POSEIDON criteria revisited

A separate thought is the role of receptor polymorphisms. The speaker's conceptual remark — "if we had known the FSH receptor, LH receptor polymorphisms" — points the way: pharmacogenomics can explain an unexpected hypo-response in advance and guide drug and dose choice even before the first stimulation.

Humaidan proposes considering POSEIDON and APHRODITE together, in one clinical context: female and male stratification cease to be parallel worlds and combine into a single picture of the couple.

Hence the overarching idea: infertility is a couple's problem, not a single patient's. Work-up and strategy must cover both partners at once, or efforts to optimise the female protocol may founder on an unaddressed male factor — and vice versa.

The dosing implications follow from the POSEIDON group: sometimes the priority is not to lose time and to add LH from the start; sometimes it is the gentlest possible stimulation with protection from hyper-response. The classification helps avoid "treating everyone the same."

Looking ahead — further individualisation: receptor and other biomarkers, merging clinical and genetic data, decision support from large cohorts. POSEIDON here is the frame onto which new layers of precision are added.

The practical sense of the POSEIDON decade is that the "difficult" patient is no longer a uniform category. The same AMH value in a woman of 32 and of 40 means a different prognosis and a different strategy, and the classification, for the first time, gave a language to articulate this — both between clinicians and with the patient herself.

Humaidan also stresses that POSEIDON does not replace clinical judgement but structures it: the group sets the frame, yet within it the decision still rests with the clinician, weighing reserve, age, available drugs and the couple's goals. This blend of system and individualisation is, in his view, the decade's main lesson.

For the clinician, the decade's lesson is simple: stratify rather than generalise; think of the couple, not one partner; and where age and reserve demand it, do not postpone LH support.