Stanford, J. B., Parnell, T. A., & Boyle, P. C. (2008). Outcomes from treatment of infertility with natural procreative technology in an Irish general practice. Journal of the American Board of Family Medicine : JABFM, 21(5), 375-384. https://doi.org/10.3122/jabfm.2008.05.070239
Stanford JB, Parnell TA, Boyle PC. Outcomes from treatment of infertility with natural procreative technology in an Irish general practice. J Am Board Fam Med. 2008;21(5):375-384. doi:10.3122/jabfm.2008.05.070239
Stanford, Joseph B., et al. "Outcomes from treatment of infertility with natural procreative technology in an Irish general practice." Journal of the American Board of Family Medicine : JABFM, vol. 21, no. 5, 2008, pp. 375-384.
NaProTechnology couples had 52.8 first live births per 100 by month 24
Among 1,072 Irish couples treated for infertility, 52.8 out of 100 had a first live birth by 24 months by life-table estimate. After evaluation, unexplained infertility as a diagnosis fell from 47 to under 1 out of 100 couples.
About 5 in 10 couples had a first live birth by 24 months of NaProTechnology care. Source: Stanford JB et al., 2008, PMID 18772291.Study at a glance, cohort of 1,072 Irish couples: 52.8 out of 100 couples had a first live birth by 24 months. Source: Stanford JB et al., 2008, PMID 18772291.
Key Findings
Among 1,072 couples who began treatment, the life-table cumulative proportion with a first live birth was 27.1 per 100 couples at 12 months and 52.8 at 24 months.
The crude proportion of first live births, counting every couple who began treatment, was 19.1 per 100 couples at 12 months and 25.5 at 24 months.
Crude 24-month live births per 100 couples were 33.7 for women 30 or younger and 13.9 over 40, and 30.8 with no previous ART attempts and 10.3 with three or more.
Unexplained infertility was the diagnosis for 506 couples (47.2%) before NaProTechnology evaluation and for 5 couples (0.5%) after it.
The cohort recorded 13 twin births, no higher order births and no ovarian hyperstimulation syndrome, and 54 women (5%) conceived with no medical treatment, using only fertility charting and timed intercourse.
Interpretation
The study followed a cohort of 1,072 couples who had tried to conceive for at least a year, with outcomes tracked through February 1, 2008. The couple is the unit of analysis because NaProTechnology treatment spans many cycles. Each time point has a crude proportion, which counts every couple who began treatment, and a life-table proportion, which adjusts for couples who withdrew or were still in treatment when follow-up ended. The authors note that over half of couples withdrew before 24 months. They conclude that trained general practitioners achieved live birth rates comparable to ART cohort studies, and they call for large multicenter prospective studies.
RRM Context
NaProTechnology looks for the reason conception is not happening before it treats. Couples chart their fertile days with the Creighton Model FertilityCare System. Unexplained infertility is undiagnosed infertility, and IVF goes around the question of why conception fails while NaProTechnology builds treatment on the answer.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objectives
We evaluated outcomes in couples treated for infertility with natural procreative technology (NaProTechnology [corrected] NPT), a systematic medical approach for optimizing physiologic conditions for conception in vivo, from an Irish general practice.
Methods
All couples receiving treatment from 2 NPT-trained family physicians between February 1998 and January 2002 were studied. The main outcome was live birth, and secondary outcomes included conceptions and multiple births. Crude proportions and adjusted life-table proportions were calculated per 100 couples.
Results
A total of 1239 couples had an initial consult for NPT, of which 1072 had been trying for at least a year to conceive and initiated treatment. The average female age was 35.8 years, the mean duration of attempting to conceive was 5.6 years, 24% had a prior birth, and 33% had previously attempted treatment with assisted reproductive technology (ART). All couples were taught to identify the fertile days of the menstrual cycle with the Creighton Model FertilityCare System, and most received additional medical treatment, including clomiphene (75%). In life-table analysis, the cumulative proportion of first live births for those completing up to 24 months of NPT treatment was 52.8 per 100 couples. The crude proportion was 25.5. Younger couples and couples without previous ART attempts had higher rates of live birth. Among live births, there were 4.6% twin births.
Conclusion
NPT provided by trained general practitioners had live birth rates comparable to cohort studies of more invasive treatments, including ART. Further studies are warranted to compare NPT directly to other treatments.
