Noninvasive testing and continuous monitoring of ultralow-concentration
hormones in biofluids have attracted increasing interest for health
management and personalized medicine, in which saliva could fulfill
the demand. Steroid sex hormones such as progesterone (P4) and β-estradiol
(E2) are crucial for female wellness and reproduction; however, their
concentrations in saliva can vary down to sub-pM and constantly fluctuate
over several orders of magnitude. This remains a major obstacle toward
user-friendly and reliable monitoring at home with low-cost flexible
biosensors. Herein we introduce a 3D micropyramidal electrode architecture
to address such challenges and achieve an ultrasensitive flexible
electrochemical immunosensor with sub-fM-level detection capability
of salivary sex hormones within a few minutes. This is enabled by
micropyramidal electrode arrays consisting of a poly(3,4-ethylenedioxythiophene):poly(4-styrenesulfonate)
(PEDOT:PSS) thin film as the coating layer and electrochemically decorated
gold nanoparticles (AuNPs) to improve the antibody immobilization.
The enhanced mass transport around the 3D tips provided by the micropyramidal
architecture is discovered to improve the detection limit by 3 orders
of magnitude, pushing it to as low as ∼100 aM for P4 and ∼20
aM for E2, along with a wide linear range up to μM. Accordingly,
these hormones down to sub-fM in >1000-fold-diluted saliva samples
can be accurately measured by the printed soft immunosensors, thus
allowing at-home testing through simple saliva dilution to minimize
the interfering substances instead of centrifugation. Finally, monitoring
of the female ovarian hormone cycle of both P4 and E2 is successfully
demonstrated based on the centrifuge-free saliva testing during a
period of 4 weeks. This ultrasensitive and soft 3D microarchitected
electrode design is believed to provide a universal platform for a
diverse variety of applications spanning from accurate clinical diagnostics
and counselling and in vivo detection of bioactive
species to environmental and food quality tracing.