Purpose This study aims to establish the viability of monitoring an appropriate and safe ovarian stimulation without the use of ultrasound and serum hormone testing.

Method As a primary marker for monitoring of the ovarian response, we used urinary estrone-3-glucuronide (E1-3G) growth rate, which was self-measured by patients daily at home, with a portable analyzer, during the stimulation. For an adequate ovarian response, an average daily rate of increase of E1-3G was estimated to be within 25 - 77%. Ovulation trigger day was determined based on the length of the menstrual cycle.

The study included 24 women. Inclusion criteria were age < 41 years and AMH >1 ng/mL. A progestin-primed ovarian stimulation protocol (PPOS) with fixed doses of gonadotropins was used.

Results The average female age was 32,9 years (±4.4), BMI 22,7 kg/m2 (±4,3), AMH 3,7 ng/ml (±2,6), stimulation days 10,6 (±1,1), collected oocytes 12,5 (±8,5), MII oocytes 10,6 (±7,8), fertilization rate 83,6% (±22,5), blastocyst 66,4% (±28,6), good quality blastocysts 31,6% (±16,9).

Absence of oocyte aspiration was found in one of the cases. There were no cases of OHSS and ovarian stimulation cancellation.

Conclusion This is the first pilot study to successfully apply a new markers for ovarian stimulation monitoring.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The studies involving human participants were reviewed and approved by the Ethics Committee of the SBALAGRM-SOFIA hospital.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes