Protocols, cumulative pregnancy rates, restorative vs IVF.
269 articles
clinical-guidelines/diagnostic-criteria-and-classification/terminology-and-definitionsethics-and-policy/advocacy-and-public-understanding/public-awarenessresearch-methods/framing-and-discourse-analysis/framing-devices
Open Access
Polyendocrine metabolic ovarian syndrome (PMOS), previously named polycystic ovary syndrome (PCOS), affects one in eight women. However, the term PCOS is inaccurate, implying pathological ovarian cysts, obscuring diverse endocrine and metabolic features, and contributing to delayed diagnosis, fragmented care, and stigma, while curtailing research and policy framing. Building on an international mandate for change, we outline an unprecedented, rigorous, multistep global consensus process for the name change. Funding and governance were established with engagement of 56 leading academic, clinical, and patient organisations. Using iterative global surveys (with responses from 14 360 people with PCOS and multidisciplinary health professionals from all world regions), modified Delphi methods, nominal group technique workshops, and marketing and implementation analyses, we identified principles prioritising scientific accuracy, clarity, stigma avoidance, cultural appropriateness, and implementation feasibility. An accurate new name was prioritised over retaining the PCOS acronym or a generic name. Implementation approaches prioritised evolution rather than transformation. Preferred terms were polyendocrine, metabolic, and ovarian, reflecting the condition's multisystem pathophysiology, and polyendocrine metabolic ovarian syndrome was the consensus new name. Accuracy was improved by omitting cysts and by capturing endocrine, metabolic, and ovarian dysfunction. A co-designed global implementation strategy, including a transition period, education, and alignment with health systems and disease classification, is under way.
Sánchez-Méndez JI et al., 2025·Front Reprod Health
Assisted reproductive technologies (ART) are widely used to address infertility; however, they are costly, associated with medical risks, and often yield suboptimal clinical outcomes. Natural Procreative Technology, also known as NaProTechnology (NPT), provides a systematic and integrative approach to infertility by thoroughly identifying and treating underlying medical conditions to restore the couple's natural fertility potential. Despite its promise, real-world data on NPT effectiveness remain limited. The objective of this study is to evaluate the take-home baby rate in a large population of infertile couples treated with NPT and to synthesize findings from previously published studies. A retrospective cohort study was conducted involving 1,310 infertile couples treated at a specialized fertility clinic in Spain over a 5-year period. Participants presented with primary or secondary infertility or recurrent pregnancy loss. Clinical data, diagnoses, and outcomes were analyzed, including surgical interventions and treatment duration. The mean age of women and men was 35.0 (SD 4.4) and 36.9 (SD 5.3) years, respectively. Primary infertility was the most common subtype (73.5%), the median infertility duration was 24 months, and prior ART attempts were recorded in 27.5% of couples. Mean number of diagnoses per couple was 2.5 (SD 1.3). The crude take-home baby rate was 35.3% (N = 463). Independent predictors of successful take-home baby included female age, recurrent pregnancy loss as the reason for consultation, duration of infertility, and the presence of endometriosis, hormonal dysfunction, male factor, and endometrial disorders as diagnoses. Considering a median duration of NPT of 10.9 months (range 8.1-17.0), the adjusted cumulative take-home baby rate was 62.1%. Rates varied significantly by female age, with higher success observed in younger women: 83.7% at 18-30 years, 53.3% at 36-40 years, and 24.4% over 40 years. A sensitivity analysis was performed to assess the impact of dropout assumptions on cumulative pregnancy rates. Nearly one-third of patients underwent surgery, most commonly hysteroscopy and/or laparoscopy. In this cohort, NPT was associated with a notably high take-home baby rate in an infertile population with unfavorable prognostic factors, including advanced maternal age, prolonged duration of infertility, or previous failed attempts at conventional ART procedures.
fertility-awareness/effectiveness/typical-and-perfect-userestorative-reproductive-medicine/naprotechnology/cumulative-pregnancy-rates
Open Access
Knowledge of the fertile and infertile phases of the menstrual cycle can be applied to conceive or to avoid pregnancy. Fertility intentions and sexual behaviors during the fertile time may influence whether and when pregnancy occurs. The Creighton Model FertilityCare System (CrMS) is a specific system of fertility appreciation used to conceive or to avoid pregnancy. The objective of this paper is to report intentions, behaviors, and pregnancy rates during use of the CrMS among couples who initially intended to avoid pregnancy.Data and methodsWe analyzed a prospective cohort study conducted in 17 CrMS centers across the USA and Canada, following 296 couples for up to one year after onset of initial use of the CrMS to avoid pregnancy. Baseline data included demographics, motivations, and pregnancy intentions for each partner. Couples contributed 2894 menstrual cycles, most of which had data collected (by questionnaires and daily diary) on cycle-specific pregnancy intentions, days of potential fertility, and fertility behaviors. Pregnancies were prospectively actively ascertained. We found a high concordance (91%) in cycle pregnancy intentions between partners. However, 44% of cycles with strong intentions to avoid pregnancy included intercourse on potentially fertile days or days of undetermined fertility status. Across all sensitivity scenarios, cumulative 13-cycle pregnancy rates with cycle intention to conceive ranged from 88.0% to 89.8%, and cumulative 13-cycle pregnancy rates with cycle intention to avoid ranged from 29.1% to 35.3%. In multivariate analysis, baseline motivations and intentions for pregnancy within 2 years were strongly correlated with the likelihood of pregnancy, more so than cycle intentions. The findings suggest that in some populations using natural family planning, baseline motivations and intentions may be more strongly related to pregnancy rates than cycle intentions. Our findings also highlight essential elements for evaluating correct use, including complete recording of intercourse and its timing.
infertility/uterine-factor/fibroids-and-polypsrestorative-reproductive-medicine/restorative-care-and-assisted-reproduction/outcome-comparisonsreproductive-surgery/uterine-surgery/myomectomy
Open Access
Bulletti FM et al., 2025·Clin Med�Insights�Reprod�Health
Infertility affects around 17.5% of reproductive-aged individuals worldwide, posing significant personal and public health challenges. Although Medically Assisted Reproduction and Assisted Reproductive Technology (ART; e.g., in vitro fertilization) have advanced outcomes, many couples fail to conceive due to unaddressed pelvic, uterine, or systemic factors. We aim to (1) define the current usage of Restorative Reproduction Medicine (RRM) in clinical practice, (2) compare RRM outcomes with conventional ART, and (3) propose an integrated model of RRM plus ART for optimal fertility care.
A systematic review following PRISMA guidelines was conducted (INPLASY registration no. INPLASY2024110069). Data sources and We searched PubMed, Scopus, and Web of Science (January 1995–October 2024), combining terms such as “restorative reproductive medicine,” “intrauterine adhesions,” “myomas,” “polyps,” “hydrosalpinx,” “endometritis,” “BMI,” “thyroid dysfunction,” “microbiome,” and “assisted reproductive technology.” Inclusion criteria: studies on uterine/systemic factors affecting infertility, focusing on surgical/pharmacological RRM interventions and ART limitations. Exclusion criteria: male-only infertility, case reports, narrative reviews, non-English publications. Quality assessment employed the Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool. We also briefly noted potential publication bias due to language and study-type restrictions. From >25,000 initial titles, 3 sequential screenings yielded 145 key articles addressing uterine (septum, myomas, polyps, adhesions) and systemic (body mass index (BMI) extremes, thyroid dysfunction, microbiome imbalance) factors. Surgical corrections (e.g., hysteroscopic removal of polyps/myomas, salpingectomy for hydrosalpinx) significantly improved natural conception and ART success (⩾20%–40% increase in clinical pregnancy). Chronic endometritis treatment, endometrial microbiome modulation, and BMI/thyroid optimization further improved pregnancy rates by 15%–20%. Comparisons of RRM versus ART alone indicated that RRM often lowers overall cost and may reduce miscarriage, while ART offers immediate embryo transfer. Combining RRM to correct pathologies prior to ART can boost implantation and live birth rates (⩾40%–70% improvement in some studies). Restorative Reproductive Medicine comprehensively addresses pelvic and systemic abnormalities, thereby enhancing fertility outcomes and complementing ART. A proposed integrated model—RRM diagnostics/interventions followed by ART if needed—maximizes success, reduces time/cost, and emphasizes holistic reproductive health. Further multicenter trials are warranted to standardize protocols and fully realize RRM’s potential in modern fertility care.
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.
Prostaglandin E2 (PGE2) is a key driver of endometriosis pathogenesis. Vipoglanstat selectively inhibits mPGES-1 enzyme activity. A Phase I trial involved 72 healthy volunteers receiving single or repeated doses, while Phase II included 69 subjects with chronic inflammatory disease receiving daily treatment. Results demonstrated the compound was safe and well tolerated at therapeutic doses and achieved complete mPGES-1 inhibition while preserving protective prostacyclin production. A Phase II endometriosis trial is scheduled to begin in 2025, focusing on pain reduction and lesion assessment via imaging.
Michaelsen MP et al., 2025·BJOG: An International Journal of Obstetrics and Gynaecology
To study the association between previous use of levonorgestrel intrauterine system (LNG-IUS) and endometrial thickness (EMT) in women undergoing in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) cycles. Multicentre historical cohort study. Eight Danish public and private fertility clinics. 12786 women aged 18-46 years contributing with an EMT measurement from 22 464 different IVF/ICSI treatment cycles between 2000 and 2021. Exposure was previous use of LNG-IUS, combined oral contraceptive pills (OCPs), progestogen-only pills (POPs), no/other contraception or combined, cumulated use of contraception when more contraceptives had been used during the inclusion period. LNG-IUS use was categorised into 0-3 years, >3-6 years, >6-9 years and >9 years. Mixed effect logistic regression adjusted for age, BMI, smoking, educational level, total FSH dose and fertility clinic was used. EMT (< 7 mm vs >= 7 mm). Statistically significantly higher odds of EMT >= 7 mm were found for OCPs [OR 3.53 (95% CI 1.29-9.65)], POPs [OR 6.43 (95% CI 1.45-28.63)] and no/other contraception [OR 6.67 (95% CI 2.37-18.74)] relative to LNG-IUS in IVF/ICSI cycles. All duration categories of ever use of LNG-IUS were associated with significantly lower odds of EMT >= 7 mm compared to no/other contraception. Previous use of LNG-IUS was associated with decreased endometrial growth in women undergoing IVF/ICSI.
1. Define premature ovarian insufficiency, diagnostic criteria, risk factors and comorbidities.
2. Discuss health concerns, as well as health and hormone management of patients suffering with POI.
3. Discuss restorative fertility approaches to those with POI.
No standard criteria exist for how to perform a diagnostic laparoscopy. This case series provides evidence of the importance of standardized, reproducible techniques. A single non-oncologic gynecologic surgeon used Near-Contact Laparoscopy (NCL) and Systematic Mapping of the Abdomen and Pelvis (S-MAP) techniques, resulting in the incidental finding and curative treatment of 4 rare cancers over 3 years. Three were neuroendocrine tumors of the appendix (incidence 0.95/100,000; probability of 3 by one surgeon: 0.0000000001). The fourth was a 2 mm well-differentiated papillary mesothelioma (WDPM). All 4 were cured. 3 of 3 infertile patients subsequently achieved pregnancy. The NCL technique was originally coined by Dr. Redwine (PMID: 3190209). The S-MAP method was described in the NaProTechnology textbook by Dr. Thomas Hilgers, and the S-MAP term coined by this author. Case D used robotic-assisted laser excision. Standardization should be incorporated as the gold standard.
Boyle P et al., 2024·Frontiers in Reproductive Health
Low serum estradiol in early pregnancy is associated with an elevated risk of miscarriage. We sought to determine whether efforts to restore low blood estradiol via estradiol or dehydroepiandrosterone (DHEA) supplementation would reduce the risk of miscarriage as part of a multifactorial symptom-based treatment protocol. This retrospective cohort study included women with low serum estradiol levels in early pregnancy, defined as ≤50% of reference levels by gestational age. Estradiol or DHEA were administered orally, and the primary outcome measure was serum estradiol level, in reference to gestational age. The secondary outcome measures included miscarriage, birth weight, and gestational age at birth. We found no significant effect of estradiol supplementation on serum estradiol levels referenced to gestational age, while DHEA supplementation strongly increased estradiol levels. For pregnancies with low estradiol, the miscarriage rate in the non-supplemented group was 45.5%, while miscarriage rate in the estradiol and DHEA supplemented groups were 21.2% (p = 0.067) and 17.5% (p = 0.038), respectively. Birth weight, size, gestational age, and preterm deliveries were not significantly different. No sexual abnormalities were reported in children (n = 29) of DHEA-supplemented patients after 5-7 years follow-up. In conclusion, DHEA supplementation restored serum estradiol levels, and when included in the treatment protocol, there was a statistically significant reduction in miscarriage.
Subchorionic hematoma (SCH) refers to the separation and bleeding of the chorion and decidua, resulting in the accumulation of blood between them. This review discusses the pathogenesis, etiology, and treatment of SCH including coagulation dysfunction, immune dysregulation, reproductive tract infections, assisted reproductive technology, and progesterone therapy.
Lo Giudice A et al., 2024·Frontiers in endocrinology
This study aimed to investigate the effects of ejaculatory abstinence on sperm parameters. Thirteen studies published between 2013 and 2022 were included in this meta-analysis. 2,315 patients enrolled. Longer abstinence associated with greater sperm concentration, sperm volume, and higher sperm DNA fragmentation (SDF), but lower progressive sperm motility. Short ejaculatory abstinence is associated with better sperm quality with higher progressive sperm motility and lower SDF.
Presentation covering three topics: (1) Review of RCOG Green-top Guideline No. 17 on Recurrent Miscarriage (Regan et al., BJOG 2023), (2) Key concepts of Restorative Reproductive Medicine with NeoFertility for recurrent miscarriage, and (3) An RRM case report demonstrating the NeoFertility multifactorial approach to recurrent pregnancy loss.
restorative-reproductive-medicine/naprotechnology/program-outcomesfertility-awareness/effectiveness/fertile-window-estimation
Open Access
Natural Procreative Technology (NaProTechnology) is a system of management of infertility and other reproductive health issues which requires the application of a woman’s observation and record of key events throughout her menstrual cycle. The study assessed the knowledge, awareness, and perception of NaProTechnology as well as the effect of an educational intervention among pharmacy undergraduate students at University of Nigeria, Nsukka. It was a cross-sectional, questionnaire-based study. The ethical approval was obtained from the research ethics committee of the Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka. At baseline, the knowledge, awareness and perception of the students were assessed. Followed by the administration of an educational video on NaProTechnology. Then a post intervention survey was done to assess the effect of the educational intervention. Key finding: s
There were 410 and 350 students in the preand post-intervention surveys respectively with relatively equal number of males and females. Majority were between 18 and 29 years old. Less than 5% were married while the highest proportion of the respondents were from 300 level The knowledge, awareness, and positive perception of NaProTechnology among the pharmacy students prior to intervention were poor but improved markedly post intervention (P < 0.001).
A video intervention was effective in improving the short-term knowledge, awareness and positive perception of NaProTechnology among pharmacy students. Key message: s
What is already known on this topic?
Natural Procreative Technology (NaProTechnology) is a system of management of infertility based on the observation and record of fertility biomarkers by a woman. What this study add: s?
The level of knowledge, awareness, and positive perception of NaProTechnology among the pharmacy undergraduates students were poor prior to a video intervention but improved markedly afterwards
How this study might affect research, practice or policy?
This study would lead to the public health system approach of informing, educating and communicating NaProTechnology to pharmacy students to achieve long-term effects by using well-designed courses and curriculum implementation.
What is the feasibility of a prospective protocol to follow subfertile couples being treated with natural procreative technology for up to 3 years at multiple clinical sites? Overall, clinical sites had missing data for about one-third of participants, the proportion of participants responding to follow-up questionnaires during time periods when participant compensation was available (about two-thirds) was double that of time periods when participant compensation was not available (about one-third) and follow-up information was most complete for pregnancies and births (obtained from both clinics and participants). Several retrospective single-clinic studies from Canada, Ireland and the USA, with subfertile couples receiving restorative reproductive medicine, mostly natural procreative technology, have reported adjusted cumulative live birth rates ranging from 29% to 66%, for treatment for up to 2 years, with a mean women's age of about 35 years. The international Natural Procreative Technology Evaluation and Surveillance of Treatment for Subfertility (iNEST) was designed as a multicenter, prospective cohort study, to enroll subfertile couples seeking treatment for live birth, assess baseline characteristics and follow them up for up to 3 years to report diagnoses, treatments and outcomes of pregnancy and live birth. In addition to obtaining data from medical record abstraction, we sent follow-up questionnaires to participants (both women and men) to obtain information about treatments and pregnancy outcomes, including whether they obtained treatment elsewhere. The study was conducted from 2006 to 2016, with a total of 10 clinics participating for at least some of the study period across four countries (Canada, Poland, UK and USA). The 834 participants were subfertile couples with the woman's age 18 years or more, not pregnant and seeking a live birth, with at least one clinic visit. Couples with known absolute infertility were excluded (i.e. bilateral tubal blockage, azoospermia). Most women were trained to use a standardized protocol for daily vulvar observation, description and recording of cervical mucus and vaginal bleeding (the Creighton Model FertilityCare System). Couples received medical and sometimes surgical evaluation and treatments aimed to restore and optimize female and male reproductive function, to facilitate in vivo conception. MAIN The mean age of women starting treatment was 34.0 years; among those with additional demographic data, 382/478 (80%) had 16 or more years of education, and 199/659 (30%) had a prior live birth. Across 10 clinical sites in four countries (mostly private clinical practices) with family physicians or obstetrician-gynecologists, data about clinic visits were submitted for 60% of participants, and diagnostic data for 77%. For data obtained directly from the couple, 59% of couples had at least one follow-up questionnaire, and the proportion of women and men responding to fill out the follow-up questionnaires was 69% and 67%, respectively, when participant financial compensation was available, compared to 38% and 33% when compensation was not available. Among all couples, 57% had at least one pregnancy and 44% at least one live birth during the follow-up time period, based on data obtained from clinic and/or participant questionnaires. All sites reported on female pelvic surgical procedures, and among all participants, 22% of females underwent a pelvic diagnostic and/or therapeutic procedure, predominantly laparoscopy and hysterosalpingography. Among the 643 (77%) of participants with diagnostic information, ovulation-related disorders were diagnosed in 87%, endometriosis in 31%, nutritional disorders in 47% and abnormalities of semen analysis in 24%. The mean number of diagnoses per couple was 4.7. LIMITATIONS The level of missing data was higher than anticipated, which limits both generalizability and the ability to study different components of treatment and prognosis. Loss to follow-up may also be differential and introduce bias for outcomes. Most of the participating clinicians were not surgeons, which limits the opportunity to study the impact of surgical interventions. Participants were geographically dispersed but relatively homogeneous with regard to socioeconomic status, which may limit the generalizability of current and future findings. Multicenter studies are key to understanding the outcomes of subfertility treatments beyond IVF or IUI in broader populations, and the association of different prognostic factors with outcomes. We anticipate that the iNEST study will provide insight for clinical and treatment factors associated with outcomes of pregnancy and live birth, with appropriate attention to potential biases (including adjustment for potential confounders, multiple imputation for missing data, sensitivity analysis and inverse probability weighting for potential differential loss to follow-up, and assessments for clinical site heterogeneity). Future studies will need to either have: adequate funding to compensate clinics and participants for robust data collection, including targeted randomized trials; or a scaled-down, registry-based approach with targeted data points, similar to the multiple national and regional ART registries. Funding for the study came from the International Institute for Restorative Reproductive Medicine, the University of Utah, Department of Family and Preventive Medicine, Health Studies Fund, the Primary Children's Medical Foundation, the Mary Cross Tippmann Foundation, the Atlas Foundation, the St. Augustine Foundation and the Women's Reproductive Health Foundation. The authors declare no competing interests. The iNEST study is registered at clinicaltrials.gov, NCT01363596.
