How One Fertility Specialist Reimagined the IVF Injection Process

For many IVF patients, the daily injections are one of the hardest parts of treatment, not medically, but emotionally. Rachel Mandelbaum, M.D., a reproductive endocrinologist and infertility specialist at HRC Fertility in West Los Angeles and Beverly Hills, experienced that anxiety firsthand as a patient herself, and it planted the idea for what would eventually become Needle-Free IVF. Drawing on her work with patients with Type 1 diabetes using insulin pumps, Mandelbaum developed and tested a subcutaneous catheter system that delivers IVF medications without repeated needle pokes, then validated it in a clinical trial before launching it in her own practice.

In this interview, Mandelbaum explains how the device works, what patients can expect while wearing it, and why she believes reducing the physical and emotional toll of injections could help more patients stay in treatment until they achieve the outcome they're hoping for. She also addresses who the option is best suited for and what she wants patients considering IVF to know before asking about it.

What led you to develop Needle-Free IVF? Was there a specific moment or pattern with patients that made you realize the daily injections needed to change?

Rachel Mandelbaum, M.D.: When I was an IVF patient about to start my cycle, I remember feeling so intimidated and anxious about giving myself injections and thinking to myself, “Wow, I’m a doctor and I feel this way; imagine people who are not in the medical field.” Fast-forward, I ended up getting pregnant that week before starting IVF, which gave me time to ruminate on those thoughts and come up with a way to do IVF without the injections. I was working as an OB-GYN resident with Type 1 diabetics who were so happy once they got a pump, and it just clicked that we should do this for IVF. Fast-forward to after my first son [was born], I tried Needle-Free IVF on myself and figured out all the nuts and bolts, and it worked amazingly well and I felt so calm knowing I didn’t have to inject. Then I did a clinical trial to prove that using Needle-Free IVF and injecting were equivalent from a hormonal standpoint and had similar outcomes. And then I launched it in my practice, then my fertility group as a whole, and now [I’m] expanding even further.

Can you walk us through how the subcutaneous catheter works—how is it different from a typical daily injection, and how long does a patient wear it during treatment?

RM: Needle-Free IVF involves placing a small quarter-sized device on your abdomen through which you can administer all the medications without individual needle-pokes. It’s painless and very easy to use. Patients wear the device throughout the two weeks, all medications go through it, and you can shower and do all your daily activities with it on.

Beyond just removing the physical needles, how have you seen this approach affect patients emotionally? Does reducing that daily burden change how people experience the rest of the IVF process?

RM: I truly feel that my patients are less anxious. I have seen so many patients who delayed egg freezing or IVF due to fear of needles or how invasive and uncomfortable this process seemed. So, I think it is improving access to fertility care as well as making it more comfortable for patients. I also think that part of IVF success is being able to keep patients in treatment until they meet success, and our No. 1 reason that people do not continue is the emotional toll that this process takes. So, I think that by making this process more palatable, we can keep patients in treatment longer until they meet their goals of the family they want and improve success rates.

Does delivering medication this way affect dosing, timing or outcomes at all, or is the goal purely to change the experience while keeping the treatment protocol itself the same?

RM: Dosing and timing is exactly the same, no changes whatsoever. To be honest, I keep thinking about if we can come up with new ways of giving medications that could work even better, for example, giving medications multiple times a day, which could potentially work better than just every-24-hours dosing, [which is] a hurdle when we are asking patients to do more injections.

Is Needle-Free IVF an option for every patient, or are there certain candidates it’s best suited for? What would you want someone considering IVF to know if they’re interested in asking about it?

RM: Anyone can use Needle-Free IVF. I would say the only people who [should] avoid it is if they have an adhesive allergy, but otherwise I really believe it can be for anyone and everyone. I would want people to know that they don’t have to have a severe needle phobia to use it, just if they don’t feel like giving a lot of injections, it’s another option. And, I believe that that’s exactly what we need in women’s health — more options for whatever makes this process easier and better.