Self-Monitoring of Urinary Hormones in Combination with Telemedicine - a Timely Review and Opinion Piece in Medically Assisted Reproduction

Abstract

Cycle monitoring via ultrasound and serum-based hormonal assays during medically assisted reproduction (MAR) can provide information on ovarian response and assist in optimizing treatment strategies in addition to reducing complications such as ovarian hyperstimulation syndrome (OHSS). Two surveys conducted in 2019 and 2020, including overall 24 fertility specialists from Europe, Asia and Latin America, confirmed that the majority of fertility practitioners routinely conduct hormone monitoring during MAR. However, blood tests may cause inconvenience to patients. The reported drawbacks of blood tests identified by the survey included the validity of results from different service providers, long waiting times and discomfort to patients due to travelling to clinics for tests and repeated venepunctures. Historically, urine-based assays were used by fertility specialists in clinics but were subsequently replaced by more practical and automated serum-based assays. A remote urine-based hormonal assay could be an alternative to current serum-based testing at clinics, reducing the inconvenience of blood tests and the frequency of appointments, waiting times and patient burden. Here we provide an overview of the current standard of care for cycle monitoring and review the literature to assess the correlation between urine-based hormonal assays and serum-based hormonal assays during MAR. In addition, in this review, we discuss the evidence supporting the introduction of remote urine-based hormonal monitoring as part of a novel digital health solution that includes remote ultrasound and tele-counselling to link clinics and patients at home.

Keywords: Home-based monitoring; In vitro fertilization (IVF); Medically assisted reproduction (MAR); Remote urine-based hormonal monitoring; Self-monitoring; Telemedicine.

Fig. 1

Specialist recommendation for the days on which hormonal monitoring could potentially be performed using urine-based assays (based on the results of 2019 survey). b-hCG; beta human chorionic gonadotrophin (pregnancy test); CP, clinical pregnancy; OP, ongoing pregnancy; OT, ovulation triggering (either with human chorionic gonadotrophin or gonadotrophin-releasing hormone agonist); S, serum-based hormonal assay; U, urine-based hormonal assay. *Additional hormonal assessments performed in the case of ovulation triggering with human chorionic gonadotrophin. †Additional hormonal assessments performed in the case of ovulation triggering with gonadotrophin-releasing hormone agonist