Infertility and NaProTechnology

If a couple use Fertility Care from the beginning of

their sexual relationship they have tremendous
insight into their fertility potential BEFORE they
ever try to conceive. This is extremely beneficial in
a society where one couple in 6 will experience
some difficulty conceiving. The earlier problems
are identified and treated, the greater the
likelihood of a successful outcome.
NaProTECHNOLOGY
NaProTechnology is an abbreviation of the term Natural
Procreative Technology, which is a scientific, holistic process of
investigating abnormal gynaecologic and reproductive health. It is
particularly effective in treating infertility and recurrent
miscarriages. NaProTECHNOLOGY was developed by Consultant
Obstetrician and Gynaecologist, Dr. Thomas W. Hilgers in
Omaha, Nebraska, USA. It involves teaching women and couples
how to monitor and record their Biological Markers of fertility
in
a
precise
and
standardised
fashion
using
the FertilityCare charting system. This information allows the
physician who is trained in FertilityCare and NaProTechnology
techniques to conduct a more thorough evaluation of the fertility
cycle to identify abnormal menstrual bleeding patterns, poor
cervical mucus flow and subtle hormonal deficiencies that are
often not detected by routine gynaecologic evaluation.
Establishing a diagnosis is essential to NaProTechnology. You
need to find the problem before you can fix it! Medical treatments
are prescribed in a timed fashion with respect to the womans
cycle. The goal of treatment is to restore a normal appearance to
the fertility chart and restore optimum fertility potential for the

couple.Correcting
underlying
charting
and
hormonal
abnormalities improves fertility and reduces the risk of
miscarriage. When optimum function is achieved, conception can
occur anywhere from the first to the twelfth effective cycle of
treatment. On average couples complete fertility evaluation and
treatment between 18 to 24 months after the initial medical
consultation, or sooner if conception occurs. Many of the
medications used with NaProTechnology are widely used in other
fertility programmes, but the precise timing and monitoring of
treatment using the FertilityCare charting system is unique to
NaProTechnology.
Become your own Fertility Expert
The system teaches couples how to become their own fertility
experts. They learn how to assess monitor and manage their
fertility through a series of consultations with their physician and
specially trained teacher-practitioner. Nearly 40 practitioners are
available in Ireland with and a further 10 in the UK. The process
of Fertility Tracking empowers couples, and is essential to
identify and treat the underlying causes of abnormal reproductive
health.
Suitability
NaProTechnology is suitable for nearly every category of infertility
and recurrent miscarriage. Couples with conditions such as
Endometriosis, Polycystic Ovaries, Pelvic Adhesions, Blocked
Fallopian tubes, Low progesterone, not ovulating, Unexplained
infertility, Unexplained recurrent miscarriage and Poor semen
analysis have all conceived using the NaProTECHNOLOGY
approach.
Male Factor Infertility

Men with very low sperm counts or anti-sperm antibodies can be

treated. If one result is poor the analysis is repeated about 2 to 3
months later following healthy lifestyle advice. The man is
advised to increase exercise, stop smoking and reduce alcohol
intake, stress reduction and vitamin & mineral supplements may
also recommended. It is important for the man to have a complete
urological assessment with a urologist interested in finding and
treating the underlying cause of male infertility. Surgical
correction of a varicocele, and medical treatments including
Indomethacin, tamoxifen, L carnitine, antibiotics, prednisolone,
coenzyme Q10 and Pycnogenol can been used to improve the
mans semen analysis. A further crucial factor is to conduct a
thorough evaluation of the womans fertility potential, with
NaProTECHNOLOGY. Often a previously un-identified female
factor is found, such as poor cervical mucus flow and suboptimal
hormones. Correction of these factors improves the overall chance
of successful treatment. Men with very low sperm counts have
conceived with this approach. If the count remains persistently
below 1 million, despite treatment, conception is less likely to
occur. The lowest (treated) semen analysis that resulted in
conception in the Irish programme had a count of 4 million with
45% motility and 96% abnormal morphology. This had improved
from untreated levels that had counts of less than 1 million. That
couple had tried and failed ICSI twice before succeeding with
NaProTechnology.
NaProTechnology has been available in Ireland since February
1998. In that time over 2,000 couples have been treated with an
overall success rate of about 40%. Even couples with a history of
failed IVF can expect to have a successful pregnancy about 30% of
the time using NaProTechnology. To date nearly 200 couples with
previously failed IVF have conceived using this approach. In cases
of recurrent miscarriage, nearly 80% of couples will have a
successful pregnancy. Couples with a history of eight to nine

previous miscarriages have now had successful pregnancies using

this system.

NaProTECHNOLOGY A Major Breakthrough In

Monitoring and Maintaining a Woman's
Reproductive and Gynecological Health
NaProTECHNOLOGY (Natural Procreative Technology) is a new women's health
science that monitors and maintains a woman's reproductive and gynecological
health. It provides medical and surgical treatments that cooperate completely with
the reproductive system.
Thirty years of scientific research in the study of the normal and abnormal states of
the menstrual and fertility cycles have unraveled their mysteries.

NaProTECHNOLOGY A Major Breakthrough.

This is the first women's health science to network family planning with
reproductive health monitoring and maintenance. It is a fertility-care based medical
approach rather than a fertility-control approach to family planning and
gynecological health.
NaProTECHNOLOGY uses the Creighton Model FertilityCare System
biomarkers to monitor easily and objectively the occurrence of various hormonal
events during the menstrual cycle. NaProtracking provides valid information that
can be interpreted by a woman and by physicians who are specifically trained in
this system.

Unlike common suppressive or destructive approaches, NaProTECHNOLOGY

works cooperatively with the procreative and gynecologic systems. When these
systems function abnormally, NaProTECHNOLOGY identifies the problems and
cooperates with the menstrual and fertility cycles that correct the condition,
maintain the human ecology, and sustain the procreative potential.
Women now have an opportunity to know and understand the causes of the
symptoms from which they suffer.

The Goals of NaProTECHNOLOGY in Infertility

A NaProTECHNOLOGY approach to the infertile couple has the following goals:
1. It works towards assessing the underlying causes of the reproductive
abnormality.
2. It allows for the treatment of these underlying causes.
3. It assists the couple in achieving pregnancy while maintaining the natural
acts of procreation.
4. If the treatment program is unsuccessful, research into the unknown causes
is undertaken.
5. If medically unsuccessful, the program will assist with successful family
building by being supportive of adoption.

Surgical NaProTECHNOLOGY

About 30 years ago, the American Board of Obstetrics and Gynecology approved
three new subspecialties in the field of obstetrics and gynecology. These
subspecialties were gynecologic oncology (womens cancer), perinatology (highrisk pregnancies), and reproductive endocrinology (infertility and other
reproductive hormones). It was the hope when these subspecialties were developed
that they would advance those three areas of womens health.
As one looks back on the development of the reproductive endocrinology training
programs, they originally started with the emphasis on pelvic surgery. However, in
1978, when the first baby was born by in vitro fertilization (IVF), the specialty
changed dramatically. Its focus, over the last 12 years, has been on the
development of the skills needed for IVF. As a result, many younger reproductive
endocrinologists do not, at this time, have the surgