A Shot in the Arm for In Vitro Fertilization

New technique employs needle-free 'injections'

WEDNESDAY, July 3, 2002 (HealthDayNews) -- A group of European doctors has used needle-free "injections" to achieve in vitro fertilization.

The announcement was made today at a meeting of the European Society of Human Reproduction and Embryology in Vienna, Austria.

"It worked. We got a 25 percent pregnancy rate, and it's much less invasive than conventional methods," says Dr. Stuart Lavery, lead author of the study and a subspecialty fellow in reproductive medicine and surgery at Hammersmith Hospital in London.

"The patients had all been through previous cycles with a conventional needle and they think this is better. There's a clear patient preference," he adds.

A 25 percent pregnancy rate is equivalent to those achieved with conventional in vitro fertilization (IVF) techniques.

Dr. Susan Lobel, director of the IVF program at Maimonides Medical Center in Brooklyn, N.Y., says that although the treatment is not new, "if this proves to be efficacious, it will make going through the cycle so much easier."

The device, called a J-Tip, was originally developed to administer local anesthesia to children and may have a host of other applications, including vaccinations, Lavery says. This is the first application in reproductive medicine.

Current in vitro techniques involve stimulating the ovaries with hormone injections to produce extra eggs. The eggs are retrieved, fertilized outside of the body and the embryos reintroduced into the mother's uterus.

The hormones are administered via injection, typically every day for a month, but sometimes as often as two or three times a day, Lobel says.

"Administering the hormones by injection, which is what we've had up to now, is problematic because patients don't like to take injections," Lobel explains. Even though most of the medications available can now be administered beneath the skin rather than intramuscularly, this still involves using a needle.

The European researchers tested the J-Tip on 20 patients between the ages of 20 and 38 years who were undergoing IVF treatment. Four patients dropped out of the study, and four of the remaining women became pregnant.

The single-use device, which looks like a pen, is loaded with the exact dose of the hormone and placed on the abdomen. A compressed carbon dioxide gas cartridge forces the hormone, under high pressure, through the gaps between the cells of the skin.

"There are no bruises because it doesn't break the skin, though you get an area of slight reddening that lasts about an hour," Lavery says.

The procedure is not completely painless, Lavery says, who has given it to himself about 35 times, using water instead of medication. "It's like a little pinch," he says. The sensation becomes more comfortable with each subsequent "injection."

The device is not yet commercially approved, though Lavery says a company is currently putting together a package that would include pricing. The J-Tip would have to receive U.S. Food and Drug Administration approval before it could be marketed in the United States.

Lavery also thinks there could be a couple of improvements made to the device.

During the study, there were several "wet injections," when the J-Tip didn't penetrate the skin completely and some of the hormone was spilled. In vitro fertilization requires exact dosing to be effective.

"We think it needs to be modified to cut down on the number of wet injections," Lavery says. "The company is looking at putting a guard around the edge."

Larger trials are needed before the J-Tip becomes a regular part of IVF, Lavery adds.

What To Do

For more information on assisted reproductive technology, visit the American Society for Reproductive Medicine or The InterNational Council on Infertility Information Dissemination.

SOURCES: Stuart Lavery, M.D., subspecialty fellow, reproductive medicine and surgery, Hammersmith Hospital, London; Susan Lobel, M.D., director, IVF program, Maimonides Medical Center, Brooklyn, N.Y; July 3, 2002, meeting, European Society of Human Reproduction and Embryology, Vienna, Austria
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