More exogenous Gn starting doses are not beneficial for poor ovarian responders in POSEIDON groups: a propensity score matching retrospective cohort study

Abstract Background: The purpose of this study was to determine whether increasing the starting dose of exogenous gonadotropins (Gn) improves in vitro fertilization and embryo transfer (IVF-ET) outcomes in patients with poor ovarian response (POR) according to the POSEIDON criteria. Methods: IVF-ET outcomes in patients with POR from January 2016 through December 2022 were compared retrospectively. We examined 2280 IVF cycles, including 1062 with less than 300 IU as the starting dose of Gn (Group A) and 1218 with more than or equal to 300 IU as the starting dose (Group B). From the original data, PSM matched 739 pairs of patients. The single-cycle cumulative live birth rate (CLBR) was the primary outcome. Multivariate logistic regression analysis of original data was used to control for confounding factors. Results: There was a statistically significant difference in the CLBR between the two PSM groups (29.3% in group A vs. 17.5% in group B, P = 0.009). The number of retrieved oocytes was significantly greater in Group A (4.15 ± 2.49) than in Group B (3.78 ± 2.3) (P = 0.004). A multivariate logistic regression analysis of the original data revealed that in the comparison of Group B to Group A, the odds ratio (OR) was 0.806, the 95% confidence interval (CI) was 0.624–1.04, and P = 0.097. In the POSEIDON Group 1 and Group 2 subgroups, the CLBR of Group B was 0.729 times greater than that of Group A (95% CI 0.55–0.966, P = 0.028). Conclusions: Exogenous Gn starting doses greater than 300 IU may reduce the single-cycle CLBR in POR patients, especially for unexpected POR patients (POSEIDON Group 1 and Group 2).