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Abstract Background Insulin resistance (IR) is related with adverse outcomes of in vitro fertilization (IVF) in women with obesity, but little is known about the relationship between IR and unexpected poor ovarian response (uPOR) in non-obese subjects with sufficient ovarian parameters (classified as POSEIDON group 1). This research aims to explore the association between the homeostasis model assessment of insulin resistance (HOMA-IR) and uPOR in non-obese women with normal biomarkers of ovarian reserve. Methods The retrospective cohort study was conducted at a fertility center. The main inclusion criteria were age

Background: Insulin resistance (IR) is related with adverse outcomes of in vitro fertilization (IVF) in women with obesity, but little is known about the relationship between IR and unexpected poor ovarian response (uPOR) in non-obese subjects with sufficient ovarian parameters (classified as POSEIDON group 1). This research aims to explore the association between the homeostasis model assessment of insulin resistance (HOMA-IR) and uPOR in non-obese women with normal biomarkers of ovarian reserve. Methods: The retrospective cohort study was conducted at a fertility center. The main inclusion criteria were age < 35 years, body mass index (BMI) < 28 kg/m2, normal ovarian reserve (anti-Mullerian hormone ≥ 1.2 ng/ml, antral follicle count ≥ 5). Women undergoing the first oocyte retrieval cycle were included consecutively between 2018 until 2023. Patients who have ≤ 9 oocytes retrieved were defined as uPOR. The multivariable logistic model and subgroup analysis were conducted after adjusting confounders. Results: A total of 6977 cycles were included. The adjusted odds ratio was 1.25 (95% confidence interval [CI], 1.12–1.39) for the increment of Ln HOMA-IR which was taken as a continuous variable. Meanwhile, as a sensitivity analysis, elevated tertile of HOMA-IR exhibited an increase in risk of uPOR for the third tertile (≥ 2.75) when compared with the first tertile (< 1.75) with OR of 1.33 (95%CI, 1.15–1.54). In the subgroup analysis, the positive association remained consistent. Conclusion: Elevated HOMA-IR values is significantly associated with increased risk of uPOR in non-obese women classified as POSEIDON group 1. Our study provided evidence for the adverse influence of IR on the ovarian response during IVF and shed light on the importance of IR measurement at the time of pre-stimulation among non-obese women. [ABSTRACT FROM AUTHOR]

Abstract Background Resveratrol is a natural polyphenolic compound present in plants and red wine with many potential health benefits. This compound has various anti-inflammatory and anti-tumor properties and can improve cellular mitochondrial activity. This trial was designed to evaluate the effect on the outcome of IVF of Resveratrol supplementation in women > 35 years with good ovarian reserve (AMH > 1.2 ng/ml). Women were randomized to receive or placebo or Resveratrol (150 mg per day) for three months preceding the ovarian stimulation (OS). All patients were stimulated with a starting dose of recombinant FSH ranging between 150 and 300 IU according to age and ovarian reserve. GnRH antagonist flexible protocol was adopted for pituitary suppression. Triggering was performed with urinary hCG (10.000 IU). Results The study was conducted between January 2019 and December 2022 with aa total of 37 cases and 33 controls were recruited. No statistically significant differences in the number of oocytes retrieved, biochemical pregnancy, clinical pregnancy and live birth rates were observed between women treated with resveratrol and control group. A statistically significant increase in the follicle output rate (FORT) and follicle-to oocyte index (FOI) was observed in women treated with resveratrol-based nutraceutical (0.92 versus 0.77 [p = 0.02], and 0.77 versus 0.64 [p = 0.006], respectively). Conclusions Preliminary results from this study indicate that pre-treatment with resveratrol may improve ovarian sensitivity to exogenous FSH, which in turn may decrease the risk of hypo-response to OS in advanced reproductive age women.

Objective: The POSEIDON criteria stratified patients with poor ovarian response into four subgroups with exclusive characteristics and assisted reproductive technology success rates. However, limited studies focused on miscarriage in the POSEIDON population. This study aimed to explore whether the miscarriage rate different among low prognosis patients according to POSEIDON criteria. Materials and methods: This is a retrospective observational study. All clinical pregnancies achieved after in vitro fertilization or intracytoplasmic sperm injection treatment between January 1998 and April 2021 were analyzed. The primary outcome was miscarriage, defined as the pregnancy loss before 20 weeks of gestation age. Miscarriage rate was estimated per clinical pregnancy and gestational sac. Results: A total of 1222 clinical pregnancies from 1088 POSEIDON patients met the inclusion criteria. The miscarriage rates per clinical pregnancy in each POSEIDON subgroup were as follows: Group 1: 11.7 %, Group 2: 26.5 %, Group 3: 20.9 %, and Group 4: 37.5 %. The miscarriage rate per gestational sac showed a similar trend as the clinical miscarriage rate. Multivariate regression analysis showed that advanced maternal age is an independent factor for miscarriage (Group 2 vs. 1: OR 2.476; Group 4 vs. 3: OR 2.252). Patients with diminished ovarian reserve (DOR) have higher miscarriage risks but without significance (Group 3 vs. 1: OR 1.322; Group 4 vs. 2: OR 1.202). Conclusion: Miscarriage rates differed among low prognosis patients according to the POSEIDON criteria. Age remains a determined risk for miscarriage. DOR might be a potential factor for miscarriage, but it didn't account for a significant impact in POSEIDON patients.

Background: Resveratrol is a natural polyphenolic compound present in plants and red wine with many potential health benefits. This compound has various anti-inflammatory and anti-tumor properties and can improve cellular mitochondrial activity. This trial was designed to evaluate the effect on the outcome of IVF of Resveratrol supplementation in women > 35 years with good ovarian reserve (AMH > 1.2 ng/ml). Women were randomized to receive or placebo or Resveratrol (150 mg per day) for three months preceding the ovarian stimulation (OS). All patients were stimulated with a starting dose of recombinant FSH ranging between 150 and 300 IU according to age and ovarian reserve. GnRH antagonist flexible protocol was adopted for pituitary suppression. Triggering was performed with urinary hCG (10.000 IU). Results: The study was conducted between January 2019 and December 2022 with aa total of 37 cases and 33 controls were recruited. No statistically significant differences in the number of oocytes retrieved, biochemical pregnancy, clinical pregnancy and live birth rates were observed between women treated with resveratrol and control group. A statistically significant increase in the follicle output rate (FORT) and follicle-to oocyte index (FOI) was observed in women treated with resveratrol-based nutraceutical (0.92 versus 0.77 [p = 0.02], and 0.77 versus 0.64 [p = 0.006], respectively). Conclusions: Preliminary results from this study indicate that pre-treatment with resveratrol may improve ovarian sensitivity to exogenous FSH, which in turn may decrease the risk of hypo-response to OS in advanced reproductive age women. [ABSTRACT FROM AUTHOR]

• Planned oocyte cryopreservation is being increasingly utilized worldwide. • Woman's age at cryopreservation and the number of mature oocytes thawed are the strongest predictors of live birth following oocyte warming. • A significant proportion of women cannot accumulate sufficient oocytes because of poor response to stimulation. • This novel, unexpected finding adds clinically relevant information for counselling and management of patients undergoing planned oocyte cryopreservation. Planned oocyte cryopreservation (OC) is being increasingly utilized worldwide. However, some women cannot accumulate sufficient oocytes because of poor response to stimulation. The POSEIDON classification is a novel system to classify patients with 'expected' or 'unexpected' inappropriate ovarian response to exogenous gonadotropins. Our study aimed to examine the prevalence of POSEIDON patients among women undergoing planned OC. We retrospectively reviewed the first cycles of 160 consecutive patients undergoing planned OC. Patients were classified into the four POSEIDON groups or as 'non-POSEIDON' based on age, AMH level and the number of oocytes retrieved. The primary outcome measure was the prevalence of POSEIDON patients. Overall, 63 patients (39.4 %) were classified as POSEIDON patients, 12 in group 1, 12 in group 2, 8 in group 3, and 31 in group 4. Compared to non-POSEIDON patients, POSEIDON patients had increased basal FSH levels and reduced serum AMH levels and antral follicle counts, required higher FSH starting doses and increased gonadotropin requirements and reached lower peak serum estradiol levels. Additionally, POSEIDON patients had a lower number of oocytes retrieved (7.6 ± 3.1 vs.20.2 ± 9.9, p < 0.001) and vitrified (5.8 ± 2.9 vs.14.7 ± 6.8, p < 0.001) than non-POSEIDON counterparts, respectively. We found a high prevalence of patients being classified as low prognosis according to the POSEIDON criteria among patients seeking planned OC. POSEIDON patients had increased gonadotropin requirements and a significantly lower number of oocytes retrieved and vitrified. This novel, unexpected finding adds clinically relevant information for counselling and management of patients undergoing planned OC. [ABSTRACT FROM AUTHOR]