Bouchard TP et al., 2022·J Womens Health (Larchmt)
Some studies have suggested minor changes in the menstrual cycle after COVID-19 vaccination, but more detailed analyses of the menstrual cycle are needed to evaluate more specific changes in the menstrual cycle that are not affected by survey-based recall bias. Using a pretest-post-test quasi-experimental evaluation of menstrual cycle parameters before and after COVID-19 vaccination, we conducted an anonymous online survey of two groups of North American women who prospectively monitor their menstrual cycle parameters daily including bleeding patterns, urinary hormone levels using the ClearBlue Fertility Monitor, or cervical mucus observations. The primary outcome measures were cycle length, length of menses, menstrual volume, estimated day of ovulation (EDO), luteal phase length, and signs of ovulation. Perceived (subjective) menstrual cycle changes and stressors were also evaluated in this study as secondary outcome measures. Of the 279 women who initiated the survey, 76 met the inclusion criteria and provided 588 cycles for analysis (227 pre-vaccine cycles, 145 vaccine cycles, 216 post-vaccine cycles). Although 22% of women subjectively identified changes in their menstrual cycle, there were no significant differences in menstrual cycle parameters (cycle length, length of menses, EOD, and luteal phase length) between the pre-vaccine, vaccine, and post-vaccine cycles. COVID-19 vaccines were not associated with significant changes in menstrual cycle parameters. Perceived changes by an individual woman must be compared with statistical changes to avoid confirmation bias.
fertility-awareness/biomarkers/cervical-mucusmenstrual-cycle/cycle-biomarkers/cervical-mucusdiagnostics/cycle-biomarkers/cervical-mucus-monitoring
Open Access
The principal objective of this study was to correlate biophysical properties of vaginal discharge present in the cervical mucus with the timing of the fertile window. In particular, we produce measures of the viscoelasticity of the cervical secretion using two methods. The first uses only the elasticity extracted from the Creighton Model Fertility Care System (CrMs) scale, calculated P-6 ovulation estimated day (OED) with respect to the peak day of the CrMs. The second uses a numerical method that takes into account the changes in viscoelasticity, but without reference to the peak day calculated using the CrMs model. Using both methods, twelve records were obtained from a single female subject. The methodology used to evaluate the viscoelasticity factor was by measuring the approximate length in centimeters (cm) of the vaginal discharge of cervical discharge. For this, the scale of the stretching graph established by observing the stretching of CrMS was used, taking into account the previous 6 days at peak day P-6. The first method, which we termed CFW (Clinical Fertile Window), uses a measure based on the approximate length (cm) of the maximal stretchiness of the vaginal discharge. The second method we termed SFW (Software-CrMS/strectching) (Software-based Fertile Window). The fertile window was detected correctly in 100% of the cases using either method, and a correlation value of 0.71 was observed between the two methods. We conclude that the assessment of viscoelasticity using SFW algorithm allowed in this pilot study to detect the fertile window and to describe the evolution pattern of cervical discharge throughout the fertile window. Our study provides support for the use of computational methods in detecting the fertile window, taking only into account the time evolution of the cervical discharge throughout the menstrual cycle.
restorative-reproductive-medicine/restorative-care-and-assisted-reproduction/outcome-comparisonsethics-and-policy/reproductive-ethics/conscience-protectionsfertility-awareness/effectiveness/comparative-effectiveness
Open Access
La progresiva medicalización de la infertilidad en las últimas tres décadas se corresponde con una creciente difusión de las Tecnologías de Reproducción Asistida (TRA), que han dejado en la sombra, casi por completo, otros enfoques más fisiológicos del tratamiento de la infertilidad, que tienen menos riesgos, son más económicos y, a la vez, igualmente efectivos. Este trabajo presenta un enfoque sistemático e integrado: la NaProTecnología (NPT), que tiene como objetivo optimizar las condiciones fisiológicas en cada ciclo menstrual, para permitir, de esta forma, una concepción por métodos naturales. Este método se postula como una mejor solución para el tratamiento de la infertilidad, desde un punto de vista que no sólo es más ético, sino que, además, es compatible con otros puntos de vistas religiosos, médicos, sociales, legales y ambientales. Los gobiernos deberían promover y financiar la NPT y, al mismo tiempo, las sociedades médicas y científicas deberían diseñar estudios para comparar de una manera justa la tasa de éxito, los costos y las complicaciones de la NPT en contraposición al método TRA tradicional.
Infertility is a worldwide problem today. The more conventional approach of medicine would be to diagnose the causes and correct them, so that the fertility potential of the couple would permit them to conceive naturally. However, since the advance of Assisted Reproductive Technologies, it has become a lucrative industry that seek to help anyone to procure a child. Lately, natural procreative processes such as NaProTechnology have arisen that can restore couples’ fertility potential through proper diagnosis and treatment. The Catholic Church prefers these latter approaches not only because they are truer to the nature of medical practice, but because they are more consistent with a healthy vision of human sexuality, procreation, and marriage.
Christ JP et al., 2021·American journal of obstetrics and gynecology
Accurate estimates of incidence and prevalence of endometriosis among nonselected cohorts are lacking in the United States, and earlier reports have produced varying results. This study aimed to define endometriosis incidence and prevalence in a US population and evaluate factors influencing these estimates over time. A 10-year retrospective cohort study using Kaiser Permanente Washington electronic health records database was completed. The primary analysis included women enrollees aged 16 to 60 years, from January 2006 to December 2015, who had a uterus, were continuously enrolled for at least 2 years before cohort entry and had at least 1 healthcare utilization. Secondary analysis included all women enrollees aged 16 to 60 years during this time. Incident endometriosis was identified using the International Classification of Diseases, Ninth Revision and Tenth Revision, diagnosis codes. Annual incidence rates were age-adjusted by direct standardization to the 2015 study population. Secular trends in incidence overall and by 5-year age group, race and ethnicity, diagnosis modality, and practitioner type were assessed using Poisson regression analyses. Prevalent cases were defined as women enrolled in 2015 and had an endometriosis diagnosis before the end of 2015. The prevalence rates of chronic pelvic pain and dysmenorrhea defined by the International Classification of Diseases, Ninth Revision and Tenth Revision, diagnosis codes in 2006-2015 were estimated. Among 332,056 eligible women who contributed 1,176,329 person-years during the 10-year study period, 2863 incident endometriosis cases were identified for an average incidence of 24.3 cases per 10,000 person-years. In our primary analysis, incidence rates declined over the study interval from a high of 30.2 per 10,000 person-years in 2006 to 17.4 per 10,000 person-years in 2015 and were highest among women aged 36 to 45 years in most years. Incidence rates were similar across race and ethnicity groups. The distribution of the 2863 incident cases by the diagnosis modality was as follows: 45.5% surgical, 5.7% imaging, and 48.8% clinical. Endometriosis incidence rates per 10,000 person-years were similar in women who were surgically and clinically diagnosed and decreased significantly from 2006 to 2015 (surgically diagnosed endometriosis dropped from 13.4 to 7.4 and clinically diagnosed endometriosis dropped from 16.1 to 8.9; P value of <.001 for linear trend over time for each). Incident case distribution by diagnosing provider was as follows: 73.6% obstetrician and gynecologist, 15.7% primary care provider, and 10.7% "other." Incidence of endometriosis diagnosed by an obstetrician and gynecologist and primary care provider decreased over the study interval (P<.001 for linear trend over time for each). Method of diagnosis and provider type did not differ by race and ethnicity. Among 135,162 women who contributed person-time in 2015, 2521 women were diagnosed with endometriosis, a prevalence rate of 1.9%. In our secondary analysis, the frequency of chronic pelvic pain diagnosis increased over the study interval from 3.0% in 2006 to 5.6% in 2015. The incidence rates of endometriosis declined over the 10-year study interval and did so uniformly across age groups, races and ethnicities, and the main diagnosing modalities and providers. Declining rates may reflect a shift in practice patterns in the United States away from the diagnosis of endometriosis both clinically and surgically, rather than favoring more general diagnoses of chronic pelvic pain. The prevalence of endometriosis in 2015 in the United States is in keeping with data from recent studies outside the United States using health record data.
ethics-and-policy/reproductive-ethics/embryo-status
Open Access
This paper looks at the ethics of assisted reproductive technology (ART) from the perspective of the Catholic Church. The three criteria of evaluation of the ethics of ART are the right to life and physical integrity of human beings, the unity of marriage, and the value of human sexuality. The paper examines the arguments based on these criteria carefully, as they apply to in vitro fertilization which is the most common ART method. It concludes that most ART methods would be unacceptable, but there are new alternatives like NaProTechnology that is promising for infertile couples.
What is the normal range of cervical mucus patterns and number of days with high or moderate day-specific probability of pregnancy (if intercourse occurs on a specific day) based on cervical mucus secretion, in women without known subfertility, and how are these patterns related to parity and age? The mean days of peak type (estrogenic) mucus per cycle was 6.4, the mean number of potentially fertile days was 12.1; parous versus nulliparous, and younger nulliparous (<30 years) versus older nulliparous women had more days of peak type mucus, and more potentially fertile days in each cycle. The rise in estrogen prior to ovulation supports the secretion of increasing quantity and estrogenic quality of cervical mucus, and the subsequent rise in progesterone after ovulation causes an abrupt decrease in mucus secretion. Cervical mucus secretion on each day correlates highly with the probability of pregnancy if intercourse occurs on that day, and overall cervical mucus quality for the cycle correlates with cycle fecundability. No prior studies have described parity and age jointly in relation to cervical mucus patterns. STUDY DESIGN, SIZE, This study is a secondary data analysis, combining data from three cohorts of women: 'Creighton Model MultiCenter Fecundability Study' (CMFS: retrospective cohort, 1990-1996), 'Time to Pregnancy in Normal Fertility' (TTP: randomized trial, 2003-2006), and 'Creighton Model Effectiveness, Intentions, and Behaviors Assessment' (CEIBA: prospective cohort, 2009-2013). We evaluated cervical mucus patterns and estimated fertile window in 2488 ovulatory cycles of 528 women, followed for up to 1 year. PARTICIPANTS/MATERIALS, SETTING, Participants were US or Canadian women age 18-40 years, not pregnant, and without any known subfertility. Women were trained to use a standardized protocol (the Creighton Model) for daily vulvar observation, description, and recording of cervical mucus. The mucus peak day (the last day of estrogenic quality mucus) was used as the estimated day of ovulation. We conducted dichotomous stratified analyses for cervical mucus patterns by age, parity, race, recent oral contraceptive use (within 60 days), partial breast feeding, alcohol, and smoking. Focusing on the clinical characteristics most correlated to cervical mucus patterns, linear mixed models were used to assess continuous cervical mucus parameters and generalized linear models using Poisson regression with robust variance were used to assess dichotomous outcomes, stratifying by women's parity and age, while adjusting for recent oral contraceptive use and breast feeding. MAIN The majority of women were <30 years of age (75.4%) (median 27; IQR 24-29), non-Hispanic white (88.1%), with high socioeconomic indicators, and nulliparous (70.8%). The mean (SD) days of estrogenic (peak type) mucus per cycle (a conservative indicator of the fertile window) was 6.4 (4.2) days (median 6; IQR 4-8). The mean (SD) number of any potentially fertile days (a broader clinical indicator of the fertile window) was 12.1 (5.4) days (median 11; IQR 9-14). Taking into account recent oral contraceptive use and breastfeeding, nulliparous women age ≥30 years compared to nulliparous women age <30 years had fewer mean days of peak type mucus per cycle (5.3 versus 6.4 days, P = 0.02), and fewer potentially fertile days (11.8 versus 13.9 days, P < 0.01). Compared to nulliparous women age <30 years, the likelihood of cycles with peak type mucus ≤2 days, potentially fertile days ≤9, and cervical mucus cycle score (for estrogenic quality of mucus) ≤5.0 were significantly higher among nulliparous women age ≥30 years, 1.90 (95% confidence interval (CI) 1.18, 3.06); 1.46 (95% CI 1.12, 1.91); and 1.45 (95% CI 1.03, 2.05), respectively. Between parous women, there was little difference in mucus parameters by age. Thresholds set a priori for within-woman variability of cervical mucus parameters by cycle were examined as follows: most minus fewest days of peak type mucus >3 days (exceeded by 72% of women), most minus fewest days of non-peak type mucus >4 days (exceeded by 54% of women), greatest minus least cervical mucus cycle score >4.0 (exceeded by 73% of women), and most minus fewest potentially fertile days >8 days (found in 50% of women). Race did not have any association with cervical mucus parameters. Recent oral contraceptive use was associated with reduced cervical mucus cycle score and partial breast feeding was associated with a higher number of days of mucus (both peak type and non-peak type), consistent with prior research. Among the women for whom data were available (CEIBA and TTP), alcohol and tobacco use had minimal impact on cervical mucus parameters. LIMITATIONS, We did not have data on some factors that may impact ovulation, hormone levels, and mucus secretion, such as physical activity and body mass index. We cannot exclude the possibility that some women had unknown subfertility or undiagnosed gynecologic disorders. Only 27 women were age 35 or older. Our study participants were geographically dispersed but relatively homogeneous with regard to race, ethnicity, income, and educational level, which may limit the generalizability of the findings. Patterns of cervical mucus secretion observed by women are an indicator of fecundity and the fertile window that are consistent with the known associations of age and parity with fecundity. The number of potentially fertile days (12 days) is likely greater than commonly assumed, while the number of days of highly estrogenic mucus (and higher probability of pregnancy) correlates with prior identifications of the fertile window (6 days). There may be substantial variability in fecundability between cycles for the same woman. Future work can use cervical mucus secretion as an indicator of fecundity and should investigate the distribution of similar cycle parameters in women with various reproductive or gynecologic pathologies. STUDY FUNDING/COMPETING INTEREST(S): Funding for the three cohorts analyzed was provided by the Robert Wood Johnson Foundation (CMFS), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (TTP), and the Office of Family Planning, Office of Population Affairs, Health and Human Services (CEIBA). The authors declare that they have no conflict of interest. N/A.
To determine whether serum anti-Müllerian hormone (AMH) level is a predictor of clinical pregnancy in women trying to achieve a natural conception. Eleven studies (4,388 women) were ultimately included in this meta-analysis. The AUC and Cochran Q indices were 0.5932 and 0.5702, respectively. Serum AMH levels have poor predictive value for natural pregnancy. Our findings suggest that low serum AMH levels are not associated with reduced fertility.
NaProTECHNOLOGY – a chance for offspring or fraud? In the media space in Poland, you can meet the concept of Naprotechnology as an alternative to the in vitro procedure. Often, many myths and untruths appear in the discussion regarding this method of treatment. Naprotechnology is a new look at the health of women and men created by prof. Thomas Hilgers. It takes into account natural fertility biomarkers thanks to observation with the Creighton Model based on the female mucus. At every stage of diagnosis and treatment, Naprotechnology respects human life from the moment of conception and the mutual dignity of the spouses. It also does not use assisted reproductive procedures for ethical reasons. Naprotechnology is part of the broader scientific discipline of restorative medicine in infertility. Thanks to the accurate diagnosis and observation of the cycle, it is possible to correctly diagnose the cause of infertility. A proper diagnosis is the starting point for the implementation of specialized pharmacological and surgical treatment for both women and men. Properly used Naprotechnology and restorative medicine are highly effective in treating marital infertility. W przestrzeni medialnej w Polsce można spotkać pojęcie Naprotechnologii jako alternatywy dla procedury in vitro. Często w dyskusji pojawia się wiele mitów i nieprawdy dotyczących takiego sposobu leczenia. Naprotechnologia, stworzona przez prof. Thomasa Hilgersa, jest nowym spojrzeniem na zdrowie kobiety i mężczyzny. Uwzględnia ona naturalne biomarkery płodności dzięki obserwacji za pomocą Modelu Creighton bazującego na kobiecym śluzie. Na każdym etapie diagnostyki i leczenia Naprotechnologia szanuje ludzkie życie od samego poczęcia oraz wzajemną godność małżonków. Nie stosuje ona też procedur wspomaganego rozrodu z powodów etycznych. Naprotechnologia jest częścią szerszej dyscypliny naukowej, jaką jest przyczynowe leczenie niepłodności. Dzięki dokładnej diagnostyce i obserwacji cyklu możliwe jest postawienie prawidłowej diagnozy dotyczącej przyczyny niepłodności. Właściwa diagnoza jest punktem wyjścia dla wdrożenia specjalistycznego leczenia farmakologicznego i chirurgicznego zarówno wobec kobiety, jak i mężczyzny. Prawidłowo stosowana Naprotechnologia i przyczynowe leczenie niepłodności cechują się wysoką skutecznością leczenia niepłodności małżeńskiej.
The reference range and potential value of inhibin B are still unclear and controversial. This study aimed to define the variation trend of inhibin B in healthy women with age and explore its value in the reflection of ovarian reserve. A total of 2524 healthy reproductive age women from eight medical institutes nationwide were recruited. The variation tendency of inhibin B with age was primarily established in the first group of 948 women and validated in another 605. We evaluated the relationship between inhibin B and classic ovarian reserve and function markers. The potency of inhibin B in predicting AFC <5-7 was also estimated and compared with FSH. The nomogram showed that serum levels of inhibin B rapidly decreased after the age of 40. Inhibin B was positively correlated with AMH (R = 0.57, P < 0.001), AFC (R = 0.34, P < 0.001) and testosterone (R = 0.10, P = 0.002), and negatively correlated with FSH (R = -0.41, P < 0.001) and LH (R = -0.20, P < 0.001) and FSH/LH (R=-0.18, P < 0.001), while no correlation was found with PRL. Unexpectedly, Inhibin B (AUC = 0.74, P < 0.001 for the establishment population; AUC = 0.78, P < 0.001 for the validation population) had a slightly higher value than FSH (AUC = 0.71, P < 0.001 for the establishment population; AUC = 0.72, P < 0.001 for the validation population) in diagnosing AFC <5-7. For healthy reproductive age women, the decline of inhibin B can reflect decreased ovarian reserve effectively, having a good consistency with AMH and AFC. More importantly, inhibin B had an advantage in predicting AFC <5-7 compared with FSH, which suggested the potential of inhibin B in predicting ovarian response.
Infertility affects one in 16 married women in the United States where 12.7% of these seek treatment. The stress of infertility and treatment is known to impact marital satisfaction, which can be further complicated by personal and religious beliefs regarding the ethics of some assistive reproductive technologies. A morally acceptable approach to infertility diagnosis and treatment is natural procreative technology or NaProTECHNOLOGY (NPT) using the Creighton Model FertilityCare™ System. A quantitative, descriptive study utilizing demographic surveys and the Index of Marital Satisfaction found that couples using NPT reported marital satisfaction.
Infertility affects \~20% of the couples in the world. Assisted reproductive technologies (ARTs) are currently the most common treatment option for infertility. Nevertheless, ARTs may be associated with complications for mothers and/or offspring. Natural procreative technology (NaProTechnology) is a natural treatment which minimizes these risks by seeking to identify the causes of infertility to enable better treatments. This narrative review summarizes the complications related to ARTs and clarifies how the NaProTechnology approach can help ARTs to achieve better results or be used in alternative to ARTs. Data in the literature indicate that NaProTechnology is a natural approach for treating infertility. The percentage of live births obtained by NaProTechnology is similar to that of ARTs. An extensive search for the genetic defects causing infertility or subfertility through genetic testing can help both ARTs and NaProTechnology to achieve successful pregnancies. By discovering the underlying causes of infertility, genetic tests enable better family counseling, like the implications of transmitting risk- and disease-alleles to future generations.
We aim to describe the diagnosis and surgical management of urinary tract endometriosis (UTE). We detail current diagnostic tools, including advanced transvaginal ultrasound, magnetic resonance imaging, and surgical diagnostic tools such as cystourethroscopy. While discussing surgical treatment options, we emphasize the importance of an interdisciplinary team for complex cases that involve the urinary tract. While bladder deep endometriosis (DE) is more straightforward in its surgical treatment, ureteral DE requires a high level of surgical skill. Specialists should be aware of the important entity of UTE, due to the serious health implications for women. When UTE exists, it is important to work within an interdisciplinary radiological and surgical team.
