Restorative reproductive medicine for infertility in two family medicine clinics  in New England, an observational study

Joseph B Stanford; Paul A Carpentier; Barbara L Meier; Mark Rollo; Benjamin Tingey

doi:10.1186/s12884-021-03946-8

Restorative Reproductive Medicine · NaProTechnology

Restorative reproductive medicine for infertility in two family medicine clinics in New England, an observational study

Stanford JB, Carpentier PA, Meier BL, Rollo M, Tingey B

Published July 7, 2021 BMC Pregnancy and Childbirth, 21(1), 495

DOI 10.1186/s12884-021-03946-8 PMID 34233646 PMC PMC8265110

RRM Academy Synopsis

Unexplained infertility fell from 23% to 1% after RRM evaluation

Among 370 infertile couples in a retrospective cohort, unexplained infertility was recorded for 23% before and 1% after evaluation by family physicians trained in NaProTechnology. Adjusted for couples who left treatment, 29% had a live birth within 2 years.

About 3 in 10 couples had a live birth within 2 years of care from NaProTechnology-trained physicians. Source: Stanford JB et al., 2021, PMID 34233646.

Study at a glance, retrospective cohort of 370 couples: Unexplained infertility fell from 23% to 1% after evaluation. Source: Stanford JB et al., 2021, PMID 34233646.

Key Findings

Adjusted for couples who left treatment (Kaplan-Meier analysis), 39% conceived and 29% had a live birth within 2 years; the unadjusted shares were 31% (116 couples) and 18% (66 couples).
Unexplained infertility was recorded for 86 couples (23%) before evaluation and 2 couples (1%) afterward. Endometriosis was recorded for 74% and male factor for 30% afterward.
Couples tracked cycles with the Creighton Model FertilityCare System (80%). Medications aimed to enhance cervical mucus production (81%), stimulate ovulation (62%) or support the luteal phase (75%); 46% were referred for laparoscopy.
Adjusted live birth was 34% under age 35 versus 23% at 35 or older (P=0.0438). It was 40% with a body mass index below 25 versus 16% at 25 or above (P=0.0008).
Of 63 births with data, 58 (92%) occurred at term and 5 (8%) at 32 to 37 weeks of gestation. Two sets of twins were born, with no higher-order multiple births.

Interpretation

The study is a retrospective cohort of couples who met infertility criteria at two Massachusetts family practices between 1989 and 2014, with 370 of 559 evaluated couples eligible. Half of the women were 35 or older. Kaplan-Meier analysis, which accounts for couples who leave treatment early, produced the adjusted figures. Age and body mass index were associated with live birth. The authors call for larger prospective studies to identify which treatments suit which diagnoses.

RRM Context

Restorative reproductive medicine (RRM) seeks to find and correct the underlying causes of infertility, which can lie with one or both partners. NaProTechnology is founded on cycle tracking with the Creighton Model FertilityCare System. The authors say primary care suits this work because infertility is common, affects the couple, and involves chronic conditions that primary care can address.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

Restorative reproductive medicine (RRM) seeks to identify and correct underlying causes and factors contributing to infertility and reproductive dysfunction. Many components of RRM are highly suitable for primary care practice. We studied the outcomes amongst couples who received restorative reproductive medicine treatment for infertility in a primary care setting.

Methods

Two family physicians in Massachusetts trained in a systematic approach to RRM (natural procreative technology, or NaProTechnology) treated couples with infertility. We retrospectively reviewed the characteristics, diagnoses, treatments, and outcomes for all couples treated during the years 1989 to 2014. We compared pregnancy and live birth by clinical characteristics using Kaplan-Meier analysis. We employed the Fleming-Harrington weighted Renyi test or the logrank test to compare the cumulative proportion with pregnancy or with live birth.

Results

Among 370 couples beginning treatment for infertility, the mean age was 34.8 years, the mean prior time trying to conceive was 2.7 years, and 27% had a prior live birth. The mean number of diagnoses per couple was 4.9. Treatment components included fertility tracking with the Creighton Model FertilityCare System (80%); medications to enhance cervical mucus production (81%), to stimulate ovulation (62%), or to support the luteal phase (75%); and referral to female laparoscopy by a surgeon specializing in endometriosis (46%). The cumulative live birth rate at 2 years was 29% overall; this was significantly higher for women under age 35 (34%), and for women with body mass index < 25 (40%). There were 2 sets of twins and no higher-order multiple gestations. Of the 63 births with data available, 58 (92%) occurred at term.

Conclusions

Family physicians can provide a RRM approach for infertility to identify underlying causes and promote healthy term live births. Younger women and women with body mass index < 25 are more likely to have a live birth.

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Topics

Restorative Reproductive Medicine › NaProTechnology › Cumulative Pregnancy Rates · Reproductive Endocrinology › Luteal Phase › Progesterone Support · Fertility Awareness › Effectiveness › Comparative Effectiveness

Joseph B Stanford, Paul A Carpentier, Barbara L Meier, Mark Rollo, Benjamin Tingey

Joe Stanford, Joey Stanford, J Stanford, P Carpentier, Barb Meier, B Meier, M Rollo, Ben Tingey, B Tingey

PMID 34233646 34233646 DOI 10.1186/s12884-021-03946-8 10.1186/s12884-021-03946-8 Stanford et al. 2021, Stanford 2021