Background and Objectives: The objective of this study was to evaluate the impact of adjuvant letrozole administration during ovarian stimulation using the gonadotropin-releasing hormone (GnRH) antagonist protocol on treatment outcomes in women categorized into POSEIDON groups 3 and 4. Materials and Methods: This retrospective cohort study analyzed data from patients classified into POSEIDON groups 3 and 4 who underwent fresh embryo transfer subsequent to intracytoplasmic sperm injection following a GnRH antagonist stimulation protocol between January 2017 and December 2021. Patients were divided into two groups: the GnRH-LZ group, who received letrozole at a dosage of 5 mg/day for five consecutive days, and the GnRH-ant group, who did not receive adjuvant letrozole. The primary outcome measure of the study was a comparative analysis of live birth rates between the two groups. Results: A total of 449 patients were deemed suitable for final analysis and were allocated into two groups: 281 patients in the GnRH-ant group and 168 patients in the GnRH-LZ group. Live birth rates were found to be comparable in both groups (11% vs. 9%, p = 0.497). Letrozole administration significantly reduced the total amount of gonadotropins required (2606.2 ± 1284.5 vs. 3097.8 ± 1073.3, p < 0.001), the duration of ovarian stimulation (11.2 ± 3.9 vs. 10.2 ± 3, p = 0.005), and the serum peak estradiol concentration (901.4 ± 599.6 vs. 463.8 ± 312.3, p < 0.001). Conclusions: Adjuvant letrozole administration did not demonstrate a significant impact on live birth rates among women categorized into POSEIDON groups 3 and 4. However, this approach may offer potential cost reductions by diminishing the necessity for exogenous gonadotropins and shortening the duration of ovarian stimulation. [ABSTRACT FROM AUTHOR]

Background: Poor responders may benefit from recruiting a ‘second wave’ of antral follicles within the same cycle. This concept forms the basis of double stimulation which has been named as ‘DuoStim’. This protocol involves ovarian stimulation in both follicular and luteal phases with egg retrieval in each phase, respectively, to increase the number of oocytes and embryos in one menstrual cycle. This can be considered a potentially valuable option for women with poor ovarian reserve/response to maximise the number of oocytes retrieved in a single ovarian cycle in the shortest possible time. Aims: The aim of this study was to evaluate the efficacy of the DuoStim protocol in women classified as POSEIDON poor responders undergoing in vitro fertilization by comparing the embryological outcomes between the follicular and luteal phase stimulations in the same menstrual cycle. Settings and Design: This was a retrospective cohort study of 131 patients who enrolled to undergo DuoStim cycles from January 2021 to Sept. 2022, at a IVF center in a tertiary care hospital. Materials and Methods: The follicular phase stimulation used a standard antagonist protocol for the first oocyte retrieval. Thereafter, the luteal phase stimulation was started 3 days after the first retrieval, with the same dose of gonadotropin along with a daily 10 mg medroxyprogesterone acetate tablet, followed by a second oocyte retrieval. Blastocysts produced in both the phases were subsequently vitrified. Statistical Analysis Used: The paired t-test was used for comparing means and 95% confidence intervals (CIs) for different parameters. McNemar’s test was used to compare paired proportions. The analysis was conducted using R statistical environment 4.2. Results: The mean number of oocytes retrieved and the mean number of utilizable blastocysts frozen per stimulation cycle were found to be significantly higher in the luteal phase as compared to the follicular phase (5.71 ± 3.95 vs. 4.87 ± 2.79, P = 0.02, and 1.43 ± 1.22 vs. 0.95 ± 1, P = 0.001, respectively). However, the mean fertilization rate and the mean blastocyst utilization rate were found to be similar between both the phases. The length of stimulation was found to be approximately 3 days longer in the luteal phase (12.63 ± 2.43 vs. 9.75 ± 1.85, P = 0.001). Overall, the odds of obtaining a usable blastocyst in the luteal phase was found to be significantly higher than in the paired follicular phase (73.9% vs. 57.7%, P = 0.012, odds ratio: 2.286 [95% CI: 1.186–4.636]). Also importantly, the luteal phase stimulation was able to rescue 68% (32/47) of patients where no blastocysts were formed in the follicular phase. Conclusion: Our data demonstrate that in women with poor reserve, the addition of luteal stimulation could increase the chances of achieving a pregnancy by significantly increasing the number of eggs and transferable embryos per menstrual cycle compared to follicular stimulation alone. Furthermore, luteal phase stimulation in the same cycle proved to be an effective strategy to rescue POSEIDON poor responders with no embryos after the first stimulation.

This essay examines Carson’s The Trojan Women: A Comic, a 2021 translation of Euripides illustrated by Rosanna Bruno. Carson’s subtitle, through the intersection of classical and modern senses of “the comic” as a genre, demands that the reader ask of her book: What is the place of comedy in a comic about one of the bleakest plays in the Western canon? The comic elements of The Trojan Women reframe Euripides’ narrative and underscore, in a bitter irony, the disastrous impact on the Greeks of the reconciliation of the gods Athena and Poseidon. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to assess the prevalence of "low prognosis" patients using POSEIDON criteria undergoing in vitro fertilization (IVF) cycle in Indian population. Study Design: This is a retrospective cohort study. Period of Study: It included data from the recruitment period from January 1, 2018 to December 31, 2021. Study Settings: The study was conducted at the Center for IVF and Human Reproduction, Sir Gangaram Hospital, New Delhi. Methodology: Out of the 3032 IVF stimulation cycles with oocyte aspirations, 596 cycles were excluded based on the exclusion criteria. The study focused on 2436 IVF/ICSI (Intracytoplasmic sperm injection) stimulation cycles that met inclusion criteria. Each cycle was categorized into one of the four groups defined by the POSEIDON criteria along with a fifth non-POSEIDON group. Prevalence was observed for each POSEIDON group and the non-POSEIDON group. Results: Out of the analyzed cycles, 1210 were classified under POSEIDON groups, representing a prevalence of 49.67%. The distribution of cycles in POSEIDON groups 1, 2, 3, and 4 was 31.4, 23.2, 19.17, and 26.19%, respectively. Conclusion: Low prognosis patients based on POSEIDON criteria, represented about half of the population. [ABSTRACT FROM AUTHOR]

To study the likelihood of obtaining at least 1 euploid embryo for transfer in poor ovarian response (POR) diagnosed per Bologna and Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) criteria, and compare it between groups and with patients without POR. Retrospective cohort study. Women undergoing an ovarian stimulation cycle with intention to pursue preimplantation genetic testing for aneuploidy. Bologna criteria and the POSEIDON classification system were applied to characterize each stimulation cycle as POR or not. Cycles identified as POR by POSEIDON were subdivided into groups I, II, III, and IV as defined by this classification system. The proportion of cycles resulting in at least 1 euploid blastocyst. Other outcome measures included cycle yields (metaphase II oocytes, fertilized oocytes, blastocysts, and euploid blastocysts), and euploidy rate per embryo cohort. A total of 6,889 cycles were included, of which 3,653 (53.0%) were classified as POR per POSEIDON criteria: 1.5% (100/6,889) in group I, 3.2% (222/6,889) in II, 11.9% (817/6,889) in III, and 36.5% (2,514/6,889) in IV. Per Bologna criteria, 23.4% (1,612/6,889) of cycles were classified as POR. Group I had similar likelihood of obtaining at least 1 euploid embryo (97.0%; 95% confidence interval, 91.5%–99.2%) as cycles not deemed POR (91.9%; 95% confidence interval, 90.9%–2.8%), whereas this decreased significantly with each subsequent POSEIDON group (II: 77.9%, 72.0%–82.9%; III: 70.5%, 67.3%–73.5%; IV: 44.8%, 42.9%–46.7%) and those meeting Bologna criteria had the lowest rates (31.9%, 29.7%–34.3%). Cycle yields correlated with ovarian reserve testing results, whereas euploidy rates were associated with age. Although younger POSEIDON groups (I and III) have higher euploidy rates than older groups (II and IV), each incremental POSEIDON group poses a higher risk of having no euploid blastocysts; with POSEIDON I being no different from non-POSEIDON, and Bologna having the worst prognosis. Although ovarian reserve appears to have little impact on euploidy rates, it remains a key prognostic factor for having at least 1 euploid embryo available for transfer through its impact on oocyte yield. To our knowledge, this is the first study to provide the odds ratio of this outcome depending on the degree of POR. [ABSTRACT FROM AUTHOR]

This article presents three unpublished Hellenistic inscriptions from the sanctuary of Poseidon in Kalaureia (modern Poros): two found during archaeological excavations on the site and one recorded in a letter that was once part of Ioannis Kapodistrias’ official correspondence. All three inscriptions were dedicatory and carved on bases supporting portrait statues. Interestingly, they were offered to Poseidon by members of a single family already known from other documents in the Kalaureian epigraphic corpus. Remarkably, eight out of the 18 inscriptions discovered in Kalaureia make repeated references to men and women of this very family, which appears to have materially dominated Poseidon’s temenos and its environs during the 3rd and 2nd centuries BC through the careful placement of portraits of its members. Most of these statues were conspicuously placed by the entrance to the sanctuary, though at least one of them was erected inside of the god’s temple. In our article, we present in detail the three new inscriptions, one of them an epigram, and attempt an analysis of the religious behaviour of this prominent local family against the background of contemporary sociopolitical developments

Minh Tam Le,1,2 Nguyen Dac Nguyen,1,2 Nhu Quynh Thi Tran,1 Duong Dinh Le,3 Quoc Huy Vu Nguyen,2 Thanh Ngoc Cao1,2 1Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam; 2Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam; 3Department of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue, VietnamCorrespondence: Minh Tam Le, Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen street, 53000, Vietnam, Email leminhtam@hueuni.edu.vnObjective: This study aimed to identify the factors that influence follicular output rate (FORT) and follicle-to-oocyte index (FOI) among infertile Vietnamese women, as described by the Poseidon classification of poor responders.Methods: This cross-sectional analysis includes women who received IVF/ICSI treatment at Hue University Hospital, Vietnam, between January 2017 and December 2019. The study population was divided into four groups: Group 1 (age < 35, AFC ≥ 5 and AMH ≥ 1.2 ng/mL, number of oocytes retrieved in the previous cycle ≤ 9), group 2 (age ≥ 35; AFC ≥ 5 and AMH ≥ 1.2 ng/mL, number of oocytes retrieved in the previous cycle ≤ 9), group 3 (age < 35; AFC < 5 and/or AMH < 1.2 ng/mL) and group 4 (age ≥ 35; AFC < 5 and/or AMH < 1.2 ng/mL). All of the patients underwent controlled ovarian stimulation utilizing GnRH antagonist.Results: A total of 243 cases were recruited into groups 1 (n = 44), 2 (n = 33), 3 (n = 54), and 4 (n = 112). There were statistically significant differences between the four groups in terms of age, infertility type, menstrual cycle, body mass index (BMI) and waist-hip ratio (WHR), endocrine tests, and total retrieved oocytes (p 0.05). The average number of oocytes per participant was 7.27, with the highest number occurring in group 1 (10.77) and the lowest occurring in group 4 (5.59). There was a relationship between FORT and BMI (ß: − 0.146, p=0.039), FSH starting dose (ß: 0.146, p=0.030), and AMH (ß:0.166, p=0.015). No statistically significant correlation was detected between FOI and other variables.Conclusion: The starting dose of FSH for ovarian stimulation and AMH concentration were positively associated with FORT in individuals with a poor prognosis, whereas BMI was negatively correlated with FORT; No other parameters were found to correlate with FOI.Keywords: follicular output rate, FORT, follicle-to-oocyte index, FOI, Poseidon, ovarian response

Importance: In the open-label phase III POSEIDON randomized clinical trial (RCT), a limited course of tremelimumab plus durvalumab and chemotherapy (T + D + CT) indicated in the first-line treatment of metastatic non-small cell lung cancer (mNSCLC), progression-free survival, and overall survival (OS) were substantially improved without significant additional tolerance burden compared to chemotherapy (CT). However, given the high cost of T + D + CT, its value needs to be evaluated in terms of both potency and cost. Objective: To evaluate the cost-effectiveness of T + D + CT versus CT in individuals with previously untreated mNSCLC from a U.S. payer perspective. Design, setting, and participants: A three-state Markov model was adopted to weigh the lifetime costs and effectiveness of T + D + CT versus CT for the treatment of first-line mNSCLC, according to the results of the POSEIDON phase III RCT involving 675 individuals with mNSCLC. Individuals were simulated to undergo either T + D + CT for up to four 21-day cycles, followed by durvalumab once every 4 weeks until disease progression or unacceptable toxic effects and one additional tremelimumab dose, or CT for up to six 21-day cycles (with or without pemetrexed maintenance; all groups) in the analysis. Main outcomes and measures: Lifetime costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) were evaluated with a willingnessto-pay (WTP) threshold of $ 100,000 to $ 150,000 per QALY. The uncertainty of the model was investigated using univariate and probabilistic sensitivity analysis. Results: T + D + CT produced additional 0.36 QALYs with additional costs of $ 217,694, compared to CT, giving rise to ICERs of $ 608,667.86/QALY. The univariate sensitivity analysis demonstrated that the outcomes were most sensitive to the cost of durvalumab. Other variables with a large or moderate influence were the utility of progression-free survival state, utility of progressive disease state, and cost of tremelimumab. Probability sensitivity analysis revealed that T + D + CT had a 0% probability of cost-effectiveness in individuals with mNSCLC at a willingness-to-pay threshold of $ 100,000 to $ 150,000 per QALY. Conclusion and relevance: In this model, T + D + CT was estimated to be less costeffective than CT for patients with mNSCLC at a WTP threshold of $ 100,000 to $ 150,000 per QALY in the United States. When new combination therapies with remarkable effect become pivotal in the first-line treatment, the price reduction of durvalumab and tremelimumab may be necessary to achieve cost-effectiveness in future possible context. [ABSTRACT FROM AUTHOR]

Background: Poor responders may benefit from recruiting a 'second wave' of antral follicles within the same cycle. This concept forms the basis of double stimulation which has been named as 'DuoStim'. This protocol involves ovarian stimulation in both follicular and luteal phases with egg retrieval in each phase, respectively, to increase the number of oocytes and embryos in one menstrual cycle. This can be considered a potentially valuable option for women with poor ovarian reserve/response to maximise the number of oocytes retrieved in a single ovarian cycle in the shortest possible time. Aims: The aim of this study was to evaluate the efficacy of the DuoStim protocol in women classified as POSEIDON poor responders undergoing in vitro fertilization by comparing the embryological outcomes between the follicular and luteal phase stimulations in the same menstrual cycle. Settings and Design: This was a retrospective cohort study of 131 patients who enrolled to undergo DuoStim cycles from January 2021 to Sept. 2022, at a IVF center in a tertiary care hospital. Materials and Methods: The follicular phase stimulation used a standard antagonist protocol for the first oocyte retrieval. Thereafter, the luteal phase stimulation was started 3 days after the first retrieval, with the same dose of gonadotropin along with a daily 10 mg medroxyprogesterone acetate tablet, followed by a second oocyte retrieval. Blastocysts produced in both the phases were subsequently vitrified. Statistical Analysis Used: The paired t-test was used for comparing means and 95% confidence intervals (CIs) for different parameters. McNemar's test was used to compare paired proportions. The analysis was conducted using R statistical environment 4.2. Results: The mean number of oocytes retrieved and the mean number of utilizable blastocysts frozen per stimulation cycle were found to be significantly higher in the luteal phase as compared to the follicular phase (5.71 ± 3.95 vs. 4.87 ± 2.79, P = 0.02, and 1.43 ± 1.22 vs. 0.95 ± 1, P = 0.001, respectively). However, the mean fertilization rate and the mean blastocyst utilization rate were found to be similar between both the phases. The length of stimulation was found to be approximately 3 days longer in the luteal phase (12.63 ± 2.43 vs. 9.75 ± 1.85, P = 0.001). Overall, the odds of obtaining a usable blastocyst in the luteal phase was found to be significantly higher than in the paired follicular phase (73.9% vs. 57.7%, P = 0.012, odds ratio: 2.286 [95% CI: 1.186-4.636]). Also importantly, the luteal phase stimulation was able to rescue 68% (32/47) of patients where no blastocysts were formed in the follicular phase. Conclusion: Our data demonstrate that in women with poor reserve, the addition of luteal stimulation could increase the chances of achieving a pregnancy by significantly increasing the number of eggs and transferable embryos per menstrual cycle compared to follicular stimulation alone. Furthermore, luteal phase stimulation in the same cycle proved to be an effective strategy to rescue POSEIDON poor responders with no embryos after the first stimulation. [ABSTRACT FROM AUTHOR]

Background and Objectives: The objective of this study was to evaluate the impact of adjuvant letrozole administration during ovarian stimulation using the gonadotropin-releasing hormone (GnRH) antagonist protocol on treatment outcomes in women categorized into POSEIDON groups 3 and 4. Materials and Methods: This retrospective cohort study analyzed data from patients classified into POSEIDON groups 3 and 4 who underwent fresh embryo transfer subsequent to intracytoplasmic sperm injection following a GnRH antagonist stimulation protocol between January 2017 and December 2021. Patients were divided into two groups: the GnRH-LZ group, who received letrozole at a dosage of 5 mg/day for five consecutive days, and the GnRH-ant group, who did not receive adjuvant letrozole. The primary outcome measure of the study was a comparative analysis of live birth rates between the two groups. Results: A total of 449 patients were deemed suitable for final analysis and were allocated into two groups: 281 patients in the GnRH-ant group and 168 patients in the GnRH-LZ group. Live birth rates were found to be comparable in both groups (11% vs. 9%, p = 0.497). Letrozole administration significantly reduced the total amount of gonadotropins required (2606.2 ± 1284.5 vs. 3097.8 ± 1073.3, p < 0.001), the duration of ovarian stimulation (11.2 ± 3.9 vs. 10.2 ± 3, p = 0.005), and the serum peak estradiol concentration (901.4 ± 599.6 vs. 463.8 ± 312.3, p < 0.001). Conclusions: Adjuvant letrozole administration did not demonstrate a significant impact on live birth rates among women categorized into POSEIDON groups 3 and 4. However, this approach may offer potential cost reductions by diminishing the necessity for exogenous gonadotropins and shortening the duration of ovarian stimulation.

Advanced marine observation infrastructures are the most significant scientific tool for the study of marine ecosystem trends and shifts. Ocean monitoring technologies, though highly demanding and expensive, are essential for the monitoring and long-term study of oceanic systems. The POSEIDON system for monitoring and forecasting the marine environment is an augmented research infrastructure, unique in the Eastern Mediterranean basin, contributing to the European Ocean Observing System implementation, focusing—among others—on biogeochemical observations and deep-sea ecosystem and geological processes. The technological evolution of the POSEIDON system through a science-coupled strategy supported by engineers and scientists, resulted in a state-of-the-art ocean observing system. There has been a continuous expansion of the infrastructure with new scientific platforms and supporting facilities. Innovative sensing technologies were introduced in the operational data acquisition and new methodologies and tools were developed to improve the system operations and efficiency. As a part of the scientific community of ocean observatories, POSEIDON contributes actively to the improving of the ocean observing. International access to engineering and field demonstrating services, data products and technology testing facilities has been offered to scientists and industry partners. POSEIDON is a widely recognizable international technology testing/demonstrating node specializing in marine technology providing high-level services. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to analyze the effectiveness of the day 3 ET strategy, and the morphology of the transferred embryos, in patients from POSEIDON and non-POSEIDON groups., Methods: 600 cycles of patients meeting the POSEIDON criteria and 600 non-POSEIDON cycles were analyzed to determine the proportion of cycles with an ET on days 3 or 5, or FET. Then we reviewed 330 day 3 ETs to compared the developmental stage, morphology, zona pellucida thickness and implantation potential of embryos transferred on day 3 from POSEIDON and non-POSEIDON patients., Results: Most cycles of POSEIDON patients end with ET on day 3 (42%) or without transfer (37%). In contrast, most cycle of non-POSEIDON patients end with FET (44%) and just 9% is canceled. The lowest percentage of embryos at the morula stage was recorded in POSEIDON groups III (10%) and IV (9%). The average number of cells in embryos was comparable in all groups. The largest percentage of top-quality embryos (grade A) were in POSEIDON group I (47%) .The highest implantation potential were observed in the non-POSEIDON group <35Y (28%), and in POSEIDON groups I (28%) and III (26%). The highest incidence of miscarriage was recorded in all POSEIDON and non-POSEIDON groups that included patients who were ≥35 years of age., Conclusions: The day 3 ET strategy still seems optimal for POSEIDON patients. The prognosis depends on which Poseidon group the patient is in. The best prognosis is for group I and the worst for group IV.

The New Dionysus or Son of Poseidon? De(con)structing the image of Demetrius Poliorcetes in modern historiography): This article is focused on the research of modern historians concerning the importance of Dionysus and Poseidon in Demetrius Poliorcetes’ self-representation. It draws attention to the change of approach adopted by recent studies and the multiple ambiguous interpretations that have been offered.

Background: To evaluate whether the addition of human menopausal gonadotropin (HMG) during the early follicular phase of controlled ovarian stimulation improves clinical outcomes in patients classified as group 4 on the Patient-Oriented Strategy Encompassing IndividualizeD Oocyte Number (POSEIDON) classification. Methods: A prospective, randomized, and non-blind controlled trial was conducted, involving 172 patients seeking infertility treatment with an indication for in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Among them, 78 patients were randomly assigned to the HMG/follicle stimulating hormone (FSH) group, receiving 75 IU of HMG for FSH on either day 2 or day 3 of menstruation, while 94 patients were assigned to the FSH monotherapy group. Results: The total dose of gonadotropin used in the HMG/FSH group (2510.77 ± 368.11) was higher than that in the FSH alone group (2310.98 ± 641.33), indicating greater medication usage (p < 0.001). In terms of the mean number of retrieved oocytes and good quality embryos, the HMG supplementation group demonstrated a slight increasing trend (3.79 and 1.43, respectively) compared to the FSH alone group (3.44 and 1.16, respectively), though these differences did not show statistical significance. There is no significant difference in the outcomes of ongoing pregnancy rates, biochemical pregnancy rates, or clinical pregnancy rates per end-cycle or embryo transfer cycle between the two groups. Conclusion: The addition of HMG to FSH during the early follicular phase for IVF/ICSI did not provide any benefits for patients classified as group 4 on the POSEIDON classification. Clinical Trial Registration: The study was registered at Chinese Clinical Trial Registry (https://www.chictr.org.cn), registration number: ChiCTR2100043040.