This study reports on 632 cycles from 105 women who were using the CREIGHTON MODEL FertilityCare™ System to avoid pregnancy and had either a serious reason to avoid pregnancy or some degree of a lack of confidence. A progesterone level was drawn on the third day after the Peak Day as they were charting, and if the progesterone level was 2.3 ng/mL or greater, then ovulation was determined to have passed. If the level was greater than 3.0 ng/mL, this indicated that an absolute period of infertility had begun. In these cases, no pregnancies were observed. In the 27 cycles in which a specific follow-up relative to pregnancy could not be definitively determined, the progesterone levels in all cases were 2.3 ng/mL or greater with 23 of the 27 cycles being 3.1 ng/mL or greater. It is highly unlikely that any of those became pregnant as well. These cycles were collected over thirteen years (2004-2016). Two case presentations are also a part of this article of two families in which the couples had very serious reasons to avoid pregnancy. In these two couples, each of the women was multi-gravid and had no evidence of subfertility or infertility. They used the family planning progesterone level (the Peak Day +3 progesterone level) for a total of 167 cycles over a number of years successfully without a subsequent pregnancy.
This article presents a thirteen-year effort to evaluate the serum progesterone level on the third day after the Peak Day as observed by women charting the CREIGHTON MODEL FertilityCare™ System. It is known that the Peak Day is associated with ovulation, and if the progesterone reaches a certain level, then an absolute period of infertility should follow. In fact, this is what this study reflects.
Mirkes R, 2020·The National Catholic Bioethics Quarterly
This article considers one question: How does the Catholic Church guide infertile couples to exercise their right to build a family? Part One examines the principal tenets of Catholic social teaching on human rights in general. Part Two focuses in particular on the Church’s guidelines regarding the right to family planning for infertile couples. And Part Three contrasts NaProTechnology protocols for infertility with in vitro fertilization and concludes that NaPro provides infertile couples not only a responsible means of conceiving a baby that remedies the injustice of in vitro fertilization but also a medical embodiment of the Church’s teaching on the right to family planning.
Endometrial BCL6 protein levels are significantly elevated in women with unexplained recurrent pregnancy loss and unexplained infertility compared with fertile controls, with 79% of subfertile women displaying elevated BCL6. Among those with abnormal BCL6 who underwent laparoscopy, most were found to have endometriosis, suggesting a continuum of progesterone resistance and inflammatory/endometriosis-related endometrial dysfunction.
Golianovskyi OV et al., 2020·Reproductive Endocrinology
There are still many complex issues in the management of autoimmune pathologies in gynecology and reproductology, endometriosis in particular. Naltrexone, a competitive antagonist of opiate receptors in the central and peripheral nervous systems, reveals new qualities such as effects on autoimmune processes. Naltrexone in low doses of 1.7–5 mg (Low Dose Naltrexone, LDN) revealed the opposite effect on opiate receptors in the form of a rebound effect and, as a consequence, a strong increase in endogenous endorphins and enkephalins. Studies of elevated levels of these neurotransmitters have provided evidence of a multidisciplinary beneficial effect on the immune system of people with endorphin and enkephalin deficiency, an association between the endogenous opiate system and cells and tissue growth in general and healthy immune function was confirmed. The most explored effects of them are such as blocking the synthesis ofpro inflammatory cytokines IL-6, IL-12, tumor necrosis factor, the effect on neuroglia through toll-like receptors, the effect on the cycle cells growth, especially malignant tumor cells, through interaction with opiate growth factor, modulation synthesis of T- and B-lymphocytes. Growing evidence of LDN efficacy is becoming a potentially effective clinical practice in autoimmune pathologies, but still off-label used.Some data of clinical trials is presented. Four studies with Crohn's disease with results of relief of symptoms and remission, including experience in pediatrics. Three clinical trials with LDN results in multiple sclerosis with improved quality of life and improved symptoms. The scientific hypothesis suggests the success of LDN due to the reduction of induced nitric oxide synthase activity. The success of management of patients with malignant tumors is also presented. The article contains the latest data from clinical trials on reported serious and non-serious side effects of naltrexone at various doses, including data confirming the safety of taking mid-therapeutic naltrexone doses throughout pregnancy. These effects of LDN may prove to be effective in management patients with endometriosis.
ethics-and-policy/reproductive-ethics/embryo-statusassisted-reproduction/safety-and-risks/procedural-safetyrestorative-reproductive-medicine/philosophy-and-principles/root-cause-approach
Open Access
Immersed in the world dominated by pragmatism, contemporary man seems to be thinking and functioning only according to the criteria of effective acting. However, life experience, philosophical reflection, and the truth of Revelation lead to the conclusion that the laws of nature must be respected in the name of care for man and for one’s genuine good, even though they may, in certain cases, limit the effectiveness of acting and the possibility to acquire current profit. This article justifies the necessity to respect natural law in the sphere of transmission of human life. The starting point of this scientific reflection is the theological vision of values and of the inviolability of human life on the basis of the description of creation from the Book of Genesis. The fundamental truths and moral norms are being neglected nowadays as—being so proud of modern technological achievements—man makes himself the creator and the master of human life. Although such activities seem impressive from the scientific point of view, they actually result in a number of serious contemporary and future threats. The second part of the article presents alarming aspects of artificial interventions in the sphere of life transmission. By exposing the threats and by trying to prevent them in the sphere of infertility treatment, the Church opposes the methods of artificial insemination and becomes engaged in promoting naprotechnology which is a method that expresses genuine humanism, and which gives hope not only to the parents who want to have a baby but also to the mankind that longs for propitious future.
Some authorities have found that, when the mean follicular diameter is >25 mm, the follicle is considered large, and these authorities are convinced that large follicles are biomarkers to ovarian pathology. Several studies have been carried out to determine the optimal maximum follicular size (MFS) that will be adequate before the use of human chorionic gonadotropin trigger to induce ovulation. None of these studies have considered the woman's age as a factor. An in vitro fertilization-based study has also shown that large leading follicles did not result in higher percentage of matured oocytes, and they even result in a lower live birth rate; however, we note that the ages of the women were not specifically mentioned in connection with the problems of large follicle. Subjects and We set out in this study to evaluate the relationship between the MFS and the woman's age both in our control group (fertile women) Group (A) and in the women attending fertility clinic Group (B). Using the Creighton Model Fertility Care System and NaProTECHNOLOGY, it was possible to determine when to start follicular tracking and also determine ultrasound diagnosis of ovulation by recording the MFS and the reduced size. In both Group A and Group B, we discovered that the MFS reduces as woman's age increases. We also discovered that the average MFS in the Group B was higher for age compared with the Group A (P = 0.0043). There was also an association between these bigger follicles for age and low mid-luteal progesterone. This is probably the first study that describes the association of follicular size and woman's age and its possible link with ovulation defects. Recommendation: We have proposed that this phenomenon of large matured maximum follicle for age could be a contributory factor to infertility and miscarriages. We propose further studies to verify this hypothesis. Despite the high percentage of complete rupturing of follicles in the AB cycles in the Group (B) there are very high proportion having low mid luteal (P+7) Progesterone. This may be due to pathologies associated with big follicles for woman's age. The E2/Pg ratio study in luteal phase strongly suggested that the women in Group (B) that may have fertility challenge are those in subgroup of AB in Group (B). Therefore matured follicular size should be considered with the woman's age. If the follicles grows bigger away from the range for a woman's age it may be the marker for infertility or reproductive health challenges.
Background. Infertility is a disease of the reproductive system manifesting with the inability to get pregnant within a minimum of 12 months. In diagnosing infertility and the therapeutic process, pharmacotherapy, surgery and assisted reproductive technology are used. In Poland, the NaProTechnology program is also available, which is a diagnostic and therapeutic method of reproductive health disorders without utilizing assisted reproduction. The midwife can play an important role in the care of the infertile couple.
A special course on Marriage, the Family and Human Sexuality was established at Kenrick-Glennon Seminary in St. Louis so as to assist the seminarians in their better understanding of the Church's teaching relative to natural methods of family planning and women's health care. This article compares the response at the beginning of this three-credit semester course to the same seven-item questionnaire given at the conclusion of the course. The preand postcourse scores were calculated for each of the questions. The scores obtained after the course were all significantly higher than they were before the course with p values ranging from 0.01 to <0.0001. Four of the items showed marked improvement including an understanding of the church's teaching related to natural methods, current methods of natural family planning, the impact of a natural method on a couple's marriage, and also the impact of a natural method on family life. Statistically significant improvement was also seen in their understanding of the topic of natural family planning and the Creighton Model System and its relevance toward the seminarian's vocation, the use of the methods to either achieve or avoid pregnancy, and how contraception and abortion are linked. In these last three items, the level of statistical significance was quite high, although not as high as the other four items. There were 104 seminarians over an eight-year period of time, who provided answers to these questions, both before and after the course. This course was modeled after a course that was initiated at the Pope Paul VI Institute for the Study of Human Reproduction, which was for priests, seminarians, and Catholic leaders, titled Love & Life Unlimited. NONTECHNICAL This is an evaluation of a ten-point, seven-question questionnaire that was utilized at the beginning of a course at Kenrick Seminary in Marriage, Sexuality, Creighton Model and NaProTECHNOLOGY. The same questionnaire was given to the students at the beginning of the course and then two to three months later at the conclusion of the three-credit course. The results show that there is a significant improvement in the seminarians' knowledge and general attitude about natural methods of family planning and suggests that such courses would be beneficial to establish in seminaries throughout the country.
Presentation examining the safety and potential benefits of low-dose naltrexone (LDN) use during pregnancy. Reports on a patient survey of 237 successful pregnancies comparing outcomes between LDN users and non-users. Addresses three key questions: safety of LDN in pregnancy, additional benefits to mother and baby, and optimal duration of treatment. Findings suggest LDN is safe during pregnancy with trends toward improved outcomes (reduced prematurity, fewer SCBU admissions, fewer complications) for those continuing LDN beyond 26 weeks, though results did not achieve statistical significance. Also discusses potential epigenetic benefits of LDN for reducing endometriosis expression in the next generation and possible reduction of autism risk through immune modification.
Catholic bioethicists have extensively addressed extrauterine tubal pregnancies, which represent the great majority of ectopic pregnancies. However, additional management options have been developed for the other 7-10 percent of ectopic pregnancies. Using two cases of interstitial pregnancy and two cases of cesarean scar pregnancy (CSP) seen at a Catholic tertiary care center, this article discusses options including expectant management, systemic methotrexate, intragestational methotrexate, intragestational potassium chloride, uterine artery embolization, dilation and curettage (D&C), vasopressin use, cornuostomy, cornual wedge resection, CSP evacuation, CSP scar excision, CSP salvage, and hysterectomy. Cornual wedge resection, vasopressin use, and CSP scar excision are morally acceptable; less clearly licit are aspiration of gestational sac contents, cornuostomy, gestational excision for CSPs, and methotrexate. Certainly illicit are any techniques leading to direct abortion such as D&Cs on live embryos or fetuses, double-balloon catheter placement, and use of potassium chloride.
An ectopic pregnancy is any pregnancy outside the uterus. These are dangerous because the pregnancy can burst out of its abnormal location and cause life-threatening internal bleeding. Most are in the part of the fallopian tube outside the uterus, but there are other types, including interstitial pregnancies (located in the part of the tube tunneling through the uterine wall) and cesarean scar pregnancies (buried in the uterine scar where the cut for a C-section was made). This article lists the ways that physicians prevent women from dying from interstitial and cesarean scar pregnancies and proposes which treatments are morally acceptable.
The Creighton Model FertilityCare(TM) System (CrM) is a standardized approach for educating women about the biomarkers of their fertility. Couples can use this information for timing intercourse during "fertile" or "infertile" days in order to try to conceive or to avoid pregnancy. The study of Creighton Model Effectiveness, Intentions, and Behaviors Assessment (CEIBA) was conducted to assess fertility motivations, intentions, fertility-related sexual behaviors, and their impact on effectiveness to avoid and to conceive among new users of the CrM. This paper reports enrollment baseline characteristics. We conducted this prospective cohort study at 17 CrM FertilityCare(TM) Centers; 16 in the USA and one in Toronto, Canada. Couples who were new or returning users of the CrM were eligible. Couples who were initially trying to conceive or had a history of subfertility were excluded. Couples were enrolled and followed prospectively by their CrM instructors and also by CEIBA study staff. They completed baseline questionnaires. 1,132 new couples were assessed; 1,090 (96%) couples were screened; 429 (39%) couples were eligible; 305 women (71%) and 290 (95%) male partners were enrolled. The majority of women was engaged (39%) or married (51%), college graduates (77%), Caucasian non-Hispanic (80%), and Roman Catholic (80%). The most common reasons for learning CrM (women) were to use a natural method for family planning (91%), for moral/ethical/religious reasons (70%), the lack of side effects (71%), or insight into the menstrual cycle and fertility (62%). Women and men intended to have a mean of three and two additional children, respectively. Of women, 21% intended to have a child within a year and 60% between 1 and 3 years. The mean positive childbearing motivation score was 3.3 for both women and men (range 1-4, with 4 being most positive). Couples beginning use of the CrM to avoid pregnancy have high levels of motivation, desire, and intention for future childbearing. The CEIBA study has prospective measures of desires, intentions, and sexual/fertility behaviors for up to 1 year. We will assess the impact of desires, intentions, and behaviors on the pregnancy rates among these couples.
Malaria is prevalent in Nigeria, and artemether + lumefantrine (artemisinin-based combination therapy [ACT]) is drug of choice in treatment of uncomplicated cases. ACT is contraindicated in early pregnancy. They release-free radicals that can compromise female fertility. Infertility and its associated complications such as miscarriages, abnormal gestation, and unstable marriages seem to be on the increase. This study aims at evaluating the effect of ACT on female fertility. The significance of this research is to draw the attention of fertility care givers to this possible cause of infertility and fertility challenges. Subjects and Creighton Model FertilityCare System and NaProTECHNOLOGY are simply technologies that can be used to assess female fertility. They are used in this study to assess the effect of ACT administered at different stages of menstrual cycles of three selected fertile adult females. The results are interpreted on the background of standard Creighton model chart. This study has shown that ACT has a significant fertility deteriorating effect on the women. It caused ovulation defect and diagnosed as partial rupture syndrome in the very cycle of use and in the first cycle after use. It also significantly reduced cervical mucus production and significantly reduced luteal phase progesterone production with an associated significant increase of luteal phase estrogen production. ACT use as antimalarial may be a possible cause of infertility and fertility challenges in women.
restorative-reproductive-medicine/naprotechnology/protocols-and-frameworkmenstrual-cycle/cycle-biomarkers/cervical-mucusethics-and-policy/reproductive-ethics/conscience-protections
Open Access
NaProTECHNOLOGY is a new field of medicine specializing in the promotion of human procreation. Its foundation is a teaching system called the Creighton Model Fertility Care System. It is based on the ability to observe and record biological biomarkers, enabling spouses to recognize and understand the naturally occurring cycle of fertility and infertility. The spouses can use their acquired knowledge both for achiving pregnancy and avoiding pregnancy. The system also enables them to broaden their knowledge to better understand sexuality and deepen their mutual love. It also plays an important role in diagnosing and treating reproductive health according to the natural cycle of women. NaProTECHNOLOGY is involved in building a "new culture of life" through integral concern for human fertility by restoring natural procreation and respecting the principles of responsible parenthood.
To our knowledge, data on comparison of myo-inositol and metformin on clinical, metabolic and genetic parameters in subjects with polycystic ovary syndrome (PCOS) are limited. This study was carried out to compare myo-inositol and metformin on clinical, metabolic and genetic parameters in subjects with PCOS. DESIGN, This randomized controlled trial was conducted among 60 subjects with PCOS aged 18-40 years. Subjects were randomly allocated into two groups to receive either myo-inositol (N=30) or metformin (N=30) for 12 weeks. Gene expression of inflammatory cytokines was assessed in peripheral blood mononuclear cells (PBMCs) of PCOS women by RT-PCR. After the 12-week intervention, compared with metformin, myo-inositol intake significantly decreased serum total testosterone (-1.4±4.2 vs +0.7±1.4 nmol/L, P=.03), modified Ferriman-Gallwey (mF-G) scores (-1.1±0.7 vs -0.5±0.8, P=.01) and serum high-sensitivity C-reactive protein (hs-CRP) levels (-2.6±3.9 vs +0.2±1.5 mg/L, P<.001). RT-PCR demonstrated that compared with metformin, myo-inositol downregulated gene expression of interleukin-1 (IL-1) (P=.02) in PBMCs of subjects with PCOS. We did not observe any significant effect of myo-inositol intake compared with metformin on other hormonal profiles, plasma nitric oxide (NO) or gene expression of IL-8 and tumour necrosis factor alpha (TNF-α). Overall, taking myo-inositol, compared with metformin, for 12 weeks in patients with PCOS with hyperinsulinism and normoinsulinism had beneficial effects on total testosterone, mFG scores, serum hs-CRP levels and gene expression of IL-1, but did not affect other hormonal profiles, NO levels or gene expression of IL-8 and TNF-α.
gynecology/infections/vaginal-and-cervical-infectionsethics-and-policy/reproductive-ethics/conscience-protectionsrestorative-reproductive-medicine/naprotechnology/protocols-and-framework
Open Access
En la actualidad hay suficiente evidencia científica que relaciona directamente adquisición, exposición y prevalencia del virus del papiloma humano (VPH) con el cáncer del cuello de uterino. Por ello, el artículo aborda el VPH en la mujer teniendo en cuenta la naprotecnología, que permite conjugar evidencia científica y planteamientos éticos. Se busca que se tengan en cuenta tanto el aspecto biológico de la sexualidad como la capacidad de hacerse persona en su núcleo sexual. De ahí que se analicen programas dirigidos a la educación sexual, basados tanto en la prevención sanitaria como en la antropología de la sexualidad, y apoyados por las instituciones familiares, que han demostrado una mejor acogida ante los riesgos de las enfermedades de transmisión sexual, y entre ellas la infección por el VPH.
The topic of how the menstrual cycle is a vital sign which could signal pathophysiologic process has received considerable attention in the past decade. The current recommendations of various academic groups will be discussed as well as the FertilityTMM Care method of charting and the Naprotechnology approach to evaluating abnormalities of the menstrual cycle. Two clinical scenarios seen in adolescent medicine, PCOS and AUB, will be analyzed looking at the pathophysiology of these clinical scenarios and their management. The approach will be one that conducts an evaluation to try to find the underlying problem and aims to restore the normal physiology of the menstrual cycle.
The American Academy of Pediatrics, the American College of Obstetrics and Gynecology and the New York Academy of Sciences have published academic statements during the past ten years emphasizing the need for providers to teach patients how to chart and the important clinical ramifications of using this charting as a vital sign. In 2006 the American Academy of Pediatrics published in the Pediatrics Journal a recommendation titled: "Menstruation in Girls and Adolescents: Using the Menstrual Sign as a Vital Sign." In 2015, the American College of Obstetrics and Gynecology published a Committee Opinion emphasizing the need to teach women the charting of their menses and the important pathophysiologic process that could be detected with the charting.
This population-based cohort study examined preconception TSH levels and their association with pregnancy outcomes in 184,611 Chinese women planning to conceive. Women were classified into reference (0.48-2.49 mIU/L), upper limit (2.5-4.28 mIU/L), and high TSH (4.29-10 mIU/L) groups. The high normal TSH group showed higher rates of spontaneous abortion, preterm birth, and operative vaginal delivery compared to reference. The high TSH group had higher rates of spontaneous abortion, stillbirth, and preterm births.
The article raises the issue of today’s application of assisted (artificial) reproduction methods, which are incom-patible with human dignity. The authors articulate the principles of human dignity, which are formulated as an evaluation tool of criteria and them revealing system of indicators in the assessed object. The article compares Naprotechnology as a contemporary holistic method of diagnosis and treatment of infertility, which comprises therapeutic, surgical and fertility awareness method, with methods of assisted reproduction and identifies their medical and ethical differences. The project of the Assisted Reproduction Law of the Republic of Lithuania is evaluated in the aspect of human dignity as well.
