Extract from "The Medical and Surgical Practice of NaProTechnology"

Dr. PHIL C. BOYLE, Family Physician, Galway, Ireland.

INTRODUCTION

Infertility is a significant problem for many couples in the developed world today. Up to 1 in 5 couples experience difficulty conceiving in the United States¹. In Europe 1 in 6 couples have difficulty conceiving². Current infertility protocols usually advise blood tests on day 3 to 7 of the menstrual cycle to assess gonadotrophin and prolactin levels, thyroid function, hemoglobin, rubella status and testosterone levels – if clinically indicated. In addition bloods tests are usually taken on day 21 or 22 of the cycle to measure progesterone levels in the probable mid-luteal phase of the menstrual cycle. Most specialists would agree that ovulation is probably occurring if progesterone levels exceed 30 nmol/l (9.5 ng/dl). After a seminal fluid analysis, post-coital test, ultrasound examination, laparoscopy and dye test and possibly a six to nine month trial of clomid those couples who have not conceived face the prospect of Artificial Reproductive Technology (ART) if they wish to continue fertility treatment. Occasionally ovulation induction with FSH (with or without intrauterine insemination) may be given for a further 3 to 6 cycles before embarking upon In Vitro Fertilization (IVF) or Intra-cytoplasmic Sperm Injection (ICSI), which we refer to as ART throughout this chapter.

NaProTechnology (NPT) is a new, safe and effective means of treating infertility that can avoid the perceived need for ART in many cases. NaProTechnology is a couple-centered, disease-based approach to investigate, diagnose and treat infertility. The term “Natural” refers to the method of conception through a natural act of intercourse as opposed to any artificial intervention which replaces intercourse.  Clinical experience and retrospective studies³ show great promise, however further prospective studies are needed to determine present day success rates and convince the greater medical community of the value of NPT fertility treatment.

Ideally couples should learn how to track the signs of fertility and understand their fertility potential, even before attempting conception. Couples who use Creighton Model FertilityCare™ System⁴ (CrMFCS) for family planning have a distinct advantage over non-users.  They can tell, even before they try to conceive, if they may be at risk of miscarriage or infertility based on their CrMFCS charting pattern. This is very useful information to help them make an informed decision about managing their fertility in a way which is appropriate to them. If couples experience infertility or miscarriage NPT should be their first choice to identify and treat whatever abnormalities may be found.

But what about couples who were unaware of the NPT approach and have tried all of the medical treatments available to them, including artificial reproductive technologies (ART) without success? Is it worth trying NPT at this point or are they simply wasting their time?

Experience from a Family Practice in Galway, Ireland has shown that 20% to 30% of couples with previously unsuccessful ART will have a successful pregnancy with NPT. This chapter will look at that select group of patients who have succeeded with NPT after failed ART.

BACKGROUND

NPT has been available to Irish patients since 2^nd Feb 1998. It was not known at that time how effective this treatment would be for infertile couples who had otherwise finished with fertility treatment. Patients were told that because NPT was a new approach we could not predict what the probability of success would be.

This Chapter will focus on the number of couples who have conceived with NPT, despite previously failed ART. We will look at 6 years of clinical practice in a Family Physician’s office from the beginning of Feb. 1998 until Feb. 2004. The percentage success rate is only available for the first 4 years of practice and will be presented in a Life Table Analysis.

It is important to bear in mind that the effectiveness of NPT improved over time as the physicians offering treatment gained greater experience and it is likely to be even more effective than present results would indicate. Also, a key factor in giving couples the best chance of success is for them to complete 12 effective cycles of treatment which can take from 18 to 24 months after beginning the program. Unfortunately many couples gave up prior to reaching this desired end point, largely because the goals of treatment were not clearly outlined by their physicians from the outset.

STUDY GROUP

All patients with previously unsuccessful ART who conceived with NPT treatment through a Family Physician’s practice in Galway, Ireland were included in this study, between 2^nd Feb 1998 and 1^st Feb 2004. 4 patients were excluded from the study because 2 were already pregnant at the initial medical consultation and a further 2 previously had a successful pregnancy with IVF prior to conceiving with NPT.

95 Patients conceived 123 times. The average female age per conception was 36.8 years, with a range from 28 to 47 years. The couples had been trying to conceive for an average of 6.1 years and had 176 failed attempts at ART, with 175 unsuccessful embryo Transfers. There was an average of 2 unsuccessful attempts at ART per couple. (See Table 1.)

TABLE 1.  Profile of ENTIRE GROUP - 95 Couples

RESULTS WITH NPT TREATMENT

There were 123 conceptions from 95 couples, resulting in 89 successful pregnancies from 74 of the couples. Fourteen out of the 74 couples had a second successful pregnancy and one had a third success with NPT. 21 of those who did conceive had a miscarriage (16) or ectopic pregnancy (4) as the final outcome. (Table 2.)

There were 3 twin pregnancies, giving a rate of 3.4% per live birth or 2.4% per conception.

TABLE 2.

A Life Table analysis shows the success rate of treatment from the first four years of practice. The figures for 6 years have not yet been calculated.

 This table shows the adjusted proportion achieving pregnancy is 26.2% at 12 to 17 months, rising to 32.6% for 18 to 25 months in the programme.

FOR COMPLETE CHAPTER WITH REFERENCES CLICK HERE

Compare with European Society for Human Reproduction and Embryology 2004 REPORT HERE (note deliveries per IVF cycle started in Ireland Table VI = 18.4%, But the clinical pregnancies are confusingly reported as 30.4% It can be very difficult for the public to understand true success rates with this kind of reporting!)

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