The impact of modified monitoring on ivf outcomes during covid.

The process of controlled ovarian stimulation (COS) for in vitro fertilization (IVF) is time-consuming and expensive, typically requiring multiple clinic visits for laboratory and ultrasound monitoring. The COVID-19 pandemic has deeply impacted healthcare, as it became imperative for healthcare providers to reduce non-emergent medical visits to minimize the spread of disease. At the onset of the COVID-19 pandemic, a modified monitoring protocol was developed at our institution to reduce potential patient exposure and risk while undergoing COS. This modified protocol eliminated ultrasound and estradiol on stimulation day six in addition to potentially the days leading up to or on the day of trigger. In this protocol, a “blind” trigger shot was administered when at least two follicles were projected to measure 18 mm, presuming follicular growth of approximately 1-2 mm per day. Modified monitoring effectively eliminated an additional 2-4 office visits per cycle. Prior research has suggested that decreased monitoring does not compromise cycle success in terms of mature oocytes retrieved or clinical pregnancy, but data is limited.1,2 A more recent Cochrane review found no difference in clinical pregnancy or OHSS rates in COS cycles utilizing ultrasound alone versus ultrasound and serum estradiol levels.3 This study seeks to add to the limited evidence on modified monitoring COS protocols with utilization of a blind trigger and the impact on assisted reproductive technology (ART) outcomes.