Flores R, 2016·Scholars Academic Journal of Biosciences
The latest retrievable data about infertility in the Philippines was made available to the public by Merck Serono, a private pharmaceutical company who commissioned the survey in 2011. The survey was conducted by Synovate in 100 participating households in the Philippines, particularly in key cities located in Luzon, Visayas and Mindanao. The survey results revealed that one out of ten Filipino couples are suffering from infertility. And these couples are not seeking treatment due to the following reasons: (1) financial constraints; (2) time constraints; and (3) the patient’s belief. Of all these, financial constraints, at 86%, is the primary reason why infertile couples are not seeking treatment. In addition to this data, the Chief of The Medical City’s Reproductive Medicine, Infertility and Gynecologic Endoscopy, Dr. Marc Anthony Ancheta, further reveals that “some 35 to 40% of a couple’s inablity to conceive a child are due to female factors; while the other 35 to 40% could be attributed to male factors.” While male factor infertility is also deserving of proper attention, it is the female factor infertility that should receive greater attention and focus in terms of treatment. Why? Because, primarily, the female’s reproductive cycle is very complex and would need months and/or years to partially identify the underlying reason/s of infertility; and second, the female’s ability to conceive naturally will fall by 50% when she reached the age of 35. Therefore, there should be urgency in treating female factor infertility in an efficient, ethical and affordable way. And these conditions can be achieved by the use of NaPro Technology.
Progesterone support in pregnancy has been in use for over 60 years, having received its start in the 1940s. Its initial use was in patients who had habitual spontaneous abortion caused by luteal phase deficiency. More recently, the administration of progesterone later in pregnancy has been considered to be justified because of an observed decrease in circulating progesterone with the onset of labor, an association of premature labor with decreased progesterone concentrations, and the observation that progesterone has a tocolytic effect. A considerable boost to the use of progestational agents to reduce preterm delivery was received with the publication of two papers which showed a significant reduction in preterm delivery rates with the prophylactic administration of either progesterone or 17-a hydroxyprogesterone caproate. Recently it has been shown, however, that its use is not universal. This may be related to the significant late sequelae that were documented following the in utero exposure of the fetus to the potent steroid diethylstilbestrol (DES) and that this bad experience cast “a long shadow,” In spite of this, the use of progesterone, at least in early pregnancy, is widespread in the various artificial reproductive programs and is growing in its use as an agent to reduce prematurity. Over the years, there has been an extraordinary amount of confusion related to the use of progesterone support in pregnancy. The Food & Drug Administration (FDA) created some of this confusion. In various labeling of progesterone products by the FDA, one of the contraindications to the use of oral progesterone is listed as “known or suspected pregnancy.” And, yet, no such contraindication is identified for the use of progesterone gel. In fact, progesterone gel is indicated for progesterone supplementation or replacement as a part of an assisted reproductive technology (ART) treatment program for infertile women with a progesterone deficiency. To make this even more confusing, oral progesterone, while it was contraindicated in “known or suspected pregnancy,” its official labeling stated that it “should be used during pregnancy only if indicated (see contraindications).” Also, up until very recently, there was a dire “warning” contained in the labeling for USP progesterone injection in sesame seed oil regarding an increased possibility of birth defects. An analysis of the fetal safety of isomolecular progesterone (Pregn-4-ene-3,20-dione) administration during the course of 1,310 pregnancies over a 35-year period of time (1979-2014) was undertaken to address this confusion.
assisted-reproduction/procedures/ivf-protocolsethics-and-policy/reproductive-ethics/embryo-status
Open Access
In vitro fertilization (IVF) is a method known almost all over the world, by which modern man is trying to cope with the problem of infertility. The aim of this article is to show the eugenic roots of in vitro and to attempt to reconciliate the supporters and opponents of this controversial procedure at a NaProTechnological plane. In order to achieve this, the author characterizes IVF from the technical, medical and legal point of view. Then, the article shows the relationship between the in vitro procedure and eugenic thought. The third section contextualizes the problem of artificial insemination in the contemporary, human uncritical faith in technological progress. The last part of this article directs the reader's attention towards NaProTechnology – a method of infertility treatement which can engage both the supporters and the opponents of IVF.
Porcaro G et al., 2015·European review for medical and pharmacological sciences
The clinic use of alpha Lipoic Acid (ALA) is linked to its capability to exert antioxidant effects and, more interestingly, to counteract the pathologic changes of complex networks of cytokines, chemokines and growth factors, restoring their physiological state. The aim of this randomized controlled clinical trial was to test the contribution of oral supplementation of ALA to the standard treatment with Progesterone vaginal suppositories, in healing subchorionic hematomas in patients with threatened miscarriage. Controls were administered only Progesterone suppositories. Nineteen pregnant women in the first trimester of gestation, with threatened miscarriage and ultrasound evidence of subchorionic hematoma, were included in the trial and randomly divided in two groups: controls, treated with 400 mg Progesterone (200 mg 2 times per day), given by vaginal suppositories, and case study treated with the same Progesterone dosage, plus ALA, given orally at the dose of 600 mg (300 mg 2 times per day, DAV(R), Lo.Li. Pharma srl, Italy). Sixteen patients completed the trial. Treatment was performed until complete resolution of the clinical picture. In both groups, the subjects improved significantly but, in general, a better and faster evolution in the major signs of threatened miscarriage was observed in the subjects treated with ALA and Progesterone. In these patients, the speed of resorption of subchorionic hematoma was significantly (p <= 0.05) superior compared to controls. The ALA and Progesterone group showed a faster decrease or disappearance of all symptoms than that observed in the control group, however the difference was not significant. These preliminary results suggest that ALA supplementation significantly contributes to speed up the process of restoration of physiological conditions in threatened miscarriage and ameliorates the medical conditions of both the mothers and the foetus, probably modulating the networks of cytokines, growth factors and other molecules.
The Creighton Model FertilityCare System (CrMS) teaches women to identify days when intercourse is likely to result in pregnancy. We sought to assess the impact of the CrMS on time to pregnancy (TTP), via per-cycle pregnancy rates (fecundability). We conducted a parallel randomised trial at the University of Utah School of Medicine, 2003-06. Women ages 18-35 years, in a relationship of proven fertility, who desired to conceive, were block-randomised and stratified for age, with allocation concealment by opaque sequentially numbered sealed envelopes. The control group received the advice to have intercourse 2-3 times per week, and the intervention group received CrMS instruction. All women were asked to begin trying to conceive starting the second cycle in the study and were followed actively up to seven cycles, without blinding of research personnel. We calculated descriptive statistics and fecundability, and estimated Cox models for TTP. (Clinicaltrials.gov NCT00161395). There were 143 women randomised: 71 to the control group (all analysed) and 72 to the CrMS group (69 analysed). The adjusted hazard ratio for the influence of CrMS on TTP was 0.86 [95% confidence interval (CI): 0.53, 1.38]. Fecundability in cycles with intent to conceive was 31% in controls and 36% with CrMS (P = 0.32). By the first cycle, fecundability was 17% in controls, and 4% with CrMS (P = 0.02). No adverse events were reported. We found no significant impact of CrMS on TTP or fecundability, but fewer of the women receiving CrMS conceived by the first cycle.
Endometriosis, an underdiagnosed and undertreated condition, affects 1 in 10 women and is associated with pain and infertility. Preoperative evaluation should include testing and management of other causes of pelvic pain. Ultrasonography can aid in surgical planning. Hormonal suppression improves symptoms, but should not be used to diagnose endometriosis, and is not shown to be effective in preventing disease recurrence nor in improving fertility. The goal of surgical management should be optimal removal or treatment of disease and should include measures for adhesion prevention. Rates of recurrence of endometriosis depend on the surgical completeness of removing the disease.
fertility-awareness/effectiveness/comparative-effectivenessrestorative-reproductive-medicine/naprotechnology/protocols-and-frameworkmenstrual-cycle/cycle-biomarkers/cervical-mucus
Open Access
L’auto-osservazione e il follow-up grafico del ciclo mestruale in caso di presunta sterilita, aiutano a diagnosticare e trattare certe alterazioni ginecologiche, al fine di attuare il rapporto sessuale finalizzato ad ottimizzare concepimento. Attraverso queste procedure naturali (naprotecnologia), prive di aspetti negativi da un punto di vista etico, possiamo ottenere tassi di natalita che sono paragonabili, o addirittura superiori, a quelle ottenute con trattamenti invasivi. ---------- Self-observation and the graphic follow-up of the menstrual cycle in cases of supposed infertility, help to diagnose and treat certain gynaecological alterations in order to carry out the sexual intercourse focused on optimising conception. Through these natural procedures (Naprotechnology), with no ethical drawbacks, we can obtain birth rates that are comparable, or even higher, to those obtained with invasive treatments.
AMH levels are commonly measured in fertility clinics to assess ovarian reserve and give an indication of female fertility potential. AMH levels are useful in deciding on stimulation protocols for IVF cycles. High AMH levels are useful to confirm a diagnosis of polycystic ovaries. Currently AMH levels cannot be used to predict a couple's ability to conceive naturally.
Naltrexone hydrochloride is a licensed drug with a growing number of novel uses. Nothing has been published on low dose naltrexone for infertility, miscarriage, PMS, or pregnancy, but there is published literature on high dose naltrexone. First synthesised in the 1960s and licensed in the USA in 1985 and Ireland in 1991, naltrexone at 50-150mg per dose is used as adjunctive treatment of opioid dependence and now alcohol dependence (unlicensed). It works through competitive inhibition of opioid receptors in both the central and peripheral nervous system.
In the last 50 years, a surge of reproductive technology has revolutionized the practice of obstetrics and gynecology. First, effective hormonal contraceptives were made available to the public in the 1960s and, since their debut, have been used to treat almost every gynecologic abnormality [1]. Second, in the past 30 years, infertility has largely been managed using assisted reproductive technologies (ART), primarily intrauterine insemination (IUI) with recourse to in vitro fertilization (IVF) when insemination fails [2]. As a result, the modus operandi in mainstream gynecology has been to suppress, or to bypass, the woman’s fertility cycle.
Physicians and patients who (1) conscientiously object to the therapeutic use of hormonal contraceptives on the grounds that it subjects patients to ineffective treatment of symptoms rather than treating their underlying disease and (2) morally oppose the ART approach to infertility on the grounds that it jettisons a loving act of marital intercourse, the one context worthy of the conception of a new human being, are now able to pursue an alternative approach that accords with their consciences. NaProTECHNOLOGY (an acronym for natural procreative technology) is a woman’s health science that encompasses a unique medical and surgical application of gynecology. The foundation of NPT is the Creighton Model FertilityCare System (CrMS), see Figure 1, the only prospective and standardized means of monitoring the various patterns of a woman’s menstrual and fertility cycle for the natural regulation of fertility.
For example, because it views infertility as a symptom rather than a disease, NPT seeks to diagnose and treat the underlying causes of infertility so that the couple can more successfully conceive within their own acts of intercourse, especially during peak-day-focused intercourse. NPT infertility protocols depend on patient-specific charting data. Some observations during the fertility cycle—dry, limited, or continuous mucus; short or variable post-peak phase; premenstrual spotting or tail-end brown bleeding—are external signs of possible underlying disease processes.
A medical interpretation of these abnormal CrMS observations leads to a targeted biochemical and hormonal evaluation, which in turn identifies target organ dysfunctions: decreased production of estrogenic cervical mucus, intermenstrual bleeding or spotting, short or variable luteal phases, and suboptimal levels of the ovarian hormones (estrogen or progesterone). Common treatments for these pathologies include induction or stimulation of ovulation, medications to enhance cervical mucus, and hormonal support in the luteal phase. When these NPT medical approaches to infertility were used in a study of 1,239 infertile couples, they resulted in a live birth rate similar to that of cohort ART treatments [3].
In many cases, medical applications of NPT are sufficient to treat infertility successfully; in other cases, surgical intervention is also required. Surgical NPT is a specialized form of gynecologic surgery the primary aim of which is to reconstruct the uterus, fallopian tubes, and ovaries. The ovarian wedge resection (surgical removal of a portion of an enlarged ovary to restore its normal size), for example, is effective in healing polycystic ovaries (contributing to the long-term treatment of some of the endocrine and menstrual cycle abnormalities associated with polycystic ovaries). It also brings the patient a 70 percent chance of pregnancy i.e., it is twice as effective as clomiphene [4].
A significant benefit of surgical NaProTECHNOLOGY is “near adhesion-free” surgery. One of the biggest pitfalls of surgery, of course, is the formation of postoperative adhesions, which can decrease tubal motility (adversely affecting fertility) and cause small bowel obstructions (that frequently require emergency reoperation) [5]. To prevent these complications, NPT surgical techniques pay meticulous attention to detail, take a systematic approach, and use Gore-Tex adhesion barriers [6]. Published Gore-Tex protocols reveal a statistically significant decrease in subsequent adhesion scores on second-look laparoscopy [7]. For some reason, the use of Gore-Tex has been overlooked in even the most recent adhesion prevention reviews [8]. One even laments that adhesion prevention is a “surprisingly neglected aspect of the treatment of endometriosis,” but the reviewers make no mention of the use of Gore-Tex as an adhesion barrier.
Other techniques of surgical NPT include laser vaporization and pelvic excision and repair surgery (PEARS) of peritoneal or ovarian endometriosis. PEARS is a form of plastic reconstructive surgery of the pelvis with the primary intent of removing diseased tissue within the pelvic organs and repairing organs in a way that does not form pelvic adhesions. PEARS can entail robot-assisted laparoscopy or laparotomy, minimizing postoperative adhesions and optimizing the patient’s chances for pregnancy.
The effectiveness of treating infertility with medical and surgical NPT is comparable to that of ART interventions. The cumulative live birth rate in patients receiving IVF is between 45-55% [10]. In a study population of 1,045 patients treated with NPT infertility protocols, more than 60 percent became pregnant within 24 months and nearly 70 percent within 36 months [11]. The overall �per-woman� NPT pregnancy rate is higher than that of ART due, in part, to the high rate of dropout or discontinuation in patients who undergo IVF treatment [12]. In addition, a meta-analysis comparing conventional surgery and IVF for treatment of endometriosis-related infertility found that the per-woman pregnancy rates with surgery were 55.3 percent while those with IVF were 9.9 percent [13]. However, while it is true patients treated with NPT have significantly lower overall fecundability (a 3.13 percent chance of conceiving within a given period) than those treated with IVF (13.3 percent), it is also true that the number of women who ultimately achieve a pregnancy with NPT is higher than the number who get pregnant using ART [14]. Thus, although achieving a live birth with NPT may take longer, it has a greater chance of occurring than with IVF.
For those interested in training in NPT, the Pope Paul VI Institute and Creighton University School of Medicine offer educational programs for those in primary care or ob/gyn (including fourth-year medical students) to train in the medical applications of NaProTECHNOLOGY [15]. They also offer a 1-year fellowship in the surgical applications of NPT for ob/gyns who have completed their residencies [16].
As the editor of the Anscombe Bioethics Centre's new book Fertility and Gender: Issues in Reproductive and Sexual Ethics (Watt 2011), I was delighted to read Sr. Renee Mirkes’ generous review in th...
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.
restorative-reproductive-medicine/restorative-care-and-assisted-reproduction/outcome-comparisonsethics-and-policy/reproductive-ethics/embryo-statusassisted-reproduction/procedures/ivf-protocols
Open Access
Infertility is a significant and constantly increasing individual and social problem. It is estimated that at present it affects approx. 15 to 20 percent of couples. Inability to conceive a child elicits a range of unfavourable implications in the scope of emotional experiences, in the partner’s relationship and in a broader social perspective. Making a decision on undergoing diagnostics and infertility treatment is a difficult and often postponed moment for many couples. This is an expression of the escape model of dealing with a situation that threatens with a fall of self-esteem. However, if a couple reacts in a task-oriented way and participates in the diagnostic and therapeutic procedure, new doubts appear connected with the medical, psychological, social and ethical sphere. Infertility treatment sometimes prompts fear connected with the stripping of intimacy, loss of control over one’s body, possible complications and unsuccessful therapy. This article is an analysis of the medical and the other aspects of struggling with infertility with reference to two extremely different methods of solving this NaProTechnology as a process of assisting natural procreation and assisted reproductive techniques with a special consideration of in vitro fertilization.
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. Retrospective cohort study. An urban Canadian primary care practice in which the physician had a part-time practice in NPT. Couples with infertility or recurrent miscarriage who received treatment in the practice between August 2000 and July 2006. 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. Live birth was the primary outcome; secondary outcomes included conceptions, multiple births, low birth weight, and prematurity. 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. 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.
Campbell S, 2011·Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
menstrual-cycle/cycle-biomarkers/hormonal-markersreproductive-endocrinology/ovulation-physiology/follicular-developmentfertility-awareness/biomarkers/urinary-hormone-monitoring
Open Access
El objetivo de este artículo es revisar los principales conceptos en la literatura acerca de la ventana de la fertilidad en pacientes con ciclos menstruales normales. El énfasis principal del artículo se ha dirigido al análisis de la teoría de Brown de la ovulación, revisar conceptos básicos de la ovulación, secreción y metabolismo de la hormona folículo estimulante, y al estudio clínico, ecográfico y bioquímicos del desarrollo folicular de la ventana de la fertilidad. Este artículo también repasa los biomarcadores clínicos y los diferentes metabolitos endocrinos que delimitan en la fase fértil del ciclo. Se revisan diferentes estudios en los cuales las valoraciones en suero y orina de los esteroides sexuales, han corroborado tener una correlación directa para enmarcar el período fértil. Actualmente tienen relevancia estos conocimientos en diferentes grupos de interés, sobre todo en mujeres con un alto nivel de motivación interesadas en el reconocimiento de su fertilidad, las cuales pueden beneficiarse mediante la aplicación de conocimientos técnicos actuales que detectan la ventana fértil. También estos conocimientos suelen cobrar importancia en aquellas personas que pertenecen a programas de regulación de la fertilidad (PRF), con intención de distanciar un embarazo, o de reconocer el periodo fértil del ciclo para conseguir un embarazo espontáneamente, o mediante programas de NaProTecnología. Otros grupos de interés, son aquellos en los cuales no se tiene experiencia en cursos de PRF, pero desean mejorar sus conocimientos en el reconocimiento de la fertilidad por medio de una breve entrevista, o por medio de cursos de orientación familiar.
The paper presents the main concepts of NaProTECHNOLOGY. Such problems as family planning effectiveness, targeted hormonal assessment of the menstrual cycle, ovarian hormone and target organ dysfunction, disorders of human ovulation, cooperative progesterone replacement therapy, premenstrual syndrome, postpartum depression, unusual bleeding, infertility and antiadhesion therapy are discussed.
Boyle PC et al., 2011·Biomedicina (Sveikatos Mokslai/Health Sciences)
Infertility is usually a consequence of multiple chronic conditions rather than a single acute condition. We propose that it is erroneous to apply acute medical interventions to a condition that is chronic in nature.
Retrospective analysis of 3 case studies which demonstrate the multifactorial and chronic nature of infertility that were previously managed unsuccessfully with acute intervention using IVF (in Vitro Fertilisation) or ART (Assisted Reproductive Technology).
Demonstration of the multifactorial approach and 3 successful singleton live births using NPT (Natural Procreative Technology or NaProTechnology). Infertility can be treated successfully with a multifactorial approach which takes into account the chronic nature of infertility and targets treatment to manage multiple factors responsible for the condition. Infertility is not a diagnosis but is often the expression of several underlying ill health conditions which if diagnosed and treated correctly will result in restoration of normal reproductive function. Physicians ought to consider broader diagnostic possibilities in their evaluation of infertile couples. A multifactorial treatment strategy for the chronic condition of infertility may be more effective than the widespread acute strategy employed by ART. Further study is required to investigate this possibility in more detail. Future studies looking at NPT and ART outcomes must be cohort studies comparing populations with similar patient characteristics.
The paper presents the main concepts of NaProTECHNOLOGY. Such problems as family planning effectiveness, targeted hormonal assessment of the menstrual cycle, ovarian hormone and target organ dysfucntion, disorders of human ovulation, cooperative progesterone replacement therapy, premustrual syndrome, postpartum depression, unusual bleeding, infertility and antiadhesion therapy are discussed.
Dr. Thomas W. Hilgers draws on decades of medical experience to provide educational and revolutionary insights into the world of women's health. The NaPro Technology Revolution provides real solutions to real problems such as infertility, repetitive miscarriage, menstrual cramps, postpartum depression, PMS, prematurity prevention, ovarian cysts, hormonal abnormalities, irregular/abnormal bleeding, chronic discharges, polycystic ovarian disease, and family planning. Hilgers sheds light on abnormal ovarian function, an issue that millions of women unknowingly suffer from. His methods have proven to assist infertile couples nearly three times more successfully than those who use In Vitro Fertilization, without the dangers of early abortions, frozen embryos, or high rates of multiple pregnancy. The NaProTechnology Prematurity Prevention Program cuts the rate from the national 12.7% to 7%. The NaPro Technology Revolution discusses what every woman has a right to know about her body, her health, and her future!
