Tham, E., Schliep, K., & Stanford, J. B. (2012). Natural procreative technology for infertility and recurrent miscarriage: outcomes in a Canadian family practice. Canadian Family Physician Medecin De Famille Canadien, 58(5), e267-74.
Tham E, Schliep K, Stanford JB. Natural procreative technology for infertility and recurrent miscarriage: outcomes in a Canadian family practice. Can Fam Physician. 2012;58(5):e267-74.
Tham, Elizabeth, et al. "Natural procreative technology for infertility and recurrent miscarriage: outcomes in a Canadian family practice." Canadian Family Physician Medecin De Famille Canadien, vol. 58, no. 5, 2012, pp. e267-74.
An adjusted 66 per 100 NaProTechnology couples had a first live birth
This retrospective cohort study followed 108 couples with infertility or recurrent miscarriage at one Canadian family practice. An adjusted 66 per 100 couples had a first live birth within 24 months of NaProTechnology. Among all 108 couples who started, 38 per 100 had a live birth.
About 4 in 10 couples had a live birth after starting NaProTechnology care. Source: Tham E et al., 2012, PMID 22734170.Study at a glance, Retrospective cohort study of 108 couples: 38 per 100 couples had a live birth after starting NaProTechnology. Source: Tham E et al., 2012, PMID 22734170.
Key Findings
In this single-practice cohort, life-table analysis gave an adjusted cumulative proportion of first live births by 24 months of 66 per 100 couples. The crude proportion was 38%.
The adjusted cumulative proportion of first conceptions by 24 months was 73 per 100 couples. The crude proportion was 47%.
Among the 51 couples who conceived, 12 (24%) used CrMS instruction alone, 35 (69%) used CrMS plus NPT medical treatment, and 4 (8%) also had surgical treatment.
There were 41 live births and no multiple births. Of these, 22 (54%) arrived after at least 37 weeks' gestation, and 32 (78%) weighed 2500 g or more.
Unexplained infertility was recorded in 43 couples (40%) before NPT evaluation and in 1 couple (1%) after it.
Interpretation
This cohort study followed couples treated at one family practice in Canada. An earlier Irish NaProTechnology cohort had a crude live birth proportion of 25.5%, compared with 38.0% here; that cohort had tried longer to conceive (5.6 years versus 3.2) and more had prior assisted reproductive technology (33% versus 8%). The authors note the sample was too small for subgroup analysis and that couples who choose NaProTechnology may differ from other couples. The findings support larger studies of this approach.
RRM Context
NaProTechnology, developed by Dr. Thomas W. Hilgers, builds treatment on cycle charting and timed hormone tests, and evaluates both partners. Unexplained infertility fell from 40% to 1% after evaluation, which fits the RRM principle that unexplained means undiagnosed.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To study the outcomes of women with infertility or miscarriage treated with natural procreative technology (NaProTechnology or NPT), a systematic medical approach to promoting conception in vivo; and to compare the outcomes with those previously published from a general practice in Ireland.
Design
Retrospective cohort study.
Setting
An urban Canadian primary care practice in which the physician had a part-time practice in NPT.
Participants
Couples with infertility or recurrent miscarriage who received treatment in the practice between August 2000 and July 2006.
Intervention
All couples were taught to identify the fertile time of their menstrual cycles using the Creighton Model FertilityCare System (CrMS) and completed a standard NPT evaluation. Many also received additional medical treatment to enhance conception in vivo.
Main Outcome Measures
Live birth was the primary outcome; secondary outcomes included conceptions, multiple births, low birth weight, and prematurity.
Results
A total of 108 couples received NPT and were included in the analysis, of which 19 (18%) reported having 2 or more previously unexplained miscarriages. The average female age was 35.4 years. Couples had been attempting to conceive for a mean of 3.2 years. Twentytwo participants (20%) had previously given birth; 24 (22%) had previous intrauterine insemination; and 9 (8%) had previous assisted reproductive technology. The cumulative adjusted proportion of first live births for those completing up to 24 months of NPT treatment was 66 per 100 couples, and the crude proportion was 38%. The cumulative adjusted proportion of first conceptions was 73 per 100 couples, and the crude proportion was 47%. Of the 51 couples who conceived, 12 couples (24%) conceived with CrMS instruction alone, 35 (69%) conceived with CrMS and NPT medical treatment, and 4 (8%) conceived after additional surgical treatment. All births were singleton births; 54% were born at 37 weeks' gestation or later; and 78% had birth weights of 2500 g or greater.
Conclusion
Natural procreative technology in a family physician's office was effective in treating infertility and miscarriage with outcomes that were comparable to those in an NPT general practice in Ireland. Larger multicentre prospective studies to compare NPT directly to other forms of infertility treatment are warranted.
