I’m thrilled to introduce you to a groundbreaking innovation in fertility care: needle-free IVF. My guest is Dr. Rachel Mandelbaum, a fertility doctor, researcher, and patient advocate who is leading the charge to make IVF more accessible and less intimidating for everyone, especially those who are needle-phobic. Dr. Mandelbaum shares her personal journey, the inspiration behind her work, and how her innovations are changing the landscape of fertility treatment.
In our conversation, we dive deep into the themes of patient empowerment, challenging outdated norms in reproductive medicine, and the importance of offering more compassionate, personalized care. We discuss the science behind needle-free IVF, the impact of patient-centered innovation, and how small changes can make a big difference in the IVF experience. This episode is all about rethinking what’s possible in fertility care and advocating for what patients truly deserve.
In this episode, we cover:
- The inspiration behind needle-free IVF and Dr. Mandelbaum’s personal journey as a patient and physician
- How needle-free IVF works and the technology adapted from diabetes care
- The results of clinical trials comparing needle-free IVF to traditional methods
- Addressing patient fears and anxieties around self-injection and how new options can improve access to care
- The importance of challenging the “just tough it out” mentality in women’s health
- Innovations in progesterone administration and reducing the need for painful injections
- The future of IVF: personalized approaches, patient advocacy, and ongoing research
Resources:
- Dr. Rachel Mandelbaum on Instagram: @rachel.mandelbaum.md
- HRC Fertility: https://www.havingbabies.com/
- The Egg Whisperer Show on YouTube: https://www.youtube.com/@eggwhisperershow
- Subscribe to The Egg Whisperer Show on Spotify
- Get The “Egg Whisperer Fertility Pants“
If you enjoyed this episode, be sure to subscribe and follow along for more conversations about fertility science, patient support, and taking charge of your reproductive health!
Full Transcript:
Dr. Aimee: What if you could do IVF without all the injections? The title of today’s episode is Needle-Free IVF, a new era in fertility care with Dr. Rachel Mandelbaum.
Today, we’re diving into one of the most exciting innovations in fertility care, needle-free IVF. Joining me is Dr. Rachel Mandelbaum, a fertility doctor, researcher, and patient advocate who is leading the charge to make IVF more tolerable and accessible for everyone. As a self-proclaimed needlephobe, Rachel created an approach to IVF that uses a subcutaneous catheter and progesterone lozenges instead of daily injections. My mind is blown. Guess what? It works just as well.
Dr. Mandelbaum is also working to change the narrative around IVF, challenging outdated ideas normalizing pain and difficulty for women in healthcare. That whole just grin and bear it, tough it out? No longer. Let’s get into how she’s changing the game, both in the lab and in the larger conversation about what patients truly deserve. Welcome, Rachel. Thank you for joining me today.
Dr. Rachel Mandelbaum: Thank you so much for having me, and thanks for that kind introduction.
Dr. Aimee: I understand from following you on Instagram that you’re a self-described needlephobe, and it was your own experience doing IVF that inspired you and inspired the innovation of needle-free IVF. I want to have you tell us about your journey and how it led you to create needle-free IVF.
Dr. Rachel Mandelbaum: There’s nothing to snap you out of being a needlephobe like eventually going through pregnancy. Maybe now I’m a little less of a needlephobe than I was back then, but when I approached the IVF process, I was an OBGYN resident. My husband and I are both physicians, so creating our family was anything but simple. At that time, we started this journey and we were approaching a long distance for fellowship, and I found out that I had really low ovarian reserve. We knew we wanted a big family. Even though I tell people time after time that AMH has nothing to do with your fertility, I found myself in that position that I see all of my patients who have a low AMH, freaking out. So, we turned to IVF.
I wasn’t yet in the fertility world, I was training on labor and delivery. At that same time, I got an outsider perspective on IVF, which I actually think was really valuable to be able to approach this as a patient before I was actually on the physician side of things. I set out on this process, they go through all of the instructions of mixing your Menopur and your Follistim, and I’m watching this thinking, “How am I going to do this to myself? Let alone, how do people who are not physicians and not in the medical world do this?” I think it was that a-ha moment that oh my god, we have to do something to address this. That drove me to create this. It all happened fortuitously because we know that AMH does not predict your fertility. I ended up getting pregnant with my first son, trying to freeze embryos at the beginning of this process, and then it gave me some time to think about this process and develop it, and then to be able to do it on myself later.
Dr. Aimee: Wow. What a story. That’s a great story. How does it work? Walk us through the process from meds to the catheter.