A somewhat pessimistic view on the prevention of postsurgical adhesions has developed over the years because rigorous surgical approaches may still result in the formation of postsurgical adhesions. In addition, postsurgical adhesion formation is associated with a significant degree of long-term morbidity. In this article, a surgical technique is presented which allows patients with the most extensive form of pelvic adhesions to undergo reconstructive pelvic surgery with a near–adhesion-free postoperative outcome. This study was undertaken to assess the effectiveness of a comprehensive, well-defined set of surgical techniques, with well-defined additions and subtractions in surgical technique over a period of 23 years and three distinct phases of implementation. This work was a systematic comparison of three case-series evaluated sequentially over time. The three surgical protocols were each completely standardized. This was a systematic comparison of three distinct case series of patients who had extensive pelvic adhesions. Three distinct and standardized surgical protocols were prospectively introduced and adhesion scores before and after surgical treatment were assessed and statistically compared for each of the three case series. Ninety-five (95) patients with extensive pelvic adhesive disease due to endometriosis or pelvic inflammatory disease participated in this assessment. They were chosen because of the extensive nature of their pelvic and adnexal adhesions. There were 26 patients in phase I (1987–1993), 44 patients in phase II (1994–2005), and 25 patients in phase III (2006–2009). Using the American Fertility Society scoring system for adnexal adhesions, the total adhesion score decreased from 33.8 to 18.1 in phase I, from 33.3 to 6.0 in phase II, and from 33.2 to 2.5 in phase III. Each decrease was statistically significant within each phase (P < 0.001). Further, a statistically significant decrease in subsequent adhesion scores (P < 0.01) was observed at the time of second-look laparoscopy, when comparing phases I to II, II to III, and I to III, with the lowest scores obtained with the phase III surgical techniques. With the use of a comprehensive, well-defined set of surgical antiadhesion techniques, it is possible to perform adhesion-free or near adhesion-free reconstructive pelvic surgery. (J GYNECOL SURG 26:31)
Couples presenting with 3 or more miscarriages fit the definition of recurrent miscarriage which affects 1% of those trying to conceive. Clinics based in Dublin and Galway use a multifactorial approach with NaProTechnology to evaluate and treat such couples. 355 couples with subfertility attended for 2+ consultations during 2010. 50 (14%) had 3+ miscarriages. Of 36 who conceived, 29 (80.6%) had live births, 4 (11.1%) miscarried, 2 (5.6%) had ectopic pregnancies. Average female age 37.5 years. Expected miscarriage rate for this population would be above 30-40%. A total miscarriage and ectopic rate of 16.7% per couple is encouraging. Women with recurrent miscarriage appear to have better than expected outcomes following a multifactorial NaPro treatment approach.
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. 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. 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. 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.
This essay sets down three directives for conscientiously objecting clinicians-physicians, particularly obstetrician/gynecologists, trained in NaProTechnology by the Pope Paul VI Institute and Creighton University School of Medicine and any medical professionals who share their natural law vision of reproductive health care-to protect their right to well-formed conscientious objection in reproductive medicine. Directive one: understand the nature of a well-formed conscience and its rightful exercise. Directive two: fulfill all reasonable American College of Obstetricians and Gynecologists' requirements for conscientious refusal. Directive three: execute a political strategy to protect health-care conscience rights.
Mikolajczyk RT et al., 2006·Paediatr Perinat Epidemiol
Approaches to measuring fecundity include the assessment of time to pregnancy and day-specific probabilities of conception (daily fecundities) indexed to a day of ovulation. In this paper, we develop an additional approach of calculating expected pregnancies based on daily fecundities indexed to the last day of the menstrual cycle. Expected pregnancies can thus be calculated while controlling for frequency and timing of coitus. Comparing observed pregnancies with expected pregnancies allows for a standardised comparison of fecundity between studies or groups within studies, and can be used to assess the effects of categorical covariates on the woman or couple level, and also on the cycle level. This can be accomplished in a minimal data set that does not necessarily require hormonal measurement or the explicit identification of ovulation. We demonstrate this approach by examining the effects of age and parity on fecundity in a data set from women monitoring their fertility cycles with the Creighton Model FertilityCare System.
Large retrospective cohort study investigating whether different causes of infertility (endometriosis, anovulation, tubal disease, male factor, cervical/uterine disorders) predict future cancer risk among 12,193 women who sought infertility treatment at five U.S. reproductive endocrinology practices between 1965 and 1988, with cancer incidence tracked through 1999.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
The CREIGHTON MODEL FertilityCare System (CrMS) rests on a decades-long body of research demonstrating that cervical mucus functions as a physiologically regulated biological valve, opening predictably at the periovulatory estrogen rise and closing in the post-Peak phase. Chapter 15 of Hilgers (2004) synthesizes hormonal, ultrasound, cytologic, and biophysical evidence to establish that a woman's external observation of her Peak Day reliably identifies the fertile window, and documents the system's effectiveness data for both achieving and avoiding pregnancy across a five-study meta-analysis of nearly 1,900 couples.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
PCOS (polycystic ovary syndrome), increasingly designated PMOS (polycystic metabolic ovary syndrome) to reflect its metabolic complexity, is far more prevalent than its classic presentation suggests, affecting roughly six percent of reproductive-age women and carrying systemic consequences well beyond fertility disruption. This chapter from the foundational NaProTECHNOLOGY textbook maps the hormonal architecture of the condition, its ovulatory defect patterns, its frequent co-occurrence with endometriosis, and the restorative surgical and cycle-tracking approaches developed at the Pope Paul VI Institute.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Male infertility plays a clinically significant role in a large share of couples who struggle to conceive, yet standard laboratory criteria for semen analysis were designed primarily to predict success with assisted reproduction, not natural fertility. NaProTECHNOLOGY approaches male factor as a diagnosable condition with identifiable root causes, applying medical and surgical options aimed at restoring sperm function and combining that work with fertility-awareness charting to maximize the couple's chances of natural conception.
Thomas W. Hilgers, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Luteal phase and early pregnancy progesterone supplementation protocols are detailed, including indications derived from Creighton Model hormone profiles and dosing regimens for intramuscular and vaginal routes. Targeted progesterone support addresses a correctable physiological deficit identified through CrMS-guided monitoring, reducing early pregnancy loss in women with documented luteal insufficiency.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Preterm birth remains a leading cause of perinatal mortality, with rates in the United States rising significantly over the latter half of the twentieth century despite decades of awareness. NaProTechnology's integrated prevention approach, developed at the Pope Paul VI Institute, addresses this problem through systematic risk stratification, hormonal support, infection surveillance, and cervical monitoring across the full course of pregnancy.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
This 2004 textbook chapter by Thomas W. Hilgers outlines the structure and content of the formal introductory session used to enroll couples in the Creighton Model FertilityCare System (CrMS). It covers the biological foundation of fertility charting, the role of cervical mucus as a biomarker of the reproductive cycle, and the educational framework designed to train couples in systematic, real-time cycle observation.
Thomas W. Hilgers, 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.
Thomas W. Hilgers, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
NaProTECHNOLOGY utilizes a defined panel of cycle-phase-specific biomarkers — including targeted progesterone, estradiol, LH, FSH, and prolactin drawn at CrMS-standardized cycle days — to characterize the hormonal profile underlying each patient's reproductive dysfunction. This biomarker summary consolidates reference ranges, collection timing rules, and clinical interpretation frameworks that govern diagnosis and treatment decisions across infertility, endometriosis, recurrent pregnancy loss, and cycle irregularity.
Thomas W. Hilgers, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Medical protocols in NaProTECHNOLOGY are cycle-phase-targeted regimens — covering ovulation induction, luteal phase hormonal support, hyperprolactinemia management, thyroid optimization, and pre-conceptual supplementation — derived from the biomarker-defined diagnosis rather than empirical stimulation. Consolidating these protocols in a single reference enables practitioners to apply evidence-based, individualized treatment sequences that address root hormonal pathology while supporting natural conception.
Thomas W. Hilgers, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
An economic analysis of NaProTECHNOLOGY compares the total treatment costs and cost-per-live-birth outcomes against assisted reproductive technologies, including IVF, drawing on outcome data from the Pope Paul VI Institute to demonstrate that NaPro's higher per-cycle success rates yield a favorable cost-effectiveness ratio despite comparable or lower upfront expenditures. Because NaProTECHNOLOGY identifies and corrects underlying pathology rather than bypassing it, its resource utilization model supports long-term gynecological health benefits that IVF cannot provide, making the economic case inseparable from the clinical one.
Thomas W. Hilgers, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
A comprehensive, thematically organized compendium of citations documents the evidentiary foundations for every clinical protocol and outcome claim presented across the preceding 88 chapters, spanning foundational cervical mucus research through contemporary reproductive endocrinology and surgical outcomes literature. Consolidating this reference architecture in a dedicated chapter provides practitioners and researchers a structured pathway to primary literature, reinforcing that NaProTECHNOLOGY is grounded in a reproducible, peer-reviewed evidence base rather than institutional convention.
Thomas W. Hilgers, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Hilgers articulates a programmatic vision for the global expansion of NaProTECHNOLOGY through the continued development of FertilityCare Centers International, advanced medical consultant training, and integration of longitudinal hormonal research into evolving clinical protocols. Establishing a roadmap for research priorities, practitioner education infrastructure, and broader medical acceptance positions NaProTECHNOLOGY as a scalable, restorative alternative to the prevailing ART-centered paradigm in reproductive medicine.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Chapter 13 of Hilgers' NaProTECHNOLOGY textbook establishes a clinical behavioral taxonomy unique to the Creighton Model FertilityCare System, distinguishing between achieving-related and avoiding-related use based on whether a couple's actions increase or decrease the probability of conception. The chapter argues that a "taking a chance" mindset is inherently contraceptive in psychology and must be replaced with intentional, education-grounded behavior that reflects a couple's genuine family planning goals.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Chapter 34 of Hilgers (2004) examines how NaProTechnology cycle charting may identify women at elevated risk for three gynecologic cancers: endometrial, breast, and ovarian. The chapter presents clinical case series and a small prospective study suggesting that observable cycle biomarkers, particularly patterns indicating suboptimal luteal-phase function, may precede diagnosis and could inform earlier evaluation, while calling explicitly for further research to validate these findings.
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
Endometriotic implants are catalogued across their full morphological spectrum—classic powder-burn lesions, red flame lesions, clear vesicles, white fibrotic plaques, and subtle vascular changes—with photographic documentation guiding surgical recognition. Familiarity with atypical implant appearances is essential because underrecognition of non-pigmented lesions leads to incomplete excision and persistent symptomatology.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Early pregnancy loss encompasses biochemical pregnancy, embryonic demise, and missed abortion, each distinguished by specific hormonal profiles and ultrasound criteria within the NaProTECHNOLOGY surveillance model. CrMS-based cycle identification enables recognition of pregnancy at the earliest stages, allowing timely hormonal intervention when progesterone or estradiol deficits are detected.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
The content and sequence of the introductory and follow-up instructional sessions that constitute the formal CrMS education series are outlined, covering observation technique, recording conventions, and the practitioner-client interaction model. Consistent delivery of these core instructions establishes the behavioral competence required for both family planning use and the medical monitoring applications that NaProTECHNOLOGY depends upon.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Surgical NaProTECHNOLOGY is defined as a cooperative surgical discipline that corrects reproductive pathology identified through CrMS monitoring and targeted diagnostic workup, employing microsurgical and laser techniques that maximize tissue preservation and minimize adhesion formation. The philosophical and technical distinctions from conventional gynecologic surgery are established, emphasizing restorative intent and anatomical precision as core principles.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
NaProTECHNOLOGY uses the Peak Day of the Creighton Model chart — the last day of the most fertile-type cervical mucus — as the reference point for dating conception, providing a biologically grounded alternative to last menstrual period dating that remains accurate across irregular cycles. Precise cycle-based dating improves the clinical interpretation of early pregnancy hormone levels, ultrasound findings, and obstetric gestational age assignments, reducing unnecessary interventions triggered by apparent growth discordance.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Hilgers presents a refined classification of follicular and luteal phase deficiencies grounded in the integration of CrMS mucus pattern characteristics, cycle-phase-targeted estradiol and progesterone profiles, ultrasound folliculometry, and endometrial histology, introducing terminology that links specific chart signatures to defined endocrine subtypes and treatment protocols. Follicular deficiencies -- marked by short or poor-quality mucus phases and suboptimal estradiol -- and luteal deficiencies -- marked by a post-Peak phase under nine days, premenstrual spotting, or blunted serial progesterone curves -- are treated with tailored ovulation induction, cooperative progesterone replacement, and correction of contributing systemic disorders including thyroid dysfunction, hyperprolactinemia, and insulin resistance.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Cumulative pregnancy and live birth data from the Pope Paul VI Institute document NaProTECHNOLOGY outcomes across diagnostic categories including unexplained infertility, endometriosis, PCOD, and tubal disease, with multi-year follow-up that captures pregnancies occurring after continued treatment — a metric not captured in per-cycle ART statistics. These outcomes provide the evidence base for positioning NaProTECHNOLOGY as a first-line rather than last-resort reproductive medicine strategy.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Disruptions along the hypothalamic-pituitary-ovarian axis — including luteal phase deficiency, inadequate LH surges, and follicular maturation failure — are among the most common and underdiagnosed contributors to infertility and recurrent pregnancy loss. Targeted hormone supplementation guided by cycle-specific progesterone and estradiol assays, timed to CrMS biomarkers, restores functional ovulatory and luteal competence without suppressing the axis.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
The sonographic ovulation classification is validated against targeted hormone profiles -- estradiol, LH, and serial post-Peak progesterone (P+3 through P+11) -- drawn at CrMS Peak-anchored time points rather than fixed calendar days. Hormone patterns corresponding to each sonographic category (e.g., absent LH surge in anovulation, progesterone rise without follicle rupture in LUF) confirm that ultrasound morphology reliably reflects the underlying endocrine disorder, establishing the biochemical legitimacy of the classification for clinical diagnosis.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Ectopic pregnancy demands prompt diagnosis and intervention to prevent life-threatening hemorrhage, and NaProTECHNOLOGY's CrMS-guided cycle monitoring enables earlier detection compared to symptom-driven presentations. Surgical management favors salpingotomy with tube preservation when feasible, aligned with the NaProTECHNOLOGY commitment to maintaining reproductive anatomy and future fertility potential.
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.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
NaProTECHNOLOGY (Natural Procreative Technology) is defined as a women's health science that monitors and cooperates with the menstrual and fertility cycles to identify, evaluate, and treat gynecologic and reproductive disorders at their root cause. Unlike suppressive approaches such as hormonal contraception or ART, NaProTECHNOLOGY maintains procreative potential and treats underlying pathology while preserving the human ecology of reproduction.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
CO2 laser vaporization technique for peritoneal and superficial ovarian endometriotic implants is described in detail, covering power density settings, spot size, vaporization depth control, and recognition of adequate treatment endpoints. Complete destruction of all visible implants, facilitated by the near-contact survey, is necessary to achieve durable symptom relief and improvement in fertility outcomes.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Premenstrual syndrome in NaProTECHNOLOGY is defined by a recurrent cluster of symptoms -- including irritability, breast tenderness, bloating, depression, and carbohydrate craving -- beginning at least four days before menses, and is associated with late-luteal deficiencies in progesterone, estrogen, and beta-endorphin identified through CrMS-anchored hormone profiling. Treatment with cycle-synchronized bioidentical progesterone, targeted HCG injections to stimulate endogenous corpus luteum function, and low-dose naltrexone to modulate opioid dynamics produces superior symptom resolution compared to SSRI therapy in Hilgers' comparative data, without suppressing ovulation.
Parnell T, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Reproductive outcomes in women aged 35 and older are analyzed using CrMS-monitored cycles, documenting that natural conception remains achievable when ovulatory function and hormonal sufficiency are maintained and underlying pathology is treated. NaProTECHNOLOGY's restorative approach offers an alternative to assisted reproduction for mature-age patients by identifying and correcting specific endocrine or anatomical barriers.
Mirkes R, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
The philosophical and ethical foundation of NaProTECHNOLOGY is examined through the lens of a "new humanism" that affirms the dignity of women, couples, and the unborn by working within — rather than against — natural reproductive processes. Hilgers and contributing author Sr. Renee Mirkes situate NaProTECHNOLOGY within a broader critique of technologized reproductive medicine and articulate a coherent framework for procreative ethics applicable to clinical practice.
Stanford JB, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
The Mucus Cycle Score, derived from the standardized CrMS daily observations, quantifies cervical mucus quality and quantity across a cycle and correlates with measured estrogen levels and fecundity rates, providing a non-invasive index of reproductive potential. Declining mucus scores are clinically actionable, directing investigation into hypoestrogenism, cervical pathology, or medication effects that reduce cycle fecundity and can be corrected before ART is considered.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Proximal tubal occlusion at the uterotubal junction, whether from salpingitis isthmica nodosa, fibrosis, or prior sterilization, requires cornual resection and microsurgical tubal reimplantation to re-establish luminal continuity. NaProTECHNOLOGY treats this as a reconstructive procedure rather than a reason to defer to IVF, and outcomes data support intrauterine pregnancy rates comparable to assisted reproduction in appropriately selected patients.
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, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Serial transvaginal ultrasound monitoring of follicular dynamics -- growth, rupture, corpus luteum formation, and free fluid -- forms the basis of a systematic classification of human ovulation disorders, including anovulation, luteinized unruptured follicle (LUF), follicular arrest, premature luteinization, and PCOS-type patterns. Anchoring sonographic findings to the CrMS Peak day allows precise correlation between ultrasound events and cervical mucus biomarkers, creating a reproducible diagnostic taxonomy that drives targeted medical and surgical treatment within the NaProTECHNOLOGY framework.
