Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY·
The institutional architecture supporting the CrMS — including the FertilityCare Centers of America network, the American Academy of FertilityCare Professionals (AAFCP), training and certification pathways, and the research programs of the Pope Paul VI Institute — is described. This infrastructure is what distinguishes NaProTECHNOLOGY from informal fertility awareness methods, providing the professional standards, peer accountability, and ongoing research capacity required for clinical credibility.
Hilgers TW et al., 2004·The Medical and Surgical Practice of NaProTECHNOLOGY·
Compounding pharmacists prepare individualized hormone formulations — including HCG, progesterone, and thyroid preparations — that are central to NaProTECHNOLOGY treatment protocols, where standardized commercial doses are often inadequate for patient-specific needs. Collaborative prescribing between NaPro practitioners and licensed compounding pharmacists ensures consistent bioidentical formulation quality, dosing precision, and regulatory compliance within fertility and reproductive endocrine management.
Workflow and Documentation · Charting Systems and Records
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY·
A systematic framework for managing patient cases within the CrMS-NaProTECHNOLOGY system is presented, addressing how FCPs and medical consultants collaborate to identify abnormal chart patterns, initiate medical referral, and coordinate ongoing care. Structured case management is the operational bridge between fertility monitoring and clinical intervention, ensuring that biomarker observations are translated into timely diagnostic and therapeutic action.
Barron ML et al., 2001·J Obstet Gynecol Neonatal Nurs·
The Creighton Model system of natural family planning (NFP) is useful in achieving pregnancy, avoiding pregnancy, and detecting some gynecologic disorders. NFP practitioners support the client in using NFP. Because the effectiveness of NFP is related to the teaching process and to teacher expertise, clients choosing NFP may be best served by referral to a certified NFP practitioner for instruction.
Chavez-Badiola A et al., 2025·Journal of assisted reproduction and genetics·
Open Access
The economics of IVF operations remain opaque despite growing prevalence and substantial investment in fertility services. Traditional accounting methods often fall short by failing to capture the complex relationship between biological inputs (number of eggs and embryos processed), skilled labor, and equipment utilization, creating a distorted view across different procedures and patient characteristics. This paper presents Activity-Based Costing (ABC) as a methodological framework for understanding true IVF laboratory costs. We demonstrate a use case with an analysis of data from five IVF laboratories (600-2200 annual egg retrieval cycles) across different US regions including time studies of 500 + procedures at each site, with theoretical projections to 4000 annual egg retrieval cycles based on queuing theory. We identify significant cost elasticity with biological inputs; costs increase by 55% for egg freezing when the number of eggs per patient triples, and by 30% for complex IVF procedures (such as those requiring embryo biopsy) when egg count per patient doubles. We also describe substantial scale effects, with marginal lab costs 40% higher in centers performing 500 yearly egg retrieval cycles versus 2000-cycle centers, and 4000-cycle centers estimated to achieve 13-40% lower costs per procedure than operations performing 500 retrieval cycles annually. Finally, we show labor efficiency increases by 30% between centers performing 500 and 2000 annual egg retrieval cycles, an observation supported by a queuing rule of thumb (QROT) analysis, with capital utilization also improving dramatically. ABC enables evidence-based pricing, capacity planning, technology assessment, and consolidation strategizing. ABC is intended to inform operational efficiency, not clinical treatment, ensuring that quality of care and patient outcomes remain the primary considerations in fertility services.
Bernot G et al., 2025·European Journal of Obstetrics & Gynecology and Reproductive Biology
Fertility treatment pathways are complex and lengthy. The current prevalence of infertility makes it a public health issue. The involvement of general practitioners and the training of fertility instructors to provide therapeutic education have been suggested as ways of involving patients in the process and improving the therapeutic trajectory of these patients, who often have co-morbidities. To describe the activity of trained fertility instructors; to assess the interest of doctors in the fertility chart provided by women; and to describe the outcomes of their fertility care pathway. 66 French fertility instructors were interviewed in June 2024. The 15 general practitioners who had received additional training were also interviewed. The records of all couples who received fertility counselling and treatment between 1 January 2022 and 31 December 2023, the study cut-off date, were analysed. Doctors declared that the women had gained a clear understanding of their menstrual cycle, which was useful for diagnosis and treatment follow-up. The chart was particularly useful for diagnosing the causes of infertility and identifying when in the cycle to take medication. Only 4 of the 551 women were lost to follow-up. Of the remaining 547 women, 204 (37%) became pregnant. Of these, 75% had a live birth or an ongoing pregnancy at study cut-off. The involvement of fertility instructors and general practitioners improved the couple s ability to interact with doctors and to adhere to infertility treatment. The fertility chart provided by the women proved to be useful in the diagnosis and treatment process.
Guidelines by Issuing Body · Specialty and Consensus Panels
Reproductive Technology Accreditation Committee et al., 2024·Fertility Society of Australia and New Zealand - RTAC
RTAC Code of Practice (Issue 9) governing accreditation requirements for reproductive technology units operating in Australia and New Zealand. Sets standards for clinical, laboratory, and quality-management practices that ART centres must meet to remain RTAC-accredited and eligible to submit cycles to ANZARD. Includes patient safety, embryology laboratory, donor-program, and incident-reporting requirements. Effective from December 2024.
Guidelines by Clinical Area · Fertility and Infertility Guidelines
Practice Committees of the American Society for Reproductive Medicine (ASRM) and the Society for Reproductive Biologists and Technologists (SRBT). Electronic address: asrm@asrm.org, 2022·Fertility and sterility
This document is a comprehensive guidance for human embryology, andrology, and endocrinology laboratories. Universal guidance applicable to all laboratories includes requirements and recommendations for accreditation and staffing in the United States, and specific guidance is included for each laboratory specialty.