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Purpose: To evaluate the effects of adjuvant letrozole administration on outcomes of gonadotropin-releasing hormone (GnRH) antagonist cycles with intra-cytoplasmic sperm injection in POSEIDON groups 3 and 4 expected poor responder women.Methods: This study was conducted by retrospective analysis of patients with expected poor ovarian response (POSEIDON groups 3 and 4) that underwent GnRH antagonist cycles with intra-cytoplasmic sperm injection between 2010 and 2020. A total of 488 patients with letrozole co-administration and 2564 patients without any adjuvant treatment that underwent GnRH antagonist cycles within the selected period of time were included in the study.Results: Implantation rates, clinical pregnancy rates and live birth delivery rates were significantly higher in letrozole administered patients in comparison to controls among POSEIDON group 3 women (0.39 ± 0.46 vs 0.27 ± 0.40, p = 0.01; 46.1% vs 33%, p = 0.014; 42.7% vs 31.5%, p = 0.034, respectively). Mean total doses of gonadotropins required per cycle were significantly lower in letrozole administered patients among both POSEIDON groups 3 and 4 women (2864.65 ± 878.47 IU vs 3757.27 ± 1088.89 IU, p < 0.001; 3286.06 ± 770.16 IU vs 3666.48 ± 959.66 IU, p < 0.001, respectively).Conclusion: Adjuvant letrozole co-administration in intra-cytoplasmic sperm injection cycles following GnRH antagonist protocol appears to improve implantation, clinical pregnancy and live birth delivery rates in women with POSEIDON group 3 expected poor ovarian response. [ABSTRACT FROM AUTHOR]

Aim of this study was to evaluate the effects of dual triggering with gonadotropin releasing hormone agonist and human chorionic gonadotropin (hCG) on outcomes of fresh embryo transfers following gonadotropin antagonist cycles in POSEIDON group 3 and group 4 low prognosis women and to compare the outcomes with hCG-only triggering. This study was conducted by retrospective analysis of patients with expected poor ovarian response (POSEIDON group 3 and 4) that underwent fresh embryo transfers following in-vitro fertilization/intracytoplasmic sperm injection cycles with either dual triggering or hCG-only triggering between January 2010 and April 2020. A total of 1068 women that underwent dual triggering and 1931 that underwent hCG-only triggering were included in the study. Number of retrieved oocytes, M2 oocytes, oocyte maturation rate, fertilization rate, obtained 2PN embryos, implantation rate, clinical pregnancy rate and live birth delivery rates were found significantly higher in dual-triggering group in comparison to hCG-only group (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.02, p < 0.001 respectively). Dual trigger with concomitant injections of GnRH agonist and hCG in GnRH antagonist cycles appears to improve IVF outcomes, increase quality of embryos, reduce miscarriage rates and consequently increase live birth delivery rates in POSEIDON groups 3/4 poor responders. [ABSTRACT FROM AUTHOR]

Motivated by new applications such as secure Multi-Party Computation (MPC), Fully Homomorphic Encryption (FHE), and Zero-Knowledge proofs (ZK), many MPC-, FHE- and ZK-friendly symmetric-key primitives that minimize the number of multiplications over Fp for a large prime p have been recently proposed in the literature. This goal is often achieved by instantiating the non-linear layer via power maps x↦xd. In this paper, we start an analysis of new non-linear permutation functions over Fnp that can be used as building blocks in such symmetrickey primitives. Given a local map F : Fmp→ Fp, we limit ourselves to focus on S-Boxes over Fnp for n ≥ m defined as SF (x0, x1, . . . , xn−1) = y0|y1| . . . |yn−1 where yi := F(xi, xi+1, . . . , xi+m−1). As main results, we prove that • given any quadratic function F : F2p→ Fp, the corresponding S-Box SF over Fnp for n ≥ 3 is never invertible; • similarly, given any quadratic function F : F3p → Fp, the corresponding S-Box SF over Fnp for n ≥ 5 is never invertible. Moreover, for each p ≥ 3, we present (1st) generalizations of the Lai-Massey construction over Fnp defined as before via functions F : Fmp → Fp for each n = m ≥ 2 and (2nd) (non-trivial) quadratic functions F : F3p → Fp such that SF over Fnp for n ∈ {3, 4} is invertible. As an open problem for future work, we conjecture that for each m ≥ 1 there exists a finite integer nmax(m) such that SF over Fnp defined as before via a quadratic function F : Fmp →Fp is not invertible for each n ≥ nmax(m). Finally, as a concrete application, we propose Neptune, a variant of the sponge hash function Poseidon, whose non-linear layer is designed by taking into account the results presented in this paper. We show that this variant leads to a concrete multiplication reduction with respect to Poseidon.

Recent advanced Zero-Knowledge protocols, along with other high-level constructions such as Multi-Party Computations (MPC), have highlighted the need for a new type of symmetric primitives that are not optimized for speed on the usual platforms (desktop computers, servers, microcontrollers, RFID tags...), but for their ability to be implemented using arithmetic circuits. Several primitives have already been proposed to satisfy this need. In order to enable an efficient arithmetization, they operate over large finite fields, and use round functions that can be modelled using low degree equations. The impact of these properties on their security remains to be completely assessed. In particular, algebraic attacks relying on polynomial root-finding become extremely relevant. Such attacks work by writing the cryptanalysis as systems of polynomial equations over the large field, and solving them with off-the-shelf tools (SageMath, NTL, Magma, . . . ). The need for further analysis of these new designs has been recently highlighted by the Ethereum Foundation, as it issued bounties for successful attacks against round-reduced versions of several of them. In this paper, we show that the security analysis performed by the designers (or challenge authors) of four such primitives is too optimistic, and that it is possible to improve algebraic attacks using insights gathered from a careful study of the round function. First, we show that univariate polynomial root-finding can be of great relevance n practice, as it allows us to solve many of the Ethereum Foundation’s challenges on Feistel–MiMC. Second, we introduce a trick to essentially shave off two full rounds at little to no cost for Substitution-Permutation Networks (SPN). This can be combined with univariate (resp. multivariate) root-finding, which allowed to solve some challenges for Poseidon (resp. Rescue–Prime). Finally, we also find an alternative way to set up a system of equations to attack Ciminion, leading to much faster attacks than expected by the designers.

Cevat Şakir Kabaağaçlı is one of the important writers of Turkish Literature. In his works, he used the name Halikarnas Balıkçısı (Fisherman of Halicarnassus) as his pseudonym because Bodrum, as its historical name Halicarnassus, was a very important and special place for him. Cevat Şakir mentioned that Bodrum and its beauties in almost all of his works. Cevat Şakir handles Bodrum as well as the Aegean Sea and the Mediterranean Sea and their coasts, natural beauties and people as a whole. This whole also contains these people’s pains, life struggles, fights for bread, beliefs, and narrations. Anatolia together with its sea and land is one huge homeland for him. Cevat Şakir, also one of the leaders of the Blue Nation Movement in our Literature, bases roots of Western Civilization to Anatolia. Kabaağaçlı tries to describe Anatolia and Blue Anatolia with their entire beauties. Meanwhile, his works also include quite a number of mythological elements, narrations, and legends. One of these mythological elements is Poseidon. The main problem of this study is how Poseidon takes place as a mythological character in Cevat Şakir Kabaağaçlı whether it contains differences from its original, or how Poseidon finds his expressions. The Blue Anatolia Movement, pioneered by Cevat Şakir, distinguishes Kabaağaçlı from other authors who include mythological elements in their works. Thus, in this study, document analysis which is one of the quantitative research methods is used, and the relevant resources are scanned within the scope of sea motifs and Poseidon’s myths. In this research, it is tried to determine the effort or way of sea motifs and Poseidon myths to survive from the ancient era to today, and it’s a reflection on Halikarnas Balıkçısı’s work, in other words, to define its traces on modern narrative.

Technological and scientific developments in the field of infertility, along with advances in treatment options, allow for new treatment approaches in previously unsolvable cases.(1) In 2016, the POSEIDON group (Patient-Centered Strategies Including Individualized Oocyte Count) implemented new criteria aimed at identifying and classifying 'poor ovarian response' patients undergoing ART. The serum level of AFC or AMH, which is a marker of ovarian reserve, forms a critical backbone of the POSEIDON criteria, but the compatibility between these two markers has not yet been investigated.(2) In our study, we aimed to examine the effect of the AMH / AFC Ratio in predicting clinical pregnancy outcomes in POSEIDON group 3 and group 4 patients. For our cross-sectional retrospective observational study, patient data from the 2017-2022 (after the definition of POSEIDON criteria) patient registration system, whose diagnosis, follow-up and treatments were planned in our Health Sciences University Etlik Zübeyde Hanım Training and Research Hospital IVF center, and whose clinical pregnancy results were achieved, were scanned retrospectively. According to POSEIDON criteria, group 3 (<35 years, AMH <1.2) and group 4 (>35 years, AMH <1.2) patients were included in the study. While investigating the predictive effect of the AMH / AFC ratio, a comparison was also made with the predictive effect of the follicle-oocyte index (FOI). Demographic laboratory and clinical data of the groups were examined. According to POSEIDON criteria, data of 351 patients in Group 3 and 392 patients in Group 4 were examined. In Group 3, correlation was observed between AMH/AFC ratio and FOI, but no correlation was observed between AMH/AFC ratio and Mature oocyte count. (Table 1) In the ROC analysis, no effect of AMH/AFC ratio was observed in predicting clinical pregnancy. The predictive effect of FOI was observed. (Figure 1,2) In Group 4, correlation was observed between AMH/AFC ratio and FOI and between AMH/AFC ratio and Mature oocyte count. (Table 1) In the ROC analysis, no effect of AMH/AFC ratio was observed in predicting clinical pregnancy. The predictive effect of FOI was observed. (Figure 3,4) In our study, while AMH/AFC ratio did not have a predictive effect on clinical pregnancy rate, the need for effective ovarian response tools for the prediction of successful IVF pregnancy is increasing. In recent years, more complex and quantitative biomarkers such as FORT and OSI have been investigated to predict ovarian function. FOI is an alternative approach to describe poor response to exogenous gonadotropin stimulation. Higher FOI has been associated with higher implantation rate and live birth rate after the first fresh embryo transfer. [ABSTRACT FROM AUTHOR]