Hilgers TW et al., 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Patients who have undergone multiple failed IVF cycles and are counseled to abandon fertility treatment represent a significant NaProTECHNOLOGY cohort in whom undiagnosed correctable pathology — including subtle endometriosis, luteal insufficiency, or immunological factors — is subsequently identified and treated. Published data demonstrate clinically meaningful pregnancy rates in this population following NaProTECHNOLOGY evaluation and treatment, demonstrating that ART failure does not predict failure of restorative approaches.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Adaptations of CrMS instruction for physiologically distinct reproductive states — including breastfeeding, post-hormonal contraceptive use, long or irregular cycles, and premenopause — are described with specific observational guidance for each context. These special protocols extend the clinical reach of the CrMS to all phases of a woman's reproductive life and ensure that charting remains interpretable even when cycle dynamics are atypical.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Structured postoperative management following PEARS procedures addresses wound care, pain control, early ambulation, hormonal support, and surveillance for complications including bleeding, infection, urinary injury, and bowel complications. NaProTECHNOLOGY postoperative protocols integrate CrMS-guided hormonal monitoring to optimize the healing environment and time the resumption of targeted fertility treatment.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Preconceptional optimization using CrMS cycle data establishes hormonal baselines, identifies correctable pathologies, and guides targeted supplementation before conception is attempted. Systematic preconceptional evaluation reduces early pregnancy loss and improves obstetric outcomes by ensuring the endocrine environment supports implantation and early embryonic development.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Endometriosis impairs fertility through direct mechanical distortion of pelvic anatomy, peritoneal inflammatory mediators, and hormonal micro-environment alterations that reduce implantation potential, making thorough surgical excision critical to restoring fertility rather than bypassing it. The PEARS classification system, used in NaProTECHNOLOGY surgical practice, enables standardized documentation of endometriotic disease extent and correlates operative findings with postoperative reproductive outcomes.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Unusual uterine bleeding -- including premenstrual spotting, tail-end brown bleeding, mid-cycle intermenstrual bleeding, and heavy menses -- is evaluated in NaProTECHNOLOGY through prospective CrMS charting combined with cycle-phase-targeted estradiol and serial post-Peak progesterone profiles, which typically reveal luteal phase deficiency, follicular estradiol insufficiency, or anovulation as the primary etiology. Treatment is etiology-directed and cycle-synchronized: cooperative progesterone replacement for luteal defects, follicular support or ovulation induction for follicular phase insufficiency, and fertility-sparing surgical correction for structural pathology such as endometriosis, polyps, or fibroids, without routine recourse to contraceptive suppression.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Escalating rates of contraceptive use, abortion, divorce, child abuse, teenage pregnancy, and out-of-wedlock births over the preceding four decades are documented as interconnected indicators of systemic failure in women's and family healthcare. Hilgers argues these trends reflect a prevailing medical culture that suppresses or bypasses reproductive function rather than supporting it, establishing the clinical and moral imperative for a restorative alternative.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Deep infiltrating endometriosis involving the rectosigmoid, appendix, and small bowel is addressed through gynecologist-performed PEARS techniques that include superficial disc excision, appendectomy, and coordinated bowel resection when full-thickness involvement requires it. Recognition of intestinal endometriosis at laparoscopy and command of the relevant surgical steps allow the NaProTECHNOLOGY surgeon to treat the complete disease burden in a single operative setting.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
The Creighton Model's standardized daily vulvar observation system -- recording discharge color, consistency, quantity, and sensation -- allows chronic pathological discharges (persistent yellow or cloudy mucus, continuous post-Peak discharge, premenstrual brown bleeding, or refractory vulvovaginitis) to be distinguished from normal cyclical mucus patterns and tracked longitudinally as a diagnostic tool. NaProTECHNOLOGY uses chronic discharge patterns as biomarkers that prompt organism-specific cultures, targeted hormonal evaluation, ultrasound, and etiology-directed treatment -- including antimicrobials, cooperative hormone replacement, or fertility-sparing surgery -- rather than empirical cycle suppression.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Endometriosis recurrence after surgical excision remains a clinical reality driven by residual ectopic implants, persistent hormonal milieu favoring re-seeding, and incomplete initial resection. NaProTECHNOLOGY addresses recurrence risk through postoperative hormone normalization guided by CrMS biomarkers, with repeat PEARS reserved for symptomatic or fertility-impairing recurrence confirmed by clinical and laparoscopic assessment.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Hilgers distinguishes isomolecular hormones -- molecules structurally identical to endogenous estradiol and progesterone -- from heteromolecular artimones, his term for synthetic analogues such as medroxyprogesterone acetate, norethindrone, and ethinyl estradiol, which differ in receptor binding, metabolic pathways, and systemic effects. NaProTECHNOLOGY restricts hormone therapy to isomolecular compounds administered in cycle-synchronized, physiologic doses because artimones suppress the hypothalamic-pituitary-ovarian axis, mask underlying pathology, and produce non-physiologic metabolite profiles incompatible with a restorative reproductive medicine approach.
Stanford JB, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Methodologically rigorous effectiveness data for the CrMS are presented, including method-effectiveness and use-effectiveness rates for pregnancy avoidance drawn from prospective cohort studies, demonstrating rates comparable to or exceeding hormonal contraception. Standardized outcome measurement is necessary to establish the CrMS's scientific credibility and to provide practitioners and patients with accurate, evidence-based counseling on system performance.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
A CrMS-synchronized hormone sampling protocol is detailed in which progesterone, estradiol, and other reproductive hormones are drawn at cycle-phase-specific time points defined by the charted Peak Day rather than by fixed cycle day, producing a targeted hormone profile that accurately reflects luteal and follicular function. This Peak Day-referenced approach substantially improves the diagnostic sensitivity for luteal phase deficiency, follicular dysfunction, and other endocrine abnormalities that fixed-day sampling routinely misclassifies.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Infertility is not merely a reproductive inconvenience but frequently signals systemic or hormonal pathology — including polycystic ovarian disease, endometriosis, thyroid dysfunction, and immune abnormalities — each carrying independent health risks beyond failure to conceive. Identifying and treating these underlying conditions reduces long-term morbidity and reframes infertility evaluation as a form of preventive medicine rather than a terminal bypass decision.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Chronic pelvic pain and dysmenorrhea in reproductive-age women most commonly reflect undertreated endometriosis, adenomyosis, ovarian dysfunction, or pelvic adhesive disease rather than psychosomatic pathology. NaProTECHNOLOGY evaluates these symptoms through a structured diagnostic pathway integrating CrMS biomarker profiles, hormonal assays, and targeted laparoscopy, directing restorative surgical and medical interventions rather than suppressive hormonal therapy.
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.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Chronic anovulation and progesterone or estradiol deficiency identified through CrMS charting represent periods of suboptimal bone accrual in women of reproductive age, because both estradiol and progesterone contribute to skeletal maintenance -- estradiol through suppression of osteoclast activity and progesterone through osteoblast stimulation. NaProTECHNOLOGY uses longitudinal CrMS records of ovulatory status and hormone profiles as a bone-health risk screen, guiding cycle-synchronized bioidentical hormone replacement to restore normal estrogen-progesterone balance and potentially mitigate progression toward osteoporosis in women with chronic cycle-based endocrine deficiencies.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Distal tubal occlusion — including hydrosalpinx, fimbrial agglutination, and peritubal adhesions — is a correctable cause of tubal-factor infertility amenable to salpingoneostomy, fimbrioplasty, and adhesiolysis under PEARS principles. Restoration of distal tubal patency and normal fimbrial architecture allows natural conception and avoids the bypassing of physiological fertilization that characterizes assisted reproductive technology.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Postpartum depression in susceptible women is linked to abrupt postpartum progesterone withdrawal following the high-progesterone state of pregnancy, particularly in those with prior PMS, luteal phase defects, or recurrent miscarriage, and NaProTECHNOLOGY evaluates this through serum progesterone, thyroid function, and prolactin assessment in the postpartum period. Treatment uses bioidentical progesterone -- preferably intramuscular for reliable absorption -- with serum levels monitored every two weeks for dose titration, and once cycles resume, dosing is resynchronized to the CrMS Peak day; Hilgers reports no increase in congenital anomalies in over 2,000 progesterone-supported pregnancies in the Pope Paul VI Institute series.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Serum estradiol and progesterone assays vary substantially across laboratories because of differences in antibody specificity, calibration standards, detection platforms, and quality-control practices, meaning that a value within one laboratory's generic reference range may represent a clinically significant deficiency when interpreted against NaPro Peak-day-specific norms. NaProTECHNOLOGY requires consistent use of a single reference laboratory and interpretation relative to cycle-phase-specific NaPro standards rather than broad lab-generated reference intervals, to avoid missing subtle follicular or luteal phase defects that standard reporting would classify as normal.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
CrMS charting features -- Peak day definition, pre-Peak mucus quality and duration, post-Peak phase length, and premenstrual spotting -- are systematically compared against sonographic and endocrine findings to demonstrate that prospective cycle observations reliably identify specific ovulation disorder categories. This clinical validation shows that the CrMS chart functions as a non-invasive biomarker map capable of directing targeted ultrasound and hormonal investigation, and that treatment guided by the classification improves ovulatory and fertility outcomes.
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.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Management of pregnancies complicated by lethal fetal anomalies is addressed within an ethical framework that provides perinatal palliative care, parental support, and medical management without recourse to induced abortion. The chapter outlines clinical protocols for continuing care that respect fetal life while attending to maternal physical and psychological wellbeing through delivery and bereavement.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Laser adhesiolysis protocols address peritubal, periovarian, and cul-de-sac adhesions using CO2 laser energy applied under direct near-contact visualization, with attention to underlying anatomy and vascular proximity. Restoration of normal adnexal mobility and tubo-ovarian relationships is a prerequisite for improved cycle-based fertility after surgical NaProTECHNOLOGY intervention.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
The Creighton Model FertilityCare System (CrMS) is introduced as a standardized, scientifically grounded method for observing and recording cervical mucus biomarkers and bleeding patterns across the menstrual cycle. Its development from earlier natural family planning methods into a fully systematized fertility monitoring tool is traced, establishing the CrMS as the observational substrate for all subsequent NaProTECHNOLOGY medical applications.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Cooperative progesterone and estrogen replacement therapy administers bioidentical hormones in precise synchrony with the woman's CrMS-identified Peak day -- beginning progesterone at P+2 or P+3 and continuing through the luteal phase -- to augment deficient corpus luteum output rather than override the cycle with suppressive dosing. Serial serum progesterone across post-Peak days guides dose titration, and the approach is applied to luteal phase deficiency, recurrent miscarriage, premenstrual syndrome, and postpartum depression while preserving ovulatory function and fertility.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
A photographic atlas documents the intraoperative appearance of endometriosis, adhesions, polycystic ovarian morphology, tubal pathology, and uterine anomalies as encountered during near-contact laparoscopy. Standardized visual reference supports consistent surgical classification, intraoperative decision-making, and communication of findings across the NaProTECHNOLOGY surgical team.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Selective hysterosalpingography combined with transcervical fallopian tube catheterization allows both precise diagnosis and non-surgical correction of proximal tubal occlusion, distinguishing true anatomical obstruction from tubal spasm or mucous plugging. In NaProTECHNOLOGY practice, this minimally invasive approach restores tubal patency without laparotomy, preserving natural conception potential in appropriately selected patients.
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.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Physiological and psychological stress disrupts hypothalamic GnRH pulsatility via CRH-cortisol pathways, producing downstream impairments in LH and FSH secretion that manifest as anovulation, delayed ovulation, follicular phase prolongation, or luteal phase deficiency -- all of which are documented cycle-by-cycle on the CrMS chart. NaProTECHNOLOGY addresses stress-induced HPO axis dysfunction by identifying the specific cycle-level disorder through charting and targeted hormone profiling, then applying cycle-appropriate ovulation induction and cooperative hormone support alongside correction of the underlying physical or psychological stressor.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Three-dimensional ultrasound enables volumetric assessment of uterine architecture, endometrial morphology, and ovarian follicular dynamics with greater anatomical precision than conventional 2D imaging, facilitating detection of septate uteri, submucosal fibroids, and endometriotic lesions that affect implantation. Integration of 3D ultrasound into NaProTECHNOLOGY evaluation protocols enhances the pre-treatment structural workup and informs targeted surgical planning for uterine factor infertility.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Amenorrhea and anovulation represent a spectrum of hypothalamic, pituitary, ovarian, and end-organ etiologies that must be differentiated through systematic hormonal and anatomical evaluation before treatment is initiated. NaProTECHNOLOGY integrates CrMS mucus charting with targeted biochemical testing to identify the level of dysfunction and guide ovulation induction or hormonal restoration appropriate to the specific cause.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Clinical and instructional decision trees guide practitioners through the interpretation of chart findings and the selection of appropriate responses — ranging from continued observation to medical referral — based on pattern recognition and established CrMS criteria. Systematic decision-making protocols reduce practitioner variability, support evidence-based care, and define the threshold at which observed abnormalities warrant further NaProTECHNOLOGY medical evaluation.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Ovarian dysfunction — encompassing luteal insufficiency, abnormal folliculogenesis, and anovulation — is treated in NaProTECHNOLOGY with cycle-timed interventions including HCG trigger, progesterone supplementation, clomiphene, and thyroid optimization, guided by prospective CrMS charting rather than protocol-driven stimulation. This approach normalizes endogenous hormonal patterns rather than overriding them, preserving uterine receptivity and reducing multiple gestation risk.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Bowel endometriosis involving the rectosigmoid, appendix, and small intestine requires specialized resection and repair techniques that fall within the competency of a general surgeon collaborating with the NaProTECHNOLOGY surgical team. Addressing bowel involvement is essential to achieving complete excision of endometriotic disease, which underpins the PEARS philosophy of restoring normal pelvic anatomy and maximizing reproductive potential.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Pelvic adhesions from prior infection, surgery, or endometriosis restrict tubal motility, occlude the fimbriae, and distort ovarian-tubal relationships, constituting a primary mechanical barrier to natural conception. Microsurgical adhesiolysis performed under NaProTECHNOLOGY protocols achieves tubal patency and restores anatomical relationships, enabling natural pregnancy in a substantial proportion of cases that would otherwise be directed to IVF.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Core microsurgical principles for adhesion prevention—continuous peritoneal irrigation, meticulous hemostasis, minimal thermal spread, avoidance of foreign material, and precise tissue approximation—are detailed as non-negotiable standards in every NaProTECHNOLOGY procedure. Postoperative adhesion formation is the primary cause of surgical failure in pelvic reconstruction, making preventive technique as important as the corrective intervention itself.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Conventional infertility care has shifted toward assisted reproductive technologies that bypass underlying pathology rather than diagnose and treat root causes, leaving a large proportion of couples with unresolved, correctable conditions. NaProTECHNOLOGY addresses this systemic deficiency by emphasizing standardized evaluation, cycle-based hormonal profiling, and targeted medical and surgical treatment before any bypass technology is considered.
Hilgers TW et al., 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Family physicians are optimally positioned to introduce NaProTECHNOLOGY to patients presenting with infertility, irregular cycles, or recurrent pregnancy loss during routine primary care, enabling early evaluation and restorative treatment before referral to subspecialists. Familiarity with CrMS charting interpretation, basic hormone panels timed to identified cycle phases, and the range of treatable NaPro diagnoses allows the family physician to substantially expand reproductive care at the primary care level.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Ovarian wedge resection reduces androgen-producing stromal tissue in women with polycystic ovary syndrome who have failed medical ovulation induction, restoring spontaneous or treatment-responsive ovulatory cycles. Within NaProTECHNOLOGY, the procedure is performed with precise tissue economy and anti-adhesion technique to preserve ovarian reserve while correcting the underlying hormonal dysfunction identified through CrMS biomarker monitoring.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Normal estradiol and progesterone reference ranges in NaProTECHNOLOGY are derived from fertile, ovulatory cycles with confirmed CrMS Peak days and sonographic ovulation, with blood sampling timed to Peak-anchored days (pre-ovulatory P-days for estradiol, P+3 through P+11 for luteal hormones) rather than to calendar cycle days. These day-specific normative values allow detection of subtle deficiencies -- such as a blunted progesterone rise at P+5 or inadequate pre-ovulatory estradiol -- that are clinically actionable for diagnosing follicular and luteal phase disorders but are invisible to standard mid-luteal or phase-independent reference intervals.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
NaProTECHNOLOGY applies the standardized biomarkers of the Creighton Model FertilityCare System to identify the specific pathophysiological causes of infertility in each couple, then directs targeted medical or surgical intervention against those causes. Published pregnancy rates demonstrate outcomes comparable to or exceeding IVF in many diagnostic categories, without the ethical, financial, or obstetric risks associated with assisted reproduction.
Hilgers TW et al., 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Pregnancy achievement rates among couples using the CrMS to target fertile days are analyzed by cycle type, reproductive history, and duration of use, demonstrating the system's capacity to accommodate irregular and abnormal cycles without reducing its fertility-targeting utility. These data are foundational to NaProTECHNOLOGY's application in infertility management, establishing that the CrMS identifies fertile windows even in subfertile populations with disrupted cycle parameters.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Ovarian cysts in NaProTECHNOLOGY are classified as functional (follicular cysts, luteinized unruptured follicle, corpus luteum cysts) or pathological (endometriomas, neoplasms) through serial cycle-timed transvaginal ultrasound correlated with CrMS Peak day observations and post-Peak progesterone and estradiol profiles. Management of functional cysts uses cooperative progesterone replacement and targeted HCG injections to normalize corpus luteum function and reduce cyst recurrence without contraceptive suppression, while pathological or persistent cysts are addressed through fertility-sparing laparoscopic surgery with anti-adhesion technique.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
A quantitative taxonomy for classifying the cervical mucus cycle is established, using standardized descriptors for mucus type, quantity, consistency, and Peak Day timing to produce objectively comparable cycle profiles across patients and study populations. This classification system is indispensable to NaProTECHNOLOGY research and clinical correlation, as it enables the linkage of specific mucus pattern anomalies to underlying endocrine pathology.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
The CrMS charting system is explained in full, including the stamp-based notation for recording mucus characteristics, bleeding, and dry days on the standardized chart, and the conventions for identifying the Peak Day. Accurate chart reading is the foundational clinical skill for NaProTECHNOLOGY practitioners, as the chart provides the biomarker timeline against which hormone profiles and pathology are interpreted.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
The PEARS (Pelvic Endoscopic Adhesion-Related Surgery) procedure for peritoneal and ovarian endometriosis combines near-contact laser vaporization, adhesiolysis, and ovarian cystectomy under strict anti-adhesion protocols to achieve comprehensive disease eradication while preserving ovarian reserve. Outcomes data demonstrate superior fertility and pain resolution compared to incomplete surgical approaches, establishing PEARS as the operative standard within NaProTECHNOLOGY.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Uterine fibroids contribute to abnormal uterine bleeding, dysmenorrhea, recurrent pregnancy loss, and implantation failure, making myomectomy a central NaProTECHNOLOGY surgical intervention for women seeking conception. PEARS myomectomy technique prioritizes uterine preservation, meticulous layered closure of the myometrial defect, and hemostasis strategies that minimize adhesion formation and support subsequent pregnancy.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Extensive pelvic adhesions — often the sequela of prior surgeries, infection, or undertreated endometriosis — distort tubo-ovarian relationships and impair fertility through mechanical obstruction and altered pelvic microenvironment. PEARS adhesiolysis principles emphasize meticulous sharp dissection, copious irrigation, and anti-adhesion adjuncts to restore normal anatomy and optimize postoperative fertility outcomes.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Postoperative pelvic adhesions are a leading cause of secondary infertility, chronic pain, and bowel obstruction following gynecologic surgery, making adhesion prevention a primary surgical quality metric in NaProTECHNOLOGY. PEARS technique integrates continuous peritoneal irrigation, meticulous tissue handling, avoidance of foreign-body contamination, and selective use of barrier agents to minimize the fibrinous cascade that initiates adhesion formation.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Women with persistent or continuous vaginal discharges — including those from chronic cervicitis, hormonal imbalance, or other gynecologic sources — present a distinct charting challenge, and this chapter provides CrMS-specific protocols for distinguishing pathologic discharge from fertile-quality cervical mucus. Correct identification is clinically critical because misclassification distorts cycle interpretation, effectiveness calculations, and the hormone-assessment timeline.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Both overt and subclinical thyroid dysfunction are recognized in NaProTECHNOLOGY as significant causes of cycle-level reproductive abnormalities -- including oligomenorrhea, anovulation, luteal phase deficiency, heavy bleeding, and recurrent early pregnancy loss -- detectable through CrMS charting before standard screening would prompt thyroid evaluation. The chapter advocates comprehensive thyroid assessment (TSH, free T4, free T3, and thyroid antibodies) with fertility-optimized reference thresholds in women presenting with cycle disorders or infertility, followed by reassessment of CrMS patterns and hormone profiles after thyroid correction to identify and treat any residual follicular or luteal phase defects.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Recurrent spontaneous abortion is examined through a systematic NaProTECHNOLOGY diagnostic framework that includes hormonal, anatomical, immunological, and infectious etiologies identified via CrMS cycle charting and targeted laboratory evaluation. Correcting underlying pathology—particularly luteal phase deficiency and uterine structural abnormalities—achieves live birth rates substantially higher than expectant management alone.
Hilgers TW, 2004·The Medical and Surgical Practice of NaProTECHNOLOGY
Serial progesterone measurement timed to the luteal phase and early pregnancy using CrMS Peak Day-referenced protocols reveals luteal insufficiency and early placental progesterone inadequacy that are associated with miscarriage risk and preterm labor. Progesterone supplementation guided by these standardized assessments has been associated with reduced pregnancy loss in NaProTECHNOLOGY-managed pregnancies, and the chapter details the specific drawing protocols, reference ranges, and supplementation decision thresholds used in clinical practice.
Over the years of my involvement in obstetrics and gynecology, and reproductive medicine and surgery I have had the opportunity to see, first hand, how the religious liberties of individual physicians, medical students, nurses, patients, etc., have been violated by the contemporary trends in reproductive medicine. Since the advent of oral contraceptives, the practice of obstetrics and gynecology as it relates to procreative medicine has dramatically changed. Contraception, sterilization, abortion and in vitro fertilization are the foundation upon which reproductive medicine decision making is made. These decisions are often made with a "steam roller effect" which is completely devoid of any consent from those who are impacted by the implementation of those decisions. It has been an interesting series of events to watch over these years as the profession has become less and less diagnostically attuned and more and more "band aid" oriented. The birth control pill is used for the treatment of almost every gynecologic malady known, even though it cures none of them. Family physicians, internists, pediatricians and others tend to follow the same approach as their OB-GYN colleagues. With in vitro fertilization, instead of finding out what the underlying cause of one's infertility or reproductive problem might be, there is a "jumping over" of the underlying causes (the diseases) and a pursuit directly to a solution which first of all is very expensive, second, is not very effective and third, is considered to be highly immoral and unethical by many people in our society.
To assess the day-specific and cycle-specific probabilities of conception leading to clinical pregnancy, in relation to the timing of intercourse and vulvar mucus observations. This was a retrospective cohort study of women beginning use of the Creighton Model Fertility Care System in Missouri, Nebraska, Kansas, and California. Data were abstracted from Creighton Model Fertility Care System records, including women's daily standardized vulvar observations of cervical mucus discharge, days of intercourse, and clinically evident pregnancy (conception). Established statistical models were used to estimate day-specific probabilities of conception. Data were analyzed from 1681 cycles with 81 conceptions from 309 normally fertile couples (initially seeking to avoid pregnancy) and from 373 cycles with 30 conceptions from 117 subfertile couples (who were initially trying to achieve pregnancy). The highest probability of pregnancy occurred on the peak day of vulvar mucus observation (.38 for normally fertile couples and.14 for subfertile couples). The probability of pregnancy was greater than.05 for normally fertile couples from 3 days before to 2 days after the peak, and for subfertile couples from 1 day before to 1 day after the peak. The cycle-specific probability of conception correlated with the quality of mucus discharge in normally fertile couples but not in subfertile couples. Standardized vulvar observations of vaginal mucus discharge identify the days with the greatest likelihood of conception from intercourse in normal fertility and subfertility and provide an indicator of the overall potential for conception in a given menstrual cycle in normal fertility.
In vitro studies demonstrated that implantation on membranes (peritoneum, amniotic membranes) can take place if there are defects on the surface of the membranes. If these mechanisms play a role for the development of endometriosis in vivo, then patients with surgical treatment of peritoneal endometriosis in the luteal phase must have a high recurrence rate. Retrospective analysis of operation charts and follow-up data. Department of gynecology, in a hospital-based endometriosis treatment center. PATIENT(S): Two hundred twenty premenopausal women. INTERVENTION(S): Laparoscopic treatment for peritoneal endometriosis, stage I and II by revised American Society for Reproductive Medicine guidelines. MAIN OUTCOME MEASURE(S): During the follow-up period of 2 years, symptoms and gynecological and sonographic findings were documented. In case of suspected recurrence a repeat laparoscopy with biopsy was performed to prove the recurrent endometriosis macroscopically and histologically. RESULT(S): The total recurrence rate after 2 years was 9.6%. The recurrence rate of group III (15%) was twice as high as those of group I (7%) and group II (8%), as indicated by subjective complaints, clinical findings, macroscopy, and histology; no differences were found between groups I and II. CONCLUSION(S): Endoscopic surgery for the treatment of peritoneal endometriosis should not be performed in the luteal phase.
To assess whether metformin safely reduced development of gestational diabetes in women with the polycystic ovary syndrome (PCOS). Prospective and retrospective study. Outpatient clinical research center. PATIENT(S): The prospective study included 33 nondiabetic women with PCOS who conceived while taking metformin and had live births; of these, 28 were taking metformin through delivery. The retrospective study included 39 nondiabetic women with PCOS who had live birth pregnancies without metformin therapy. INTERVENTION(S): Metformin, 2.55 g/d, throughout pregnancy in women with PCOS. MAIN OUTCOME MEASURE(S): Development of gestational diabetes in women with PCOS. RESULT(S): Before metformin therapy, after covariance adjustment for age, the two cohorts did not differ in height, weight, basal metabolic index, insulin, insulin resistance, or insulin secretion. Both cohorts had high fasting insulin, were insulin resistant, and had high insulin secretion. Among the 33 women who received metformin, gestational diabetes developed in 1 of 33 (3%) pregnancies versus 8 of 12 (67%) of their previous pregnancies without metformin. Among the 39 women who did not take metformin, gestational diabetes developed in 14 of 60 (23%) pregnancies. When all live births were combined, gestational diabetes occurred in 22 of 72 pregnancies (31%) in women who did not take metformin versus 1 of 33 pregnancies (3%) in those who took metformin. With gestational diabetes as the response variable and age at delivery and treatment group (metformin or no metformin) as explanatory variables, the odds ratio for gestational diabetes in women with metformin versus without metformin was 0.093 (95% CI: 0.011 to 0.795). With gestational diabetes in 93 pregnancies as the response variable and age at delivery and treatment group (metformin no metformin) as explanatory variables, the odds ratio of gestational diabetes in pregnancies in women taking metformin versus without metformin was 0.115 (95% CI: 0.014 to 0.938). CONCLUSION(S): In PCOS, use of metformin is associated with a 10-fold reduction in gestational diabetes (31% to 3%). It also reduces insulin resistance and insulin secretion, thus decreasing the secretory demands imposed on pancreatic beta-cells by insulin resistance and pregnancy.
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.
Effective use of natural family planning is strongly dependent upon adequate instruction. The Creighton Model Fertility Care System (CrMS) has a standardized protocol for instruction of new users that includes individual follow-up visits in the first year of use. This study evaluated the number of follow-up visits completed by new CrMS users from eight CrMS centers in the United States. Four follow-up visits were completed by 75.7% of women. Women who continued instruction were more likely to be educated, Catholic, and white, and to have a more challenging reproductive status (discontinuing oral contraceptives, or breastfeeding). These results suggest that the number of follow-up visits needed varies among new CrMS users. Future research should address the optimal length of instruction for adequate use of the CrMS by women with different characteristics and needs.
The primary mechanism of oral contraceptives is to inhibit ovulation, but this mechanism is not always operative. When breakthrough ovulation occurs, then secondary mechanisms operate to prevent clinically recognized pregnancy. These secondary mechanisms may occur either before or after fertilization. Postfertilization effects would be problematic for some patients, who may desire information about this possibility. This article evaluates the available evidence for the postfertilization effects of oral contraceptives and concludes that good evidence exists to support the hypothesis that the effectiveness of oral contraceptives depends to some degree on postfertilization effects. However, there are insufficient data to quantitate the relative contribution of postfertilization effects. Despite the lack of quantitative data, the principles of informed consent suggest that patients who may object to any postfertilization loss should be made aware of this information so that they can give fully informed consent for the use of oral contraceptives.
To evaluate pregnancy probabilities during use of the Creighton Model Fertility Care System (CrMS). Couples who began use of the CrMS were entered into this observational cohort study. Follow-up included detailed reviews of use of the CrMS. Pregnancy probabilities were calculated with both net and gross life-table analysis through 18 months. A natural family planning service delivery program based at an urban hospital in Houston, Tex. A group of 701 couples who received instruction in the CrMS were entered into the study. Most couples (93%) were engaged or married. Most women were white (83%), between the ages of 20 and 34 years (88%), and college graduates (58%). Pregnancies were classified based on a detailed evaluation involving the pregnant woman (usually with her partner). At 12 months, the following net pregnancy probabilities were found per 100 couples: method-related pregnancies, 0.14; pregnancies caused by user and/or teacher error, 2.72; pregnancies caused by achieving-related behavior (genital contact during a time known to be fertile), 12.84; unresolved pregnancies, 1.43; and total pregnancies, 17.12. Pregnancy probabilities were similar when stratified by the following reproductive categories: uncomplicated regular cycles, long cycles, discontinuing oral contraceptives, breastfeeding, and other. Pregnancy probabilities of the CrMS compare favorably with those of other methods of family planning. Most pregnancies result from genital contact during a known fertile time. Women need not have regular cycles to use the CrMS successfully.
To assess the intratubal pressure (ITP) and patency status of the fallopian tubes before and after transcervical catheterization of the fallopian tubes (TCFT). Prospective procedural assessment. Pope Paul VI Institute for the Study of Human Reproduction. PATIENT(S): Two hundred thirty-four women with either primary or secondary infertility. INTERVENTION(S): Patients underwent selective hysterosalpingography and, in some cases, TCFT with measurement of the ITP before and after the procedure. MAIN OUTCOME MEASURE(S): The ITP before and after TCFT. RESULT(S): The mean (+/-SD) ITP in freely patent tubes was 0.53 +/- 0.06 atm, that in partially obstructed tubes was 1.23 +/- 0.52 atm, and that in completely obstructed tubes was 2.79 +/- 1.40 atm. After TCFT, the mean (+/-SD) ITP in partially obstructed tubes decreased to 0.64 +/- 0.31 atm and that in completely obstructed tubes decreased to 1.86 +/- 1.35 atm. The ITP was normalized in 76% of partially obstructed tubes and in 29.5% of completely obstructed tubes. In all cases of complete obstruction in which surgical correction was attempted, organic pathology was identified. CONCLUSION(S): The procedure described is a safe and easy means of obtaining reliable and significant information on the status of the proximal fallopian tube.
To evaluate the use effectiveness of Creighton Model (CrM) NaProEducation Technology for avoiding pregnancy. CrM is a medical model of natural procreation education that is a fully standardized modification of the Billings ovulation method. This system has been used as a means to avoid pregnancy and has been prospectively evaluated in five use effectiveness studies. A prospective life-table analysis of the five studies (meta-analysis) was undertaken, yielding both net and gross rates. Discontinuation rates were also calculated. These studies were conducted at CrM centers in Omaha, St. Louis, Wichita, Houston, and Milwaukee. A total of 1,876 couples used CrM NET for a total of 17,130.0 couple months of use. The method and use effectiveness rates for avoiding pregnancy were 99.5 and 96.8 at the 12th ordinal month and 99.5 and 96.4 at the 18th ordinal month, respectively. The discontinuation rate was 11.3% at the 12th ordinal month and 12.1% at the 18th ordinal month. CrM is highly effective as a means of avoiding pregnancy in both its method and use effectiveness. The method effectiveness has remained stable over the years of the studies, but the use effectiveness for avoiding pregnancy appears to have improved over the study period.
This open trial assessed the effects of adjunctive progesterone therapy on seizure frequency in 25 women with catamenial exacerbation of complex partial (CPS) and secondary generalized motor (SGMS) seizures. Progesterone was well tolerated by 23 of the 25 women and had readily reversible dose-related side effects of asthenia and emotional depression in two. Eighteen women (72%) experienced a decline in seizure frequency during a 3-month treatment period compared with the 3 months prior to therapy (p < 0.01). Average daily CPS frequency declined by 54% (p < 0.01), SGMS by 58% (p < 0.02).
To compare the impact of expanded polytetrafluoroethylene (PTFE; Gore-Tex Surgical Membrane; W. L. Gore & Associates, Inc., Flagstaff, AZ) and oxidized regenerated cellulose (Interceed TC7, Johnson & Johnson Medical, Inc., Arlington, TX) on the development of postsurgical adhesions. A multicenter, nonblinded, randomized clinical trial. University medical centers. Each barrier was allocated randomly to the left or right sidewall of every patient. Thirty-two women with bilateral pelvic sidewall adhesions undergoing reconstructive surgery and second-look laparoscopy. Adhesion score (on a 0- to 11-point scale), the area of adhesion (cm2), and the likelihood of no adhesions. The use of both barriers was associated with a lower adhesion score and area of adhesion postoperatively. However, those sidewalls covered with PTFE had a significantly lower adhesion score (0.97 +/- 0.30 versus 4.76 +/- 0.61 points, mean +/- SEM) and area of adhesion (0.95 +/- 0.35 versus 3.25 +/- 0.62 cm2). Overall, more sidewalls covered with PTFE had no adhesions (21 versus 7) and, when adhesions were present on the contralateral sidewall, the number of sidewalls covered with PTFE without adhesions was greater than those covered with oxidized regenerated cellulose (16 versus 2). Expanded polytetrafluoroethylene was associated with fewer postsurgical adhesions to the pelvic sidewall than oxidized regenerated cellulose.
The following is an address presented to a summit meeting on natural family planning sponsored by the Pontifical Councilfor the Family in December, 1992
I am honored and privileged to have this opportunity to be with all of you at this summit meeting on natural family planning. I wish to thank Alfonso Cardinal Lopez Trujillo for his invitation and all ofthe members ofthe Pontifical Council for their generosity and hospitality.
I have been asked to discuss with you what has become known as the Creighton Model Natural Family Planning System. This system obtained its name from my personal association, in its early days of development, with Creighton University School of Medicine in Omaha, Nebraska. This discussion will be, by its very nature, a summary of work that has been done and work that is currently ongoing.
The Creighton Model is referred to as a "model" as opposed to a "method" because it is an integrated education, research and service oriented system which meets the demands of the allied health and medical professions in the field of natural family planning. This system was specifically built to accomplish accountability and competency through a strong professional infra-structure. At the same time, it has been built within the context of a Catholic ethical and moral service delivery framework. It uses a standardized modification of the Billings' Ovulation Method in accomplishing these goals.
I personally became involved in natural family planning with a research project I did as a senior medical student in 1968. As I investigated the salivary albumin concentrations in women during the course of their menstrual cycles, I was looking for a reported decrease in albumin around the time of ovulation. Unfortunately, a project which I had no doubt would solve the problems related to natural family planning (sic), proved to be not a very good idea. . .
Fehring RJ et al., 1994·J Obstet Gynecol Neonatal Nurs
To determine the use effectiveness of the Creighton model ovulation method in avoiding and achieving pregnancy. Prospective, descriptive. A natural family planning clinic at a university nursing center. Records and charts from 242 couples who were taught the Creighton model. The sample represented 1,793 months of use of the model. Creighton model demographic forms and logbook. At 12 months of use, the Creighton model was 98.8% method effective and 98.0% use effective in avoiding pregnancy. It was 24.4% use effective in achieving pregnancy. The continuation rate for the sample at 12 months of use was 78.0%. The Creighton model is an effective method of family planning when used to avoid or achieve pregnancy. However, its effectiveness depends on its being taught by qualified teachers. The effectiveness rate of the Creighton model is based on the assumption that if couples knowingly use the female partner's days of fertility for genital intercourse, they are using the method to achieve pregnancy.
"Uterine Isolation" has been discussed, in one form or another, since the early 1940's by such notable American theologians as Fr. John C. Ford, SJ, Fr. Gerald Kelly, SJ; Fr. Francis J. Connell, C.SS.R.; Fr. L. Bender; Fr. John R. Connery; SJ, Fr. Edwin F. Healy, SJ; and Fr. Thomas J. O'Donnell, SJ.l The term "uterine isolation" originated with Fr. O'Donnell. O'Donnell, who is personally convinced of the validity of the arguments for the solid probability of the "uterine isolation" view, was also responsible for having this deleted from the "Ethical and Religious Directives for Catholic Health Facilities" which were published and approved by the bishops in 1971." 'Isolation of the uterus' or 'uterine isolation' " he says, "had taken root in the medical-moral community and, either through misunderstanding or deception, was being used as a presumably morally acceptable semantic for various forms of clearly contraceptive sterilization."l O'Donnell states that the following three points need to be understood by Catholic hospital administration and staff with regard to the term "uterine isolation procedure":
1. Hysterectomy in the presence of a uterus which has been so damaged or weakened by multiple cesarean sections that it is judged to be incapable (because of the damage within the uterus itself) of safely supporting another pregnancy is, with solid probability, not a contraceptive sterilization and is permitted . . . 2. In this case, and only in this case, the isolation of such a uterus at its tubal adnexa, instead of its extirpation, if clinically indicated, is, with solid probability, not a contraceptive sterilization and thus may be permitted and practiced; unless, of course, this is disapproVed by the bishop of the diocese who might well foresee greater harm in the danger of misunderstanding and morally unwarranted extension of the procedure as a semantic to conceal directly contraceptive sterilizations. 3. If, after further study and investigation, there would be a sufficient consensus of theological opinion or a decision by the Congregation for the Doctrine of the Faith that either of the procedures described above (either the hysterectomy in this case or the isolation procedure) is indeed a direct sterilization (such as to discount the solid probability that it is not), then neither of the procedures could be done within the context of Catholic teaching. The sale moral defense of either procedure is the solid probability of the moral opinion that it is not a directly contraceptive sterilization (emphasis applied). I wish to emphasize the need for further study and investigation of this issue because the experience with "uterine isolation" is compelling and proves that the practice is nothing but direct contraceptive sterilization. It is also a practice with inappropriate medical justification . . . a practice which, in the 1990's, cannot be justified on medical moral grounds. One of the most important questions that needs to be asked with regard to "uterine isolation" is "What are we isolating the uterus from?" It is clear that the uterus is not being isolated from either the sperm or the ovum since they present no potential of risk. It is equally clear that the isolation of the uterus, so proposed, is not isolating the uterus from any known disease condition. the only possible thing that this procedure could be isolating the uterus from is a pregnancy . Thus, it seems equally clear that the primary intent of such a "uterine isolation" is contraceptive sterilization. Furthermore, the actual application of "uterine isolation" policies in Catholic hospitals suggests that it is direct contraceptive sterilization.
Hilgers TW et al., 1992·The Journal of reproductive medicine
Fifty consecutive clients achieved pregnancy using a standardization modification of the Billings ovulation method (the Creighton Model Natural Family Planning System). Of 50 clients followed, 38 (76%) achieved pregnancy in the first cycle of fertility-focused intercourse, 45 of 50 (90%) achieved pregnancy by the third cycle and 49 of 50 achieved pregnancy by the sixth cycle (98%).
Fifty consecutive clients achieved pregnancy using a standardization modification of the Billings ovulation method (the Creighton Model Natural Family Planning System). Of 50 clients followed, 38 (76%) achieved pregnancy in the first cycle of fertility-focused intercourse, 45 of 50 (90%) achieved pregnancy by the third cycle and 49 of 50 achieved pregnancy by the sixth cycle (98%).
A simple technique of placing two Kocher clamps on the anterior rectus fascia for the elevation of the anterior abdominal wall during the insertion of the veress needle and the laparoscopic trocar is described in 243 consecutive patients. There were no failed insufflations during this study and no cases of preperitoneal emphysema. The technique is simple to use and adds safety to a basically blind procedure.
To determine if repetitive administration of hCG causes decreased pregnancy wastage rates in patients who are at a high risk of luteal inadequacy. Ovulation induction using human menopausal gonadotropin (hMG)/human chorionic gonadotropin (hCG) or clomiphene citrate (CC) is associated with luteal phase defects that may cause increased pregnancy wastage. An increased risk of abortion exists also in pregnancies in patients with previous repeated miscarriage, women older than 37 years, and various causes of infertility such as hyperprolactinemia. Because the presumed common denominator to the increased rate of pregnancy wastage in all these cases is luteal dysfunction, repetitive hCG administration, 2,500 U two times weekly, was carried out between the 4th and 8th week of gestation in 249 cases of ovulation induction and/or previous abortions, whereas 198 gestations served as controls (no hCG administration). In the hCG treatment group, 43 ended in miscarriage (17.3%) versus 97 abortions in the control group (49%, P less than 0.01). In 160 cases of hMG/hCG generated gestations, 94 received hCG and 66 did not. The pregnancy wastage rates were 21.3% and 42.4%, respectively (P less than 0.05). In 144 cases of CC/hCG-induced pregnancies, 95 received hCG and 49 served as controls. The respective abortion rates were 15.8% and 44.8% (P less than 0.01). The remaining 143 spontaneous conceptions occurred in infertile patients with previous repeated abortions. In 60 of these conceptions, hCG was administered during the first 4 weeks of gestation and 83 cases served as control. The pregnancy wastage rates were 13.3% versus 56.6%, respectively (P less than 0.001). Repetitive administration of hCG during the early gestation in cases that are at high risk of luteal inadequacy may significantly decrease the pregnancy wastage rate.
The empty follicle syndrome was assessed using transvaginal ultrasonography in a group of 152 consecutive women with unmedicated menstrual cycles being studied because of primary or secondary infertility or repetitive miscarriage. The overall frequency of the empty follicle syndrome was found to be 43.4%. The frequency increased with age but was independent of gravidity. The empty follicle syndrome may be a significant etiologic factor in infertility or other reproductive abnormalities, and transvaginal ultrasound represents a good, non-invasive means of evaluating it.
