Keefe, C. E., Mirkes, R., & Yeung, P. P., Jr. (2012). The Evaluation and Treatment of Cervical Factor Infertility a Medical-Moral Analysis. The Linacre Quarterly, 79(4), 409-425. https://doi.org/10.1179/002436312804827127
Keefe CE, Mirkes R, Yeung PP Jr. The Evaluation and Treatment of Cervical Factor Infertility a Medical-Moral Analysis. Linacre Q. 2012;79(4):409-425. doi:10.1179/002436312804827127
Keefe, Catherine E., et al. "The Evaluation and Treatment of Cervical Factor Infertility a Medical-Moral Analysis." The Linacre Quarterly, vol. 79, no. 4, 2012, pp. 409-425.
Pontifical John Paul II Institute for Studies on Marriage and Family05xphj289
Linked to ROR, the Research Organization Registry
RRM Academy Synopsis
NaProTECHNOLOGY evaluates and treats cervical factor infertility
A 2012 medical-moral analysis reports that NaProTECHNOLOGY evaluates and treats cervical factor infertility directly, while ART bypasses it. The Creighton Model FertilityCare System (CrMS) quantifies cervical mucus observations for the evaluation. The authors build on a clinical case and judge both approaches by Catholic natural law.
Key Findings
The authors report that the ART evaluation lacks the means to measure cervical mucus. ART experts no longer recommend the postcoital test, noting that IUI and IVF negate any cervical factor.
The CrMS grades mucus as dry, limited or regular mucus cycles. A study of 1,681 menstrual cycles charted with the CrMS found a positive correlation between mucus score category and pregnancy probability.
In the case, a 29-year-old woman with five years of inability to conceive and limited mucus cycles achieved pregnancy after two cycles of a mucus enhancer and fertility-focused intercourse.
In a cited trial, six-month pregnancy rates were 23 percent with natural-cycle IUI (191 couples) and 17 percent with expectant management (193 couples), a difference not found to be significant.
Under Catholic natural law, the authors judge the CrMS and NaProTECHNOLOGY approach moral because it assists the couple's act of sexual union, and conventional and modified IUI immoral because they replace it.
Interpretation
The paper pairs a case report with an ethical analysis rooted in Roman Catholic natural law. The clinical section compares NaProTECHNOLOGY with the ART evaluation of cervical factor infertility. It cites published studies and a standard textbook. The moral section applies Catholic teaching on the unitive and procreative meanings of sexual union, so its conclusions state the authors' position. The authors conclude that NaProTECHNOLOGY appears more cost-efficient and more effective than IUI for cervical factor infertility. They note that more robust comparative studies and more research are needed.
RRM Context
Restorative reproductive medicine evaluates how the body works before treatment begins. Cervical mucus shows how estrogen and progesterone act on the cervix during the cycle. The Creighton Model FertilityCare System gives that sign a standard score. The score supports diagnosis of cervical factor infertility, and NaProTECHNOLOGY uses it to follow treatment.
Our editorial summary of this paper, not the article's abstract.
Abstract
The current approach to infertility of assisted reproductive technology (ART) completely misses and then bypasses the evaluation and treatment of cervical factor infertility. In contrast, the Creighton Model Fertility Care System (CrMS), a method of fertility awareness that has the unique ability to quantify cervical mucus observations, and natural procreative technology (NaProTECHNOLOGY or NPT) directly evaluate and treat cervical factor infertility. The ART treatment of choice for cervical factor infertility--intrauterine insemination (IUI)--is also morally disparate from the NPT treatment protocol: while the latter genuinely assists the infertile couple's act of sexual union to achieve its natural end of pregnancy, IUI replaces the natural act, depriving human conception of the one context worthy of the dignity of human life and procreation, a reciprocal self-gifting act of love between husband and wife. A renewed interest and focus on the direct evaluation and treatment of cervical factor infertility is needed.
