse effect of overweight in assisted reproduction treatment outcomes. JBRA Assisted Reproduction 21, 212–216.CrossRefGoogle ScholarPubMed
Sunkara, S.K., Rittenberg, V., Raine-Fenning, N., Bhattacharya, S., Zamora, J. and Coomarasamy, A. (2011) Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles. Human Reproduction (Oxford, England) 26, 1768–1774.CrossRefGoogle ScholarPubMed
Turathum, B., Gao, E.M. and Chian, R.C. (2021) The function of cumulus cells in oocyte growth and maturation and in subsequent ovulation and fertilization. Cells 10, 2292.CrossRefGoogle ScholarPubMed
Ubaldi, F.M., Cimadomo, D., Vaiarelli, A., Fabozzi, G., Venturella, R., Maggiulli, R., Mazzilli, R., Ferrero, S., Palagiano, A. and Rienzi, L. (2019) Advanced maternal age in IVF: still a challenge? The present and the future of its treatment. Frontiers in Endocrinology 10, 1–18.CrossRefGoogle Scholar
Velthut, A., Zilmer, M., Zilmer, K., Kaart, T., Karro, H. and Salumets, A. (2013) Elevated blood plasma antioxidant status is favourable for achieving IVF/ICSI pregnancy. Reproductive Biomedicine Online 26, 345–352.CrossRefGoogle ScholarPubMed
Wallace, W.H. and Kelsey, T.W. (2010) Human ovarian reserve from conception to the menopause. PLoS One 5, e8772.CrossRefGoogle Scholar
Warshaviak, M., Kalma, Y., Carmon, A., Samara, N., Dviri, M., Azem, F. and Ben-Yosef, D. (2019) The effect of advanced maternal age on embryo morphokinetics. Frontiers in Endocrinology 10, 686.CrossRefGoogle ScholarPubMed