Mild stimulation (MS) consists in prescribing gonadotropin at the minimum amount alone or in combination with other compounds. This strategy has gained popularity in assisted reproduction for the reduced costs, better patient compliance, and reduced risk of hyperstimulation syndrome. Some investigators proposed MS even in women with low prognosis. The Poseidon group proposed new criteria to identify these patients categorizing them into 4 different groups, each one characterized by a specific segment of prognosis. The use of MS in women with low prognosis involves risks that cannot be overlooked. The most crucial concerns are the increased rate of cycle cancellation and the reduced number of eggs collected. Notably, the number of eggs collected still represents the most accurate predictor of live birth and cumulative live birth rate. Despite promising preliminary data, recent evidence has confirmed that MS does not improve gamete quality. Hence, considering that no robust strategy was identified so far to improve oocyte quality, the only reasonable strategy to improve the chance of live birth in women with low prognosis is to collect the necessary number of oocytes to maximize the probability to obtain at least 1 good-quality embryo. In this sense, conventional protocols offer better results when compared with the mild approach. Given the difficulty in collecting enough oocytes in a single round of stimulation, accumulation strategy could represent a valuable approach especially in women with advanced reproductive age and reduced ovarian reserve. [ABSTRACT FROM AUTHOR]

It is conventionally assumed that conserved pathways evolve slowly with little participation of gene evolution. Nevertheless, it has been recently observed that young genes can take over fundamental functions in essential biological processes, for example, development and reproduction. It is unclear how newly duplicated genes are integrated into ancestral networks and reshape the conserved pathways of important functions. Here, we investigated origination and function of two autosomal genes that evolved recently in Drosophila : Poseidon and Zeus , which were created by RNA-based duplications from the X-linked CAF40 , a subunit of the conserved CCR4–NOT deadenylase complex involved in posttranscriptional and translational regulation. Knockdown and knockout assays show that the two genes quickly evolved critically important functions in viability and male fertility. Moreover, our transcriptome analysis demonstrates that the three genes have a broad and distinct effect in the expression of hundreds of genes, with almost half of the differentially expressed genes being perturbed exclusively by one paralog, but not the others. Co-immunoprecipitation and tethering assays show that the CAF40 paralog Poseidon maintains the ability to interact with the CCR4–NOT deadenylase complex and might act in posttranscriptional mRNA regulation. The rapid gene evolution in the ancient posttranscriptional and translational regulatory system may be driven by evolution of sex chromosomes to compensate for the meiotic X chromosomal inactivation (MXCI) in Drosophila. [ABSTRACT FROM AUTHOR]

Advanced marine observation infrastructures are the most significant scientific tool for the study of marine ecosystem trends and shifts. Ocean monitoring technologies, though highly demanding and expensive, are essential for the monitoring and long-term study of oceanic systems. The POSEIDON system for monitoring and forecasting the marine environment is an augmented research infrastructure, unique in the Eastern Mediterranean basin, contributing to the European Ocean Observing System implementation, focusing—among others—on biogeochemical observations and deep-sea ecosystem and geological processes. The technological evolution of the POSEIDON system through a science-coupled strategy supported by engineers and scientists, resulted in a state-of-the-art ocean observing system. There has been a continuous expansion of the infrastructure with new scientific platforms and supporting facilities. Innovative sensing technologies were introduced in the operational data acquisition and new methodologies and tools were developed to improve the system operations and efficiency. As a part of the scientific community of ocean observatories, POSEIDON contributes actively to the improving of the ocean observing. International access to engineering and field demonstrating services, data products and technology testing facilities has been offered to scientists and industry partners. POSEIDON is a widely recognizable international technology testing/demonstrating node specializing in marine technology providing high-level services.

Several legends associate the god Poseidon with islands set on the margins of human space and time. The Dolions of Kysikus and their neighbours “Born of the Earth”, Cos and the Merops, but also the island of Phaeacia in the Odyssey, are some examples of isolated and immutable worlds outside of history where Poseidon’s protection maintains a fragile balance between human populations and the presence of gods, giants or other non-human creatures. In all these cases, the irruption of an external agent breaks this order and balance, puts an end to the proximity between human and non-human beings and forces these worlds to enter the purely human space and time. These islands then enter the normal course of history, from which they had remained separated until there. But this rupture is not a defeat for Poseidon: quite on the contrary, the god sometimes seems to protect this shift from immutability to history.

To present our experience using four consecutive minimal COS (TetraStim) followed by oocyte retrieval and vitrification to increase the number of oocytes in patients with POR for whom oocyte donation is not an option. We performed an observational study evaluating 128 poor responders submitted to TetraStim instead of oocyte donation cycles. Patients were submitted to four consecutive minimal COS started at luteal phase, oocyte retrieval, oocyte vitrification/warming, ICSI, endometrial priming and embryo transfer. We evaluated the number of vitrified oocytes, survival rate after warming, fertilization rate, cleavage rate, number of embryos transferred, clinical pregnancy rate, miscarriage rate and live birth rate. The mean age was 38.1 ± 3.1 years. A total of 791 oocytes were recovered (6.1 ± 2.7/patient), 682 (86.2%) Metaphase II (5.3 ± 2.4/patient) were vitrified, 95.3% survived warming (5.1 ± 2.3/patient), 82% showed normal fertilization after ICSI (4.2 ± 2/patient), 79.2% reached cleavage stage (3.3 ± 1.6/patient), 313 cleavage stage embryos were transferred to 115 patients (2.7 ± 0.7/patient) and 14.7% of the patients had surplus embryos that were vitrified. Clinical pregnancy rate per patient was 31.3% and live birth rate per patient was 22.6%. To our knowledge this is the first study that demonstrates that TetraStim can be an effective alternative for patients with POR with an indication to perform IVF with donated oocytes, but do not agree to use. TetraStim is a feasible alternative to increase the number of oocytes and embryos and improve pregnancy rates with no dropouts and very low cycle cancelation rate. However, randomized controlled studies must be performed to compare TetraStim with other treatments. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether minimal ovarian stimulation (mOS) is as effective as conventional ovarian stimulation (cOS) for older women belonging to different groups according to the Poseidon criteria. Material and methods: Observational retrospective multicentre cohort including women from Poseidon's groups 2 and 4 that underwent in vitro fertilization (IVF). We performed a mixed-effects logistic regression model, adding as a random effect the patients and the stimulation cycle considering the dependence of data. Survival curves were employed as a measure of the cumulative live birth rate (CLBR). The primary outcomes were live birth rate per embryo transfer and CLBR per consecutive embryo transfer and oocyte consumed until a live birth was achieved. Results: A total of 2002 patients underwent 3056 embryo transfers (mOS = 497 and cOS = 2559). The live birth rates per embryo transfer in mOS and cOS showed no significant difference in both Poseidon's groups. Likewise, the logistic regression showed similar live birth rates between the two protocols in Poseidon's groups 2 (OR 1.165, 95% CI 0.77–1.77; p = 0.710) and 4 (OR 1.264 95% CI 0.59–2.70; p = 0.387). However, the survival curves showed higher CLBR per oocyte in women that received mOS (Poseidon group 2: p < 0.001 and Poseidon group 4: p = 0.039). Conclusions: Minimal ovarian stimulation is a good alternative to COS as a first-line treatment for patients belonging to Poseidon's groups 2 and 4. The number of oocytes needed to achieve a live birth seems inferior in mOS strategy than cOS. [ABSTRACT FROM AUTHOR]

