TITLE:
A New Protocol for Controlled Ovarian Stimulation Monitoring by Self-Determination of Estrone-3-Glucuronide and Single Ultrasound (COSSESU)
AUTHORS:
Iavor K. Vladimirov, Martin Vladimirov, Desislava Tacheva
KEYWORDS:
COS Monitoring, E3G, Estradiol, TVUS, Telemedicine
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.11 No.9,
September
26,
2021
ABSTRACT: Background: Answering
the question of what is the optimal protocol for monitoring controlled ovarian
stimulation (COS) still remains a challenge. The rapid introduction of new
diagnostic methods and various components of telemedicine makes it possible to
reduce the number of patient visits during ovarian stimulation, which will
reduce the loss of time, costs, and risk for the patient from COVID-like
situations. Methods: The different COS monitoring protocols are examined, thus proposing a new
approach consisting of two successive phases. Results: In the first
phase, E3G in urine samples is being examined, which is performed by the
patient themselves with a small portable analyzer. Based on the results, the
specialist prescribes the doses for stimulation. The second phase involves one
single determination of the size and number of follicles at the end of
stimulation, using TVUS, as well as the dynamics of serum levels of P4 and E2.
This proves to be in many cases sufficient. Conclusions: It is of
our opinion that on the basis of new diagnostic tests such as E3G in urine and
telemedicine, patients are able to independently and actively participate in
the treatment process. This new approach to COS monitoring can be successfully
implemented in different protocols for ovarian stimulation.