Dr. Rachel Mandelbaum: The way that it works is, we’re borrowing technology here that has already been created for the diabetes world. The diabetes world is steps ahead of us because insulin, just like the hormones that we are giving for IVF, is not orally active. Diabetics have dealt with this injection problem for a long time, and they found the technology for an insulin pump. This is similar technology, but it just hasn’t been done in IVF before.
What this does – and I brought one to show – we use a small little catheter that looks like this. It’s a small little device. Some people will liken it to a port. Basically, we insert it on your abdomen. We use a little insertion device that looks like this, so it’s an auto-inserter. If you’ve watched someone put on a glucose monitor, it’s very similar. It’s a little button and in a millisecond it deploys this catheter under the skin. You wear this device throughout the duration of your cycle and all of the medications go through this. You basically pull out this cap piece, attach a tubing, and all of the medications can go through it.
The medications are otherwise the same. We’re just taking out the thirty-ish needle pokes that an IVF cycle or egg freezing cycle entails.
Dr. Aimee: I’m sure there are skeptics out there.
Dr. Rachel Mandelbaum: Many.
Dr. Aimee: You’ve done a study on it. What did you find as far as how effective needle-free IVF is and how it compares to regular pincushion IVF, what do the numbers show in terms of egg yield, hormone levels, and pregnancy rates?
Dr. Rachel Mandelbaum: Yes. Of course, you’re right, there’s a lot of skeptics out there. I don’t take this lightly. Right? Anything that we are studying when it comes to IVF, it’s such a high stakes environment. This is why I did it on myself before I launched the study. I did needle-free IVF in my own stimulation. If anybody had a risk for doing poorly, it was me with a horrible AMH level. My cycle went great. I monitored my FSH level.
For the listener, IVF is actually kind of a unique environment to study something like a subcutaneous catheter because it’s different from diabetes as a model for studying. When you look at diabetes, we’re giving insulin, and then the thing to measure is not insulin itself, but you’re measuring how glucose responds to insulin. We have a wealth of data looking at subcutaneous infusion systems, or subcutaneous catheters like this, or a pump, with how it works well for insulin. Now, IVF is actually an even better model to study because when we do IVF, we’re shutting down the brain or the pituitary’s production of follicle stimulating hormone, FSH. Everything, or the vast majority of that hormone in the bloodstream is what we’ve given through an injection or this device. It’s a really beautiful model to study because you can compare somebody who is using this catheter and say “what are their levels of FSH?” and compare it directly to somebody who is doing an injection, and make sure that the same amount of hormone is reaching the bloodstream and therefore the ovaries.
So, I did it on myself first. I measured all of my own hormone levels. I found that they were exactly what I expected and rock solid throughout my IVF cycle. Then we launched a clinical trial. I took patients who used needle-free IVF and compared them to patients who were doing needle injections, and we followed their FSH levels. We found that there were no differences in their FSH levels, and therefore no differences in how much hormone or medication was actually reaching their bloodstream and their ovaries.
Dr. Aimee: Wow. That is so cool. That is pretty amazing. I am predicting that patients who use it are very complimentary, very thankful, and show you so much gratitude, especially patients who have done IVF the traditional needle way. Going the needle-free way, I imagine it’s a big difference. What do the patients say? I mean, I haven’t had a patient do it yet. What do they say about the experience?
Dr. Rachel Mandelbaum: In our trial, we had a couple of patients who had previously done cycles with injections. Granted, there is a selection bias here. Right? This is people who didn’t like the injections, who are looking for an alternative approach. But all of them preferred using this device as opposed to needle injections.
In my own practice, 70% of my patients use it. I use it all day long, every day. Patients love it. It’s not for everybody. I think my big mission is just to create more options for people. I don’t want the injections to ever be a barrier for someone when they need fertility technology.
This is unpublished data, but after I developed needle-free IVF, we did a survey study where we just planted a survey in our waiting room. We had all comers, so people who were considering doing IVF, people who were not doing IVF, but everybody coming to the fertility clinic, what are their fears going into this process. Sixty percent of people coming in our door had significant fear and anxiety surrounding self-injection. Of those people, there were a significant percentage that had actually delayed coming into our clinic because of that fear. That is reason in and of itself. This won’t be for everybody. There are some people who don’t have a problem with needles, and that’s fantastic, they don’t need this, they can just inject themselves. But there are definitely people out there, and a significant number, where this really either makes IVF and fertility technology, egg freezing, whatever they need, accessible, or at least makes it more comfortable.
Dr. Aimee: Brilliant. I imagine it causes less fights. I have patients texting me, “My husband did this, the way he put the needle on, I don’t like it. I think there’s an air bubble in it.” I imagine that if you did a survey on how often you fight with your partner over your injections, I think there’s probably going to be less fighting during needle-free IVF.