Copyright of Folklor / Edebiyat is the property of Cyprus International University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Governing human-environmental ecosystems is a complex problem. Rule-based fisheries models are faced with several challenges. First, for large geographical problems like oceans, they require considerable time to find satisfactory solutions. Second, they tend to be reactive rather than anticipatory. Behavioural assumptions directly impact fishers' capacity for adaptation and behaviour, which influences possible management strategies. To capture style and speed of adaptation to changes in the environment, coupled human-environment models must progress toward cognitively and socio-culturally realistic representations of fisher decision-making. In this paper, we implement the erotetic decision-making model in the POSEIDON fisheries model. The agents replicate observed behaviours such as fishing the line of a Marine Protected Area, using Individually Tradable Quotas, and returning to favoured fishing locations, and learning to break rules given harsh constraints. This provides a principled proof that reasons-based cognitive structures allow for anticipatory behavioural adaptation rather than reactive behavioural adaptation. [ABSTRACT FROM AUTHOR]

ObjectiveTo investigate ovarian sensitivity in subgroups of patients with a low prognosis, as defined by the POSEIDON criteria, undergoing in vitro fertilization treatment and measures to improve ovarian sensitivity in these patients.DesignWe conducted a retrospective cohort analysis.SettingThe study was conducted at an IVF clinic in a public hospital.PatientsA total of 32,128 fresh IVF cycles from January 2014 to October 2018 at a single IVF clinic were included in the analysis. Patients with a low prognosis were categorized into four groups based on the POSEIDON criteria.InterventionsNone.Main Outcome MeasureThe primary outcome measures were the follicular output rate (FORT) and the follicle-to-oocyte index (FOI).ResultsThe FORTs in the order from the highest to the lowest were 1.18 in group 3, 0.98 in group 4, 0.76 in group 1, and 0.68 in group 2. The trend in the FOI values was consistent with that in the FORTs. Among patients with poor ovarian sensitivity, 58.41% of patients with FORTs ≥ 0.30 in the second cycle underwent an adjustment to the ovarian stimulation (OS) protocol and 41.59% underwent an adjustment to the gonadotropin (Gn) starting dose. Among patients with normal ovarian sensitivity, 43.56% of those with FORTs ≥ 0.80 in the second cycle underwent an adjustment to the OS protocol and 56.44% underwent an adjustment to the Gn starting dose.ConclusionOvarian sensitivity was the highest in group 3 (young women with poor ovarian reserve), followed by groups 4 (women at advanced age with poor ovarian reserve) and 1 (young women with good ovarian reserve), and it was the lowest in group 2 (women at advanced age with good ovarian reserve). For patients with poor ovarian sensitivity, it is preferred to recommend an adjustment to the OS protocol, while for those with normal ovarian sensitivity, adjusting the Gn starting dose is preferred.

Objective: The objective of this study was to examine whether the combined Stop GnRH-agonist (GnRH-ag), letrozole priming, and multiple-dose GnRH-antagonist (GnRH-ant) protocol may improve in vitro fertilization/intracytoplasmic sperm injection cycle in poor ovarian responders (PORs).Design: This was a historical cohort, proof of concept study under tertiary setting at University affiliated Medical Center.Patients: Five PORs fulfilling the POSEIDON Group 4 criteria were included.Main Outcome Measures: Number of oocytes retrieved, number of top-quality embryos (TQEs), and controlled ovarian hyperstimulation (COH) variables were the main outcome measures.Results: The combined Stop GnRH-ag, letrozole priming, and multiple-dose GnRH-ant COH protocol revealed significantly higher number of follicles >13 mm on the day of hCG administration and higher number of oocytes retrieved, with non-significantly more TQEs and a reasonable clinical pregnancy rate.Conclusions: The combined Stop GnRH-ag, letrozole priming, and multiple-dose GnRH-ant COH protocol is a valuable tool in the armamentarium for treating POSEIDON Group 4 patients. Further large prospective studies are needed to elucidate its role in POR and to identify the specific characteristics of women (before initiating ovarian stimulation) that will aid both fertility specialists' counseling and their patients in adjusting the appropriate COH protocol. [ABSTRACT FROM AUTHOR]

The strategy for the poor responder patients continues to represent one of the most challenging tasks for the clinicians. The reduced number of follicles reaching advanced stages of folliculogenesis may be due to atresia/cellular mitosis malfunction in the early stages of follicle development (exclusively controlled by paracrine factors) or to endocrine activity issues (especially of gonadotropins) in the final stages of development. Due to its complexity, the reproductive process inevitably entails a wide variety of possible pathologies. The aim of the present study was to review the currently available data on poor responder patients and to anticipate further steps for a better management of this condition. [ABSTRACT FROM AUTHOR]

Background: Poor ovarian reserve and a high rate of pregnancy failure associated with low quality and quantity of oocytes are observed in poor responders to in vitro fertilization. Objective: To assess the effect of age, body mass index (BMI), endometriosis, and history of ovarian surgery on ovarian reserve in a group of poor responders. Materials and Methods: In this cross-sectional study 749 women who referred to Yasmin Clinic of Dr. Cipto Mangunkusumo National General Hospital from January 2013 to June 2017 were enrolled. Two definitions of poor responders and Poseidon criteria and consecutive sampling techniques were used. Participants were divided into good and poor responder groups based on the ovarian reserve test; participant with oocyte ≤ 3 was classified as a poor responder. Based on this, 188 participants with nine (4-47) oocytes were included in the poor responder group. While, good responder comprised of two (0-3) oocytes. Results: Age and anti-Mullerian hormone level (AMH) were significantly associated with ovarian reserve in the poor-responder group (p < 0.001). However, in multivariate analyses, age was the only significant predictor of ovarian response in the poorresponder group (p = 0.004). While endometriosis was the significant predictor of Poseidon groups 1 and 4, surgical history was the significant predictor of Poseidon groups 2 and 3. Meanwhile, an increase in BMI decreased the risk of classification under Poseidon group 3. Conclusion: Age, AMH, BMI, endometriosis, and history of ovarian surgery affected the risk of classification of the Poseidon group. [ABSTRACT FROM AUTHOR]

It is argued in this article that the gods in Euripides' tragedy Hippolytus are equally concerned with testing and breaking their rules of conduct and behaviour as the humans are. The gods in the Hippolytus are repeatedly confronted with conflicting divine norms and laws which are essential for the dramatic progress, yet these lead to various inter-divine conflicts. Further more, it is demonstrated that the divine descent of Hippolytus adds to the complexity of his character, a character who stands between the world of the humans and the gods. [ABSTRACT FROM AUTHOR]

Objective: To investigate ovarian sensitivity in subgroups of patients with a low prognosis, as defined by the POSEIDON criteria, undergoing in vitro fertilization treatment and measures to improve ovarian sensitivity in these patients. Design: We conducted a retrospective cohort analysis. Setting: The study was conducted at an IVF clinic in a public hospital. Patients: A total of 32,128 fresh IVF cycles from January 2014 to October 2018 at a single IVF clinic were included in the analysis. Patients with a low prognosis were categorized into four groups based on the POSEIDON criteria. Interventions: None. Main Outcome Measure: The primary outcome measures were the follicular output rate (FORT) and the follicle-to-oocyte index (FOI). Results: The FORTs in the order from the highest to the lowest were 1.18 in group 3, 0.98 in group 4, 0.76 in group 1, and 0.68 in group 2. The trend in the FOI values was consistent with that in the FORTs. Among patients with poor ovarian sensitivity, 58.41% of patients with FORTs ≥ 0.30 in the second cycle underwent an adjustment to the ovarian stimulation (OS) protocol and 41.59% underwent an adjustment to the gonadotropin (Gn) starting dose. Among patients with normal ovarian sensitivity, 43.56% of those with FORTs ≥ 0.80 in the second cycle underwent an adjustment to the OS protocol and 56.44% underwent an adjustment to the Gn starting dose. Conclusion: Ovarian sensitivity was the highest in group 3 (young women with poor ovarian reserve), followed by groups 4 (women at advanced age with poor ovarian reserve) and 1 (young women with good ovarian reserve), and it was the lowest in group 2 (women at advanced age with good ovarian reserve). For patients with poor ovarian sensitivity, it is preferred to recommend an adjustment to the OS protocol, while for those with normal ovarian sensitivity, adjusting the Gn starting dose is preferred. [ABSTRACT FROM AUTHOR]

