As a continuation of our three part series on NaProTECHNOLOGY, I will be addressing how NaPro can be used to help couples struggling to conceive achieve their dreams. I am Dr. Christine L. Cimo Hemphill, an OB/GYN at Bon Secours Commonwealth Fertility & Women’s Health near Richmond, Virginia. I spent one year training directly with NaPro Founder, Dr. Thomas Hilgers to become a graduate of the Pope John Paul II Fellowship in Medical and Surgical NaProTECHNOLOGY.
NaProTECHNOLOGY is a relatively new women’s health science that works cooperatively with a woman’s natural cycle. As mentioned before, it can be used to diagnose and treat many gynecologic, hormonal, and even emotional problems. However, what it seems to be known for best is treatment of infertility. The approach that a Medical Consultant (a physician, advanced practical nurse, or physician’s assistant trained in NaPro) takes is that infertility is not the diagnosis but a symptom of other underlying disease processes. By identifying the underlying cause or causes (as it is often multi-factorial), NaPro is able to treat the source of the problem instead of using a Band-Aid solution.
Allow me to explain better using the symptom of a headache as the example. If you experience a headache, you are noticing a symptom of something else going on. Sure, we could try a quick fix of taking some pain medicine, which may help some for a short amount of time, but without knowing what caused the headache, we can’t treat the real problem. The headache may be due to hunger, spasms of the blood vessels, a brain tumor, eye strain, or a bleed in the head, just to name a few possible causes. Each cause requires a different approach in treatment: eating, relaxing the blood vessels, removal of the tumor, using the correct strength corrective lens, or stopping and removing the blood from the site of the bleeding.
With infertility, it is the same thing. Endometriosis, abnormalities of the shape of the uterus, blocked or sluggish fallopian tubes, scar tissue, hormone insufficiency, thyroid dysfunction, low-grade infections of the uterus, fibroids, polyps, abnormal ovulation, polycystic ovaries, low sperm counts or other sperm abnormalities can contribute to infertility. Thus, once a complete diagnostic evaluation has been performed, a treatment plan can be implemented to specifically address the underlying problem(s). Additionally, there is more of a holistic approach to treatment. Diet modification, vitamins, herbals, supplements, and emotional/spiritual support may be recommended and offered as well.
Traditional Infertility Treatment
Unfortunately, in my personal experience as a patient and physician in training, as well as the stories I hear from my patients, treatment does not often take this diagnostic and holistic approach. Many patients are told they have to wait 1 year before they can be diagnosed with an infertility problem. However, with NaProTECHNOLOGY and the Creighton Model FertilityCare System, couples can begin seeking diagnostic evaluation and therapy after only 6 months. With the traditional approach to infertility, a general gynecologist will usually start by just trying an ovulation induction medication, like Clomid or Clomiphene Citrate. They will often recommend obtaining a seminal fluid analysis, which is commonly obtained through an act of masturbation. This is often degrading to the male partner, objectifies women if pornography is used, and may not give as accurate a picture of sperm production since the stimulation received is not the same as intercourse and the pre-ejaculate fluid, which has a high concentration of sperm, may be missed. Finally, a hysterosalpingogram (HSG) may be performed using x-ray or a dye may be pushed through the tubes at the time of a surgery to evaluate the patency or openness of the fallopian tubes. Some hormone labs may also be ordered. Once these are done and several cycles have gone by with the couple “trying”, the couple may get referred to an infertility specialist, often known as an REI (Reproductive Endocrinology and Infertility specialist). At the REI’s office, the couple then gets coerced into stronger ovulation medications, which can increase the complications the woman experiences during treatment and even pregnancy, especially if the pregnancy is with multiple babies.
Often IUI, or intra-uterine insemination, is offered. To do this, the man must masturbate so that the sperm is collected, the sperm is then ‘washed’ in order to only get the best looking sperm, and it is placed into a syringe. With ultrasound guidance, a long catheter is inserted into the woman’s uterus and the sperm are injected into the uterine cavity around the time of expected ovulation. At best, this procedure can be described as uncomfortable. Also, I have been told that the man feel helpless in supporting the woman during this procedure.
Occasionally, the couple may be offered a surgery to evaluate for anatomic problems. Most surgery is done laparoscopically now, but it is often used to say that there is so much wrong that IVF (in vitro fertilization) is recommended, as with the cases of stage 3 and stage 4 endometriosis, or a corrective surgery is attempted, but the surgical approach is one in which there may be a high risk of developing scar tissue, which can affect fertility and cause pain.