Guidelines by Clinical Area · Fertility and Infertility Guidelines
Practice Committee of the American Society for Reproductive Medicine et al., 2021·Fertility and sterility
This document is designed to provide a framework for assisted reproductive technology (ART) programs that meet or exceed the requirements suggested by the Centers for Disease Control and Prevention for certification of ART laboratories. This document replaces the document "Revised Minimum Standards for Practices Offering Assisted Reproductive Technologies: A Committee Opinion" published in 2019.
Gleicher N et al., 2019·Hum Reprod Open·
Open Access
With steadily improving pregnancy and live birth rates, IVF over approximately the first two and a half decades evolved into a highly successful treatment for female and male infertility, reaching peak live birth rates by 2001-2002. Plateauing rates, thereafter, actually started declining in most regions of the world. We here report worldwide IVF live birth rates between 2004 and 2016, defined as live births per fresh IVF/ICSI cycle started, and how the introduction of certain practice add-ons in timing was associated with changes in these live birth rates. We also attempted to define how rapid worldwide 'industrialization' (transition from a private practice model to an investor-driven industry) and 'commoditization' in IVF practice (primary competitive emphasis on revenue rather than IVF outcomes) affected IVF outcomes. The data presented here are based on published regional registry data from governments and/or specialty societies, covering the USA, Canada, the UK, Australia/New Zealand (combined), Latin America (as a block) and Japan. Changes in live birth rates were associated with introduction of new IVF practices, including mild stimulation, elective single embryo transfer (eSET), PGS (now renamed preimplantation genetic testing for aneuploidy), all-freeze cycles and embryo banking. Profound negative associations were observed with mild stimulation, extended embryo culture to blastocyst and eSET in Japan, Australia/New Zealand and Canada but to milder degrees also elsewhere. Effects of 'industrialization' suggested rising utilization of add-ons ('commoditization'), increased IVF costs, reduced live birth rates and poorer patient satisfaction. Over the past decade and a half, IVF, therefore, has increasingly disappointed outcome expectations. Remarkably, neither the profession nor the public have paid attention to this development which, therefore, also has gone unexplained. It now urgently calls for evidence-based explanations.
Nurses and other health care professionals often have little knowledge of methods of natural family planning (NFP) and do not readily prescribe natural methods for their patients. One reason for this is that little or no information on NFP is provided in nursing or medical schools. The holistic, informational, and integrative nature of NFP fits well with professional nursing practice. A university online distance education NFP teacher training program, which offers academic credit and includes theory, practice, and the latest developments in fertility monitoring, has been developed for health care professionals. Professional NFP services in the United States need to meet worldwide standards and include documenting and assessing pregnancy outcomes, tailoring NFP services to the client or couple, and simplifying them for ease of use in a standard health care practice.
The Care Team · Coordinating With Conventional Care
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY·
Nursing within the NaProTECHNOLOGY practice encompasses preoperative preparation, intraoperative assistance, postoperative monitoring, hormone administration protocols, and patient education on cycle-based treatment timing. Nurses fluent in CrMS charting language and NaProTECHNOLOGY biomarker systems function as clinical integrators, ensuring that laboratory and treatment protocols are executed in alignment with the individualized menstrual cycle data driving each patient's care plan.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY·
The structured protocols used to train and certify FertilityCare Practitioners (FCPs) in the uniform delivery of CrMS instruction are detailed, covering the sequence of follow-up sessions, the use of standardized teaching aids, and quality-control mechanisms that ensure inter-instructor consistency. Standardization is essential to the scientific validity of CrMS data, because chart comparability across practitioners and study populations depends on identical observation and recording conventions.
Hilgers TW et al., 2004·The Medical and Surgical Practice of NaProTECHNOLOGY·
The FertilityCare Practitioner (FCP) is the trained educator and coach who teaches the Creighton Model FertilityCare System to clients, standardizes charting methodology, and serves as the primary data interface between the patient and the NaProTECHNOLOGY physician. Accurate, consistent chart data from FCPs directly determines the quality of biomarker interpretation, targeted intervention timing, and longitudinal outcome assessment throughout medical and surgical care.
The Care Team · Coordinating With Conventional Care
Hilgers TW et al., 2004·The Medical and Surgical Practice of NaProTECHNOLOGY·
Family physicians trained in NaProTECHNOLOGY serve as primary coordinators of medical management — prescribing targeted hormone support, monitoring biomarker trends, and triaging surgical referrals — within a collaborative care model. Their longitudinal relationship with patients and ability to integrate reproductive medicine into whole-person primary care is a structural advantage of the NaProTECHNOLOGY delivery system over specialist-only models.
Anti-Infective and Anti-Inflammatory Agents · Antibiotics in Reproductive Care
Since 1981 our physicians' office has developed an outpatient parenteral antibiotic therapy programme which has shown advantages in patient care and provided significant cost savings. While we were able to provide any parenteral antibiotic available, the mainstay of our programme was ceftriaxone because of its broad range of activity, safety, and once-daily administration. Two hundred and ninety cases of outpatient ceftriaxone usage were recorded between January 1989 and March 1990. Ceftriaxone was found to be most useful for bone, soft tissue, and gynaecological infections. Not only was it highly clinically successful, but it was safe to use in the twice-weekly monitoring parameters we routinely perform in our office. The use of ceftriaxone alone during the 15-month period accounted for savings of over US $1.2 million compared to the cost of hospitalization during this period.