We report an interesting case of above-normal serum estradiol concentration of unknown origin. A 30-year-old white woman was seen for infertility problems. Hormonal evaluation revealed the following results. Postovulatory progesterone concentrations and profile (a plot of hormone concentration vs time of cycle) were within the normal range for our laboratory (Table 1). However, the post-ovulatory estradiol concentrations were extremely high, although the curve appeared normal in profile (Table 1).
James Parkinson, a general physician, was interested in all facets of medical care, and wrote two books for the lay public that contained comments on diverse things. He may have been one of the first physicians to publicly describe child abuse. Some of his advice to the public was of a neurologic nature, and included directions on the diagnosis and treatment of pseudoseizures, epilepsy, drowning, and stroke.
Twenty-four women with luteal phase defects who were ovulatory on clomiphene therapy with or without human chorionic gonadotropin (hCG) at midcycle for three to eight cycles yet failed to produce a live birth were treated with a short course of menotropin (hMG-S), one to two ampules for five days in the early follicular phase followed or not followed by hCG at midcycle for three to eight cycles. The luteal phase defect was diagnosed with repeat endometrial biopsies with a lag time of three or more days prior to clomiphene therapy. A complete infertility workup revealed only eight patients (33%) with a purely endocrine factor (luteal phase defect). The rest (16 patients, or 67%) had one or two additional infertility factors. Two abortions occurred in this group during clomiphene therapy, while five pregnancies (four live births and one spontaneous abortion) occurred during hMG-S therapy. The ovulation rates were similar for hMG-S (89%) and clomiphene (91%) therapy, but the frequency of a normal ovulatory cycle was significantly greater (P = .026) for hMG-S therapy (71%) than for clomiphene therapy (57%). The midluteal mean serum progesterone level was lower and the mean luteal length shorter in the cycles with less than 130 ng/mL/d of total integrated luteal progesterone. The postcoital test results showed better cervical mucus, with increased mucus volume and better fluidity and spinnbarkeit, in hMG-S cycles than in clomiphene cycles. It appears that hMG-S treatment can improve ovarian function and achieve successful pregnancy in patients with luteal phase defects who fail to produce a live birth during clomiphene treatment.
The sonographic definition of the empty follicle syndrome is presented in a group of 89 consecutive, unmedicated menstrual cycles in women with primary or secondary infertility. The incidence of the empty follicle syndrome was found to be 50%. The incidence increased with age and was independent of gravidity or the type of follicular rupture (or lack of rupture). These data suggest that the empty follicle syndrome may represent a significant etiologic factor in infertility or other reproductive abnormalities.
The records of 139 consecutive patients who underwent major gynecologic abdominal surgery in which 32% dextran 70 was used as an antiadhesion adjuvant were carefully reviewed for the presence or absence of dextran-related complications. Eleven patients (8.0%) were thought to have dextran-related complications, including postoperative ileus (2.9%), pleural effusion (2.2%), allergic reactions (1.4%), wound infection (1.4%) and labial swelling (0.7%). The mean amount of dextran used was 183 mL. The study indicated that dextran can be used in moderate amounts when instilled intraperitoneally and has an acceptably low rate of complications. Since dextran is used often in spite of scanty evidence of its effectiveness as an antiadhesion adjuvant, understanding its safety and potential complications is especially important.
Cervical mucus observation may be difficult for women who experience continuous mucus throughout their menstrual cycles. This study aims to prove the value of cervical mucus methods for these women. Rather than examining a woman's onset of cervical mucus, this study evaluates the "Point of Change" in the mucus and its correlation to the woman's hormone levels.
Progesterone (P), the natural hormone, binds to its specific receptors to induce specific progestational effects. In addition to this binding, P is able to interfere with the binding sites of other steroids. Therefore the natural hormone exhibits an anti-estrogenic activity, and anti-androgenic activity and also exerts anti-mineralocorticoid effects. For a long time progesterone could not be used in clinical applications because of a rapid liver inactivation after oral administration. An oral micronized preparation of progesterone is now available which produces adequate plasma and tissue levels of progesterone. The preparation reproduces the anti-estrogenic effect of the natural hormone on the endometrium at the dose of 200 mg daily. It also reproduces the anti-mineralocorticoid effect and has no androgenic action. No side effects have been reported as far as lipids profile, coagulation factors and blood pressure are concerned. Therefore oral micronized progesterone appears suitable for hormonal replacement therapy in various areas, essentially postmenopause therapy, premenstrual syndrome, correction of irregular cycles and pregnancy maintenance.
The potential tocolytic effect of natural progesterone administration on premature labor was investigated in a double-blind study. An oral progesterone formulation was used because its ability to increase both plasma and myometrial concentration of progesterone in pregnant women had been previously demonstrated. Furthermore, no commercial intravenous or intramuscular natural progesterone formulation is currently available in France. Fifty-seven patients in two obstetric clinics, admitted because of the risk of premature delivery, were included in the study, and uterine contractility and fetal cardiac rhythm were monitored in all of them. At random and after 30 minutes' rest, 29 women absorbed four capsules of 100 mg of progesterone each and 28 women absorbed four capsules of a placebo. Plasma progesterone levels were evaluated in all cases after 30 minutes' rest and 1 hour after absorption of the capsules. The results showed that bed rest and placebo administration decrease uterine activity in 42% of the cases and oral progesterone decreases activity in 75% to 88% of cases, depending on the initial severity of the menace of premature delivery. The difference between the effects of progesterone and of placebo is significant. The tocolytic effect of oral progesterone is not as intense or as rapid as the effect of intravenous beta-mimetics but is sufficient in 80% of cases, on the average, to stop the premature labor without any detectable side effects. This tocolytic effect of oral progesterone is related not just to an increase in plasma progesterone levels but probably to an increase in myometrial progesterone concentration.
There is no information available about the effect of iron in formula on the development of gastrointestinal humoral immune response in early human infancy. We compared standard Enfamil to iron-fortified formula during the first 8 weeks of human life on the development of local gastrointestinal humoral immune response by measuring fecal secretory immunoglobulin A (SIgA). Thirty children were studied and classified according to feeding in two groups: plain Enfamil (n = 15) and Enfamil with iron (n = 15). Fecal specimens were analyzed at birth, 2 weeks, 4 weeks, and 8 weeks of age. Fecal SIgA was assayed by RID (radial-immune diffusion) during these four infantile periods in the two groups. Marked SIgA changes were detected in the group with iron-fortified formula versus non-iron-fortified formula. These changes appeared to have statistical significance in all the three infantile periods (2 weeks, 4 weeks, and 8 weeks). There were no observed clinical side effects with the use of iron-fortified formula as detected by appropriate questionnaire. The possible role of iron in earlier and enhanced development of immunologic competence and host defense is discussed. These data may suggest a beneficial effect of low-dose iron in formula during early infantile human life by the protective role of the earlier and enhanced production of SIgA in the gut.
A double blind, randomised, crossover trial of oral micronised progesterone (two months) and placebo (two months) was conducted to determine whether progesterone alleviated premenstrual complaints. Twenty three women were interviewed premenstrually before treatment and in each month of treatment. They completed Moos's menstrual distress questionnaire, Beck et al's depression inventory, Spielberger et al's state anxiety inventory, the mood adjective checklist, and a daily symptom record. Analyses of data found an overall beneficial effect of being treated for all variables except restlessness, positive moods, and interest in sex. Maximum improvement occurred in the first month of treatment with progesterone. Nevertheless, an appreciably beneficial effect of progesterone over placebo for mood and some physical symptoms was identifiable after both one and two months of treatment. Further studies are needed to determine the optimum duration of treatment.
A single dose of micronized oral progesterone was administered to 15 pregnant women immediately prior to elective cesarean section. Levels of progesterone, 17 beta-estradiol, and estrone were measured in the plasma, in the placenta, and at different sites in myometrium obtained during the surgical procedure. Results were compared to those observed in a control group of women who did not receive progesterone. Progesterone levels demonstrated a marked increase in plasma and in the whole myometrium 150 minutes after administration. The levels then decreased rapidly to control values in 1 hour. The concentrations of progesterone in the placenta did not show any changes. No difference appeared in 17 beta-estradiol levels in the plasma or the myometrium, whereas an increase was observed in the placenta. Estrone levels did not change in the plasma, but they decreased in the myometrium and in the placenta.
One hundred thirty-seven premenopausal women with premenstrual tension underwent laparoscopy for bleeding, pain and/or infertility. Endometriosis was the associated gynecologic disease observed most frequently (66 patients). Other associated disorders were primary dysmenorrhea (31), poststerilization syndrome (24), chronic pelvic inflammatory disease (8) and leiomyoma uteri (8). Screening for prolactin and thyroid-stimulating hormone in patients with galactorrhea (74) revealed one patient with pituitary microadenoma and two with primary hypothyroidism. The midluteal progesterone levels were significantly decreased, whereas the midluteal estradiol 17 beta levels were significantly elevated. Because of the frequent association of premenstrual tension with other gynecologic diseases, screening for premenstrual tension in all premenopausal women is recommended.
The possibility that beta-endorphin, an endogenous opiate, is involved in the regulation of the menstrual cycle was examined. Daily serum beta-endorphin levels, in conjunction with luteinizing hormone, progesterone, and 17 beta-estradiol were measured during 26 hormonally normal menstrual cycles. Twenty-one cycles showed a preovulatory peak and postovulatory trough of beta-endorphin, 2 cycles had a postovulatory peak, and 3 had a postovulatory peak with sustained elevation. The raw data were standardized by conversion to "Z-scores," and the composite values were computed for each of the three classes described above. Significance within these three classes was assessed using a one-way analysis of variance with an F-ratio at 95% confidence limits. The composite plot of the 26 cycles showed a statistically significant preovulatory peak occurring 2 days prior to the luteinizing hormone surge and a postovulatory trough of beta-endorphin 5 days later. These results suggest that beta-endorphins play a significant role in the neurochemical mechanisms of gonadotropin release.
The estimated time of ovulation (ETO) was correlated with the day of defined postovulatory infertility in 66 hormonally normal menstrual cycles from 24 subjects for each of 15 different natural family planning methodologies. Inherent weaknesses were identified in methods based upon calendar calculations or basal body temperature only. These weaknesses could be removed for the basal body temperature-only methods if symptoms, especially the peak mucus symptom, were added to the temperature records. However, the peak mucus symptom alone had the greatest precision of all methods studied. No advantage could be identified in combining the basal body temperature with the peak symptom.
Genetic errors of many kinds are connected with the reproductive processes and are favored by a nunber of largely uncontrollable, endogenous, and/or exogenous factors. For a long time human beings have taken into their own hands the control of this process. The regulation of fertility is clearly a forceful request to any family, to any community, were it only to lower the level of the consequences of genetic errors. In connection with this request, and in the context of the Congress for the Family of Africa and Europe (Catholic University, January 1981), 1 question must still be raised and possibly answered. The question is: do or can the so called "natural methods" for the regulation of fertility increase the risks of genetic errors with their generally dramatic effects on families and on communities. It is important to try to give as far as possible a scientifically based answer to this question. Fr. Haring, a moral theologian, citing scientific evidence finds it shocking that the rhythm method, so strongly and recently endorsed again by Church authorities, should be classified among the means of "birth control" by way of spontaneous abortion or at least by spontaneous loss of a large number of zygotes which, due to the concrete application of the rhythm method, lack of necessary vitality for survival. He goes on to state that the scientific research provides overwhelming evidence that the rhythm method in its traditional form is responsible for a disproportionate waste of zygotes and a disproportionate frequency of spontaneous abortions and a defective childern. Professor Hilgers, a reproductive physiologist, takes on opposite view, maintaining that the hypotheses are arbitrary and the alarm false. The strongest evidence upon which Fr. Haring bases his moral principles about the use of the natural methods of fertility regulation is a paper by Guerrero and Rojos (1975). These authors examined, retrospectively, the success of 965 pregnancies which occurred in women who were using the temperature method for family planning and who had recorded the menstrual day of insemination, and they concluded that their results suggested that aging of human spermatozoa in the female genital tract is associated with a increased frequency of spontaneous abortions and that postovulatory aging of human ova results in postimplatation. Their results and conclusions were accepted with great caution by the scientific community. The kind of evidence which suggests that the use of natural methods may increase, in particular cases, the loss of embryos or fetuses, stimulates further research, but it seems a very weak basis for the establishment of principles of human behavior. At the present stage of knowledge the natural methods for the regulation of fertility cannot be qualified as methods which necessarily and considerably increase the risks of abortion of malformed progeny.
Several periovulatory symptoms sometimes used in natural family planning are correlated with the estimated time of ovulation in 23 subjects and 64 hormonally normal menstrual cycles. The data suggest that intermenstrual pain may not be due to 1 specific cause but rather to several related factors. As a symptom of ovulation, intermenstrual pain was more specific than lower backache, abdominal bloating, and intermenstrual bleeding nonetheless, intermenstrual pain has a broad periovulatory association. The most reproducible and predictable sign of this series appeared to be the postovulatory occurrence of breast tenderness.
The luteinized unruptured follicle syndrome is a frequent phenomenon, occurring in half of our women with regular cycles and infertility. Progesterone concentrations and 17 beta-oestradiol concentrations were assayed in peritoneal fluid of women during the luteal phase. Up to day 20 of the cycle, the concentrations were significantly higher in women with an ovulation stigma than in women without an ovulation stigma on their corpus luteum. The range of concentrations was sufficiently different in the early luteal phase to be used diagnostically, the only limitation being the presence of a cystic corpus luteum. We suggest that the assay of progesterone and 17 beta-oestradiol in peritoneal fluid should be done in all women with infertility and biphasic basal body temperature charts in order to diagnose the luteinized unruptured follicle syndrome.
Now that principles of NFP have been established specific programs are necessary to disperse information and to teach techniques. The hospital-based NFP program offers the community a needed service and benefits the hospital.
Four points on the basal body temperatures (BBT) curve have been correlated with the estimated time of ovulation (ETO), as determined by indirect hormonal parameters, in 74 menstrual cycles from 24 subjects. Only 10 of 66 hormonally
I read with interest the recent article by Wade and associates, "A randomized prospective study of the use-effectiveness of 2 methods of natural family planning: an interim report" (134: 628, 1979). In reference to the study of the ovulation method, the authors noted that abstinence begins on the 1st day of mucus secretion and continues until the evening of the 4th day beyond the peak or maximal mucus secretion. In the ovulation method, the peak symptom is not the same as maximal mucus secretion as was indicated in the paper. The peak symptom is defined as the last day of the mucus discharge that is clear and/or stretchy and/or lubricative. In the definition of peak symptom, the amount of mucus discharge is not specifically important and may often be misleading. I had the opportunity to do a site visit at this study at the request of the National Institutes of Health while the study was in progress. I analyzed several pregnancies which occurred in users of this ovulation method. Some of the pregnancies occurred as the result of poor teaching of the concept of peak symptom. In the ovulation method, proper understanding and teaching of that concept are essential to the measurement of its effectiveness. Noticeably missing from this interim report was any discussion of the quality control procedures which were utilized to guarantee a high-quality educational service to the people entered into the study. While the authors claim that the methods were taught by professional teachers, these teachers were actually women who had previously used the method and/or had formalized training in teaching the method. Simple use of either of the methods certainly does not qualify an individual to teach natural family planning. For those with formalized teaching, such training should have been outlined since judgment on the effectiveness of the teaching cannot be made; such a judgment is essential to the proper analysis of results. Finally, while the study claims to be a use-effectiveness study, it is rather a modified version of extended use-effectiveness. No objective definition of "user failure" is provided. One cannot ascertain how many pregnancies were related to poor teaching, nor can one tell how many occurred as the result of the couples' last minute exercise of their freedom to use their fertility. The use-effectiveness of the 2 methods under study as a means to achieve a pregnancy have been ignored. In doing so, the investigators have ignored use-effectiveness reality.
It is commonplace for gynecologists to refer to "midcycle" ovulation of women. This concept has often led to the routine diagnosis of ovulatory status on day 14 of what is expected to be a 28-day menstrual cycle. For example, the postcoital test in an infertile patient, or intercourse to achieve pregnancy in a normally fertile patient, is often timed around day 14 under the assumption that ovulation is occurring then. Advocates of natural family planning (NFP) have criticized the concept of "midcycle" ovulation, because their clinical experience suggests that the natural irregularity of menstrual-cycle length militates against ovulation's occurring with any great frequency on day 14.
This report analyzes the relationship of day 14 and the actual midcycle of the menstrual cycle to each other and to indirect hormonal parameters that more directly estimate the time of ovulation.
St. Louis University Natural Family Planning Center. St. Louis. Missouri and Creighton University Natural Family Planning Education and Research Center, Omaha. Nebraska
From January 1, 1968 to May 31, 1973, 100 patients received first kidney transplants from sibling donors. All recipients have been followed for at least two years and several as long as 7.5 years. One hundred per cent follow-up information is available. The absolute two-year patient survival is 85% and the absolute two-year kidney function survival is 76%. Patients with diabetes (especially males) have less success following transplantation than do patients without diabetes. When diabetic patients are excluded, older patients appear to do slightly less well than younger patients. Patients with phenotypically identical HL-A matches with the donor do better than patients without such matches. In the nondiabetic technically perfect transplant recepient, better than 90% long-term transplant function can be expectedwith no kidney losses after the first few months. In contrast, the less well-matched transplant demonstrated both an increased early rejection rate and a high rate of loss after the third to fifth year. Increasing doses of anti-lymphoblast globulin (ALG) had beneficial results in HL-A mismatched sibling transplants, but were slightly detrimental in phenotypically identical HL-A donor-recipient pairs because of an increased rate of infection. The results are compared with the results of transplants from other related donors and from cadavers performed during the same period.
Fifteen years have passed since our group first proposed the use of clomiphene citrate as an ovulation-inducing agent. Our 15-year experience with over 2,000 patients has not dampened our enthusiasm for this drug. The benefits have far outweighted the minor side effects or the possibility of multiple births. Serious birth defects were minimal and have been no greater than what one may expect in the general population. Clomiphene citrate has been a boon to womankind and deserves the confidence of both patient and physician: it is a drug with a record of utility and with but minor risks.
We conducted a double-blind study to determine the efficacy of 17alpha-hydroxyprogesterone caproate in preventing premature delivery in 43 high-risk patients. Premature delivery did not occur in 18 patients receiving the progestational agent, whereas 41 per cent of the 22 receiving the palcebo had premature delivery (P less than 0.01). The mean duration of pregnancy and the mean birth weight in the former group (38.6 weeks +/- 1.6 S.D., and 2836 g +/- 412 S.D.) were both significantly greater (P less than 0.025) than that in the latter (35.2 weeks +/- 6.7 S.D.; 2361 g +/- 1085 S.D.). The perinatal mortality rate in the group given the progestational agent (O per cent) was significantly less than that observed in the placebo group (27 per cent) (P less than 0.05). Although there were no complications attributable to the progestational drug, the study population was too small for assessment of immediate or long term safety. However, the results indicate a possible obstetric use for this drug.
A new progestational steroid, the acetophenone derivative of 16α,17α;- dihydroxyprogesterone, was compared with several progestogens for masculinizing effects on the offspring of rats treated during pregnancy. The results were similar to those obtained with progesterone and 17α-hydroxyprogesterone caproate: this new steroid did not alter the normal male:female sex ratio and did not virilize the internal or external sex structures of the newborn. The present results confirm those of others in finding that 6α-methyl-17α-hydroxyprogesterone acetate, 17α-ethinyl-19-nortestosterone and 17aethinyl- 19-nortestosterone acetate increased the number of male and intersex offspring, as determined by ano-genital measurements and masculinization of internal and external sex organs.
*We are offering you a comprehensive look into women's health. By understanding natural methods and the science behind the menstrual period, the fundamental elements of conception and infertility can be easily understood.*
Creighton Model charting & scientific/physiological foundations
Creighton model data, and how it relates to the NaProTechnology application
Treatment approaches of NaProTechnology & Restorative Reproductive Medicine in gynecology and infertility
Benefits of RRM vs standard Conditions and Treatments