INJECTION-FREE CONTROLLED OVARIAN STIMULATION: FEASIBILITY OF A SUBCUTANEOUS CATHETER IN PATIENTS UNDERGOING CONTROLLED OVARIAN STIMULATION FOR IN-VITRO FERTILIZATION OR OOCYTE CRYOPRESERVATION

Self-injections for controlled ovarian stimulation (COS) often compound the physical and emotional stresses of assisted reproduction. Subcutaneous catheters have demonstrated success in diabetic and rheumatologic populations for subcutaneous medication administration but have not previously been applied to COS. The objective of this study was to assess the feasibility and acceptability of a subcutaneous catheter for COS. This is a pilot study of 10 patients undergoing COS, both first and repeat cycles, using the Neria Guard subcutaneous infusion set, manufactured by Convatec. A pre-cycle survey was administered using validated screening questions from the Multidimensional Fear-of-Injection Scale and the Injection Phobia Scale-Anxiety. Catheters were placed at cycle start, and patients were taught to use and administer medications via the catheter. All medications for COS were administered via the catheter. Catheters were assessed at each visit and replaced as needed, with a maximum of 7 days in-situ. FSH, estradiol levels, and follicular growth were measured at each visit. A post-cycle survey was administered the day following retrieval to gauge patient satisfaction. Pre-cycle, 50% of patients had moderate to severe fear of needle injections on both scales; 30% of these patients admitted that their anxiety delayed pursuing treatment. Of 3 patients for whom this was not their first cycle, injections were previously very (n=2) or slightly (n=1) bothersome. Patients used an average of 2.5 (SD 0.71) catheters per cycle. FSH values were highly correlated with recombinant FSH dose (r=0.992, P=0.008). Mean FSH values over the cycle were 38.9 ± 6.1, 33.1 ± 3.8, 21.9 ± 2.1, and 15.2 ± 3.1 for 450, 375, 300, and 225 IU doses, respectively. 30% of patients had mild local catheter-related symptoms, including bruising (n=1), skin allergy to adhesive (n=1), and erythema (n=3). There were no cases of catheter malfunction/ leakage, infection, hematoma, or lipohypertrophy. There were no unscheduled catheter replacements. No patients required a needle injection secondary to catheter failure. All patients were very satisfied (90%) or satisfied (10%) with the catheter. 100% stated that the catheter eased their fear of needles and anxiety during treatment, it was easy to use, and they would recommend it to a friend. No patient reported that the catheter impeded any daily activities. In patients for whom this was a repeat cycle, 100% stated that they preferred the catheter to traditional needle injections. A subcutaneous catheter is a feasible alternative to traditional needle injections for controlled ovarian stimulation. It is well-tolerated, effective, easy for patients to use, and improved patient satisfaction.