With IVF, a couple may actually have their fertility cycles stopped with the use of oral contraceptive pills or Lupron, which causes temporary menopause, in order to prepare the uterus for the procedure. Then, high doses of ovulation stimulating medications are used to recruit many eggs for harvest. This places the woman at risk for a complication called ovarian hyperstimulation syndrome, which can be deadly. Once the eggs are harvested, sperm is collected and then they are placed together so that fertilization may occur. In some situations, sperm is directly injected into the egg in a procedure called ICSI (intracytoplasmic celluar injection). After a few days, the fertilized eggs are then evaluated. The ‘best’ eggs are chosen and then are injected into the uterus in a similar manner to the previously mentioned intrauterine insemination (IUI) process. Often more than 1 egg is placed in the uterus, so there is a higher risk of multiples compared to natural conception. Nothing has been done to correct the environment of the growing baby, so sometimes the pregnancy will end in miscarriage or become a high risk pregnancy.
How NaPro is Different
In contrast, the NaPro approach is to heal the body so that conception can occur from a natural act of intercourse between man and woman, allowing for the dignified conception of a human. The woman is made to be healthier overall so that she can not only conceive, but have a healthy pregnancy. The national preterm delivery rate is about 12%. Assisted Reproductive Technology’s preterm delivery rate is higher than this (the CDC quoted 31% in 2010). However, NaPro’s preterm delivery rate is about 7%.
A typical Napro evaluation and treatment would begin with having the woman chart her cycles in order to identify biomarkers of underlying medical problems, time diagnostic studies, and later time therapies. These biomarkers may include abnormal bleeding patterns, brown bleeding at the end of menses, unusual discharges, and decreased amounts of mucus.
When evaluation of seminal fluid is necessary, it is recommended that the couple collect the seminal fluid via an act of intercourse with the aid of a seminal fluid collection device. This device is basically a perforated, non-spermicidal condom. The perforation allows for the possibility of conception to occur, so that there is no separation between the unitive and procreative aspects of intercourse. It also allows for stimulation of the male partner to occur in a similar way to how conception will naturally occur. The pre-ejaculate fluid is less likely to be missed, so the count is likely to be more accurate. This may also help the couple remember the importance of their relationship in the family rather than making it just a medical procedure.
Once the woman has been charting adequately, she can undergo a hormone profile to evaluate whether she has any hormonal abnormalities and when they occur in the cycle. This allows for treatment to be targeted specifically to the part of the cycle that needs support and decreases the woman’s exposure to medication. Additionally, when hormones are used in NaProTECHNOLOGY, they are the exact chemical structure that the body naturally makes, unlike hormonal contraception and many menopausal hormone supplements which use progesterone-like and estrogen-like hormones, which resemble progesterone and estradiol, but have slight changes in their structure. It is believed that these slight changes in structure are the reason for the side-effects and increased health risks associated with these medicines, such as cardiovascular disease and cancers.
The woman can also undergo an ultrasound evaluation of ovulation. With this, the follicle which holds the egg is observed on a daily basis for growth, release of the egg, and development of the corpus luteum, which produces an important hormone called progesterone. If there is an ovulation defect, then ovulation induction is warranted. Additionally, there is one particular type of ovulation defect that, in general, is not responsive to oral ovulation induction. If this is identified, time is not wasted on oral medications.
Sometimes, surgical evaluation and correction may be recommended. This may include testing the openness of the fallopian tubes. Some NaPro providers will do this in a special way which will also allow them to open the tubes at the time of surgery if they are partially blocked by mucus and cellular debris. A hysteroscopy (video of the inside of the uterus) and a laparoscopy (video of the inside of the abdomen/pelvis) may occur. With these tests, signs of inflammation, endometriosis, scarring, cysts, fibroids, and other things are evaluated. Depending on what is found, it may be possible to correct the problems at the time of surgery. However, sometimes a second surgery is needed in order to properly plan the surgery for the best success with little risk of forming subsequent scarring. Treatment of endometriosis with NaPro techniques results in less recurrence (between 7% and 22% depending on the technique used) compared to traditional gynecologic approaches, which have recurrence rates as high as 60%. Also, there is an approach to treating polycystic ovarian syndrome (PCOS) surgically, which is not often offered in traditional gynecology any more, even though it has higher pregnancy rates compared to current traditional therapies. This is an ovarian wedge resection, and it may even correct other health problems like insulin resistance and elevated male hormones.
With all of these corrections in health, the woman’s body is better equipped to support a pregnancy, which leads the NaPro quoted pregnancy rates of between 60-80% at 1 year after therapy has begun. Even the best IVF clinics in the nation only quote success rates in the 50% range. However, you have to keep in mind that only those couples who can afford IVF are getting that success rate. There are many couples who can’t even try IVF. That being said, because NaPro techniques are correcting medical problems, the majority of the tests and treatments are covered by insurances, even when “infertility” is not included in the policy. This allows for a greater number of couples to seek treatment! Even couples who have tried assisted reproductive technologies (ART) to conceive but were unsuccessful are still candidates for NaProTECHNOLOGY treatments. There are many stories of couples who have tried ART, some more than once, and later conceived and delivered babies with NaPro.
Stay tuned in for the last installment of our series on NaProTECHNOLOGY. We are excited to be able to share the news of not just another way, but a better way of treating women’s health problems.”