Okay. I have to ask you this. I kind of know the answer. This is good for subcutaneous shots, but I have to tell you, the PIO, which is a pain in the ass, literally, are you working on a way to solve that?
Dr. Rachel Mandelbaum: Yes.
Dr. Aimee: Oh? Tell us.
Dr. Rachel Mandelbaum: Somehow, these two missions have aligned here. Yes. I also just published another study. Now, this isn’t a clinical trial like needle-free IVF. This is retrospective data, but using sublingual progesterone. We’ve had great success with sublingual progesterone.
I think this conversation requires a little bit of history here. We used to give vaginal progesterone for most people who were doing medicated embryo transfer cycles. I think over the past, let’s say, decade, things have shifted so that we’ve been using these gnarly PIO shots, progesterone in oil shots. There has been some data that suggests improved outcomes using the progesterone in oil. The question is systemic progesterone just the important part here, maybe it doesn’t need to be intramuscular, maybe we can just get it into the bloodstream in some other way than just vaginal. Sublingual is actually a route of medication administration which we’ve underutilized. Because it has direct access to the bloodstream, as opposed to when you swallow something and it goes through the stomach, through the digestive system.
We did a study comparing people who were doing euploid embryo transfers, and comparing those who used sublingual plus vaginal progesterone to those who were doing intramuscular progesterone plus vaginal. We found no differences in any pregnancy outcomes. This is the other way we can address those PIO shots and just, again, another option for people. There are people who will not like the sublingual and there are people who will prefer the PIO, but I really think this all just comes back to more options.
Dr. Aimee: Yes. I imagine there are going to be fertility doctors calling you, like I did, saying, “How can I get my hands on needle-free IVF?” Can you tell us about how I can get my hands on this, how can my patients, how can people listening here utilize this for their next IVF cycle?
Dr. Rachel Mandelbaum: There are a variety of products out there that are similar. The bottleneck here is getting the devices. I’m working on it to try to make this more widely accessible. There are certainly some hurdles here, but it’s something that I’m working on. I would love this to be available for everybody. I get messages all the time from patients who want it. Because there are skeptics here, as you said. There are people who are like, “Why do you even need this? Why? They’re not that bad,” and all of this noise here. I wish I could just show them my inbox.
Dr. Aimee: Right? Same.
Dr. Rachel Mandelbaum: That’s the proof in the pudding that people want this. People find enough of an issue with the injections that it’s worth it to give people another option, another alternative. Anyway, I’m working on it, TBD. Hopefully, we’ll get there soon so that it’s widely available.
Dr. Aimee: Awesome. Stay tuned, follow Dr. Mandelbaum, and I’m sure you’ll announce when we can all get needle-free IVF in our clinics.
Dr. Rachel Mandelbaum: Yes.
Dr. Aimee: Okay. And you’re right, there have been some critical comments on Instagram about this tech, which you’ve noticed, falling into two harmful narratives. One is that women should “man up and just deal with the pain” and that doing IVF the hard way is a rite of passage because that’s how others did it. I think that’s silly. What do you think is going on with these types of comments, why do we think that’s okay?
Dr. Rachel Mandelbaum: I think it’s exactly like you said. I think that this has been – look, the upside of IVF, the reward at the end is so great, the possibility of walking away from this process with a baby and your family and everything you’ve hoped and dreamed of. I always say women are so strong. If you tell me I need to walk over hot coals to get to my goals of a family at the end, I will do it. I’ll have the scars at the end of it, but I’ll do it. I’m very confident that all of my patients can do it.
But the whole point is that I feel like we need to reevaluate this process. Just because others have gone through the pain and discomfort, it doesn’t mean that we shouldn’t be critically evaluating this process and saying would this improve someone’s experience of IVF. Even if it’s 10% of people that would find some solace in not doing injections, not doing as many blood draws, vaginal ultrasounds, whatever it may be, it’s worth having it as an option. I think things in medicine are starting to shift as patients are advocating for themselves and speaking up. They’re saying, “Do you think it would be an option if I did this,” or, “I’m having this discomfort. How can we address it?” I think that conversation is starting, but I think we’re really behind in getting there compared to where we should be now in being able to cater to patients that have different fears, anxieties, all of that.
Dr. Aimee: Yes. Anytime I have a guy that complains about his blood draw, because sometimes that happens, the infectious test is just a blood draw.
Dr. Rachel Mandelbaum: You can see the difference, the inequity here. Semen analysis has been a big issue for men for a long time. Right? They complain about coming in and having to produce in the office and how artificial that feels and they don’t like it. We already have options to collect at home. That’s already a market. Yet we don’t have as many options to make this process more comfortable for the female. I take issue with that. Those voices are louder than our voices.
