Latest IVF protocols prove more user friendly. (Fewer Shots, side Effects).

RANCHO MIRAGE, CALIF. - In vitro fertilization is getting a bit easier on patients than it used to be.

Success rates are high enough now that convenience is drawing more attention. "There's a big push to make in vitro fertilization (IVF) more patient friendly," Dr. Paul Kaplan said at the annual meeting of the Pacific Coast Reproductive Society.

Ovulation induction became easier with the introduction of recombinant gonadotropins, which can be administered subcutaneously to trigger controlled ovarian hyperstimulation before intrauterine insemination. In contrast, urinary gonadotropins used for induction have historically been administered intramuscularly, requiring a second person to help give the shot in the buttocks. Subcutaneous injections can be self-administered in other parts of the body and cause less pain. Still, recombinant gonadotropins cost more than urinary gonadotropins.

Dr. Kaplan of Oregon Health Sciences University Portland, and his associates recently showed that urinary HMG could be given successfully by subcutaneous injection, and they now use this method routinely. In a study of 35 patients who completed 41 cycles of infertility treatment, there were similar success rates in patients randomized to receive HCG by subcutaneous or intramuscular injection, he reported in a poster presentation at the meeting.

Subcutaneous administration of urinary HCG should lower costs relative to recombinant gonadotropins and improve the convenience of ovarian stimulation for intrauterine insemination, he said.

Another advance involves GnRH antagonists for controlled ovarian hyperstimulation for IVF. Many of the presentations at the meeting focused on ways of tweaking IVF protocols using GnRH antagonists instead of GnRH agonists so that patients would need fewer injections and experience fewer side effects.