Patients with poor ovarian response (POR) to exogenous gonadotropins stimulation for assisted reproductive technology (ART) have decreased circulating androgens during spontaneous cycles. The Patient-Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) is a 4-tier stratification of women with POR to controlled ovarian stimulation (COH) based on age and biomarkers of ovarian reserve has been proposed to maximize the clinical management of this group for ART. The aim of the present study was to characterize the levels of androgens during COH in follicular fluid (FF) and serum in POSEIDON subgroups and compared them with women of normal ovarian response. Sixty nine consecutive patients undergoing ART were included and testosterone, androstenedione, dehydroepiandrosterone sulfate (DHEA-S), estradiol, sex hormone-binding globulin (SHBG), and insulin-like growth factor 1 (IGF-1) were measured in serum and FF collected at the time of oocyte pick-up. The number of retrieved oocytes was registered for each patient for their allocation to the respective POSEIDON subgroup. The control group comprised 19 women and the POSEIDON group 1 (age < 35, normal ovarian reserve biomarkers) n = 14, group 2 (age ≥ 35, normal ovarian reserve biomarkers) n = 8, group 3 (age < 35, poor ovarian reserve biomarkers) n = 6 and group 4 (age ≥ 35, poor ovarian reserve biomarkers) n = 22. Serum levels of total testosterone, androstenedione and DHEA-S were not different in group 1 vs. control but significantly decreased in group 3 vs. control. DHEA-S in FF was also significantly decreased in group 3 vs. control. In addition, serum testosterone was decreased in groups 2 and 4 vs. control; and serum androstenedione and estradiol were reduced in group 4 vs. control. No differences were observed for estradiol, SHBG and IGF-1 in FF. Finally, a high correlation between serum and FF DHEA-S was observed when data from samples of all groups were pooled. Group 1 did not show hypoandrogenemia however group 3 had low levels of all measured androgens in serum and DHEA-S in FF. Such differences might help to better characterize and/or improve the clinical management of women with POR according to their respective POSEIDON stratification.

Growth Hormone (GH) has been considered as a therapeutic option to increase the number of growing follicles during Assisted Reproductive Technology (ART) for more than 30 years. In this review the biological rationale for therapeutic GH usage is explained through evidence in animal models, aiming to put this into a clinical context. First, we explain the GH—Insulin like Growth Factor (IGF)-1—gonadal axis and its role in reproduction. Evidence suggests that GH can stimulate the secretion of IGF1 not only in the liver but also in the peripheral target structures, including the ovary. Moreover, IGF-1 can be secreted locally under the influence of stimuli other than GH. In the case of the ovary, steroid hormones, gonadotropins or the combination of both seems to be involved. Even more interesting, the ovary itself can secret GH locally and exert a paracrine action modulating the intracellular signaling pathway of GH, i.e., not by the systemic pathway where GH binds to the extracellular domain of the GH receptor. Finally, these aspects from animal models are put into clinical perspective by discussing results and shortcomings of studies and meta-analyses in order to put forth the state-of-the-art rationale for therapeutic GH usage in modern ART.

Objective: To investigate the characteristics and outcomes of low prognosis patients defined by POSEIDON criteria undergoing IVF treatment.Design: Retrospective cohort analysis.Setting: An IVF clinic in a public hospital.Patients: 18,455 fresh aspirated IVF cycles with subsequently frozen embryo transfer from Jan 2014 to Jan 2017 in a single IVF clinic were included in the analysis. The low prognosis patients were categorized into 4 groups based on POSEIDON criteria: group 1: age < 35, antral follicle count (AFC) ≥ 5, number of oocytes retrieved ≤ 9 in the previous cycle; group 2: age ≥ 35, AFC≥5, number of oocytes retrieved ≤ 9 in the previous cycle; group 3: age < 35, AFC < 5; group 4: age ≥ 35, AFC < 5. The non-low prognosis patients: group 5: AFC ≥ 5, previous number of oocytes retrieved > 9 oocytes; group 6: AFC ≥ 5, no previous ovarian stimulation.Intervention(s): None.Main Outcome Measure: The primary outcome was cumulative live birth rate (CLBR).Result(s): Taking group 1 as reference, the CLBR from young women in group 3 (35.5%, OR 0.9, 95% CI 0.7–1.2) was slightly lower than that in group 1 (44.6%, p = 0.615). The CLBR in group 2 (24.5%, OR 0.6, 95% CI 0.4–0.8, p = 0.004) and group 4 (12.7%, OR 0.4, 95% CI 0.3–0.6, p < 0.001) was significant lower than that in group 1. In non-poor prognosis patients, the CLBR from young women in group 5 (53.5% OR 1.3 95% CI 0.9, 1.7, p = 0.111) was a slight higher than the reference group 1 while the highest CLBR was originated from the first IVF patients with good ovarian reserve in group 6 (66.9%, OR 2.0, 95% CI 1.6, 2.4).Conclusion(s): The CLBRs and implantation rates in the young women (group 3) with diminished ovarian reserve was similar in those young women (group 1), and was significantly higher than in advanced age women with a fair ovarian reserve (group 2). Though patients in group 2 had better ovarian reserve, more oocytes and more embryos, the pregnancy outcome was inferior to that of group 3 patients with poorer ovarian reserve, fewer oocytes and fewer embryos.

Objective: To study the actual controlled ovarian stimulation (COS) management in women with suboptimal response, comparing clinical outcomes to the gonadotropins consume, considering potential role of luteinizing hormone (LH) addition to follicle-stimulating hormone (FSH).Design: Monocentric, observational, retrospective, real-world, clinical trial on fresh intra-cytoplasmic sperm injection (ICSI) cycles retrieving from 1 to 9 oocytes, performed at Humanitas Fertility Center from January 1st, 2012 to December 31st, 2015.Methods: COS protocols provided gonadotropin releasing-hormone (GnRH) agonist long, flare-up, short and antagonist. Both recombinant and urinary FSH were used for COS and LH was added according to the clinical practice. ICSI outcomes considered were: gonadotropins dosages; total, mature, injected and frozen oocytes; cumulative, transferred and frozen embryos; implantation rate; pregnancy, delivery and miscarriage rates. Outcomes were compared according to the gonadotropin regimen used during COS.Results: Our cohort showed 20.8% of low responders, defined as 1–3 oocytes retrieved and 79.2% of “suboptimal” responders, defined as 4–9 oocytes retrieved. According to recent POSEIDON stratification, cycles were divided in group 1 (6.9%), 2 (19.8%), 3 (11.7%), and 4 (61.5%). The cohort was divided in 3 groups, according to the gonadotropin's regimen. Women treated with FSH plus LH showed worst prognostic factors, in terms of age, basal FSH, AMH, and AFC. This difference was evident in suboptimal responders, whereas only AMH and AFC were different among treatment groups in low responders. Although a different result, in terms of oocytes and embryos detected, major ICSI outcomes (i.e., pregnancy and delivery rates) were similar among groups of COS treatment. Outcomes were significantly different among Poseidon groups. Implantation, pregnancy and delivery rates were significantly higher in Poseidon group 1 and progressively declined in other POSEIDON groups, reaching the worst percentage in group 4.Conclusions: In clinical practice, women with worst prognosis factors are generally treated with a combination of LH and FSH. Despite low prognosis women showed a reduced number of oocytes retrieved, the final ICSI outcome, in terms of pregnancy, is similarly among treatment group. This result suggests that the LH addition to FSH during COS could improve the quality of oocytes retrieved, balancing those differences that are evident at baseline.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03290911