Dr. Aimee: What’s your vision for the future of IVF, especially when it comes to making the experience easier, more inclusive, and more compassionate?
Dr. Rachel Mandelbaum: I believe in a personalized approach to IVF. I think this is not a one-size-fits-all. I think that we need to treat people as a whole person and an individual. What are their family goals? Really tailoring this to the individual, I think that’s my hope. I hope that other parts of it may change. I’m really excited about IVM, in vitro maturation. Maybe we don’t have to be stimulating people to the extent that we do. Maybe in vitro gametogenesis will provide an alternative for the future. But for right now, I think we’re getting the best outcomes with what we’re doing, so all we can do is chip away at the low-hanging fruit and the things that we hear patients saying. It really just takes listening to them and saying, “How can I critically evaluate what I’m doing and change it?”
Dr. Aimee: Right. I came out with The Egg Whisperer pants. I don’t know if you’ve seen them.
Dr. Rachel Mandelbaum: I have.
Dr. Aimee: It’s so funny. I get all these trolls that are like, “She’s just trying to make money off of IVF patients.” I’m like, I’m not, I actually give them for free to my patients. It’s just so they don’t have to sit there waiting with their pants off. When you’re doing a transfer and you have a room full of people, embryologists you’ve never met, you’re more comfortable.
Dr. Rachel Mandelbaum: Totally.
Dr. Aimee: Then the trolls are like, “I can’t believe it. Why can’t you just sit there with your pants off?” I’m like, oh please. Try doing that five times in two weeks. It gets pretty darn old.
What do you want people just starting out on the journey of IVF to know, especially if they’re needlephobes like yourself?
Dr. Rachel Mandelbaum: I think the first thing is that you’re not alone in this process. There’s all different ways to create your family, to meet success in this process. I remember one of my colleagues had a patient who just insisted on absolutely no injections whatsoever for egg freezing, and got to it with Clomid alone. There’s all different options. I think don’t let the process deter you. Find a doctor who is willing to listen to what you need, will work with you, who cares for you as an individual and your family goals. I think that’s my biggest thing.
Dr. Aimee: Yes. I’ve had patients who say no blood draws, and I can basically do everything off one of these home monitoring systems, I don’t have to do a single hormone test, no pelvic ultrasounds, all ultrasounds vaginally, and you can go through a cycle, just like you said, without a single injection or any of these things that you don’t want to do.
For doctors out there, for students that might be listening, medical students, you could be inspiring someone right now to make a change. What can you share to help those doctors and inspire them to make a change for their patients?
Dr. Rachel Mandelbaum: I think it just has a ripple effect. I think you find that, once you start asking the question, it’s almost like we just didn’t ask so people weren’t telling us. I think that is what I’ve been most surprised by, is just the outsider perspective, or even somebody who has never gone through IVF, but you’re explaining from a bird’s eye view what this process is like. Sometimes these ideas come from that. Like, “You’re doing what?” Getting these other perspectives and being open to it.
I guess if there is anybody out there, I’m really passionate about research. I think there is no better way to communicate findings, show people that there is an alternative approach that’s just as effective as publishing a study and doing the formal way to show a finding. I think it’s important that people publish what they’re doing so that everybody can see what’s out there and try to implement it in their own practice.
Dr. Aimee: I imagine people listening or watching us talk are going to say, “I need to see Dr. Mandelbaum.” Can you tell us where people can find you?
Dr. Rachel Mandelbaum: I’m at HRC Fertility in West LA and Beverly Hills, so in Los Angeles. Then I am active on Instagram, my handle is @Rachel.Mandelbaum.MD, and I’d love to connect with people there.
Dr. Aimee: Awesome. Thank you again for joining us today. I appreciate you taking the time out from your busy schedule to share so much of your wisdom and your patient-centered approach. Is there anything else you’d like to share today?
Dr. Rachel Mandelbaum: No. I’m just so grateful to be on the podcast. I’m a big fan and follower, and I really admire how much you push the envelope as well. I think it’s really fun to find a like-minded physician that’s open to trying new things. I think it’s really important. I’m honored to be here and I look forward to connecting more.
Dr. Aimee: Thank you. Dr. Mandelbaum, thank you for being here and for the work you’re doing to rethink what’s possible in fertility care. Your story and your research are helping people feel less afraid and more empowered in their journey.
If you loved today’s episode, be sure to subscribe to The Egg Whisperer Show on your favorite podcast app and follow along on YouTube for new episodes every week. We cover everything from fertility science to emotional support, always with a goal of helping you take charge of your reproductive health. Remember, just because something has always been done a certain way doesn’t mean it should stay that way. Thanks for listening. I’m Dr. Aimee. I’ll see you next time on The Egg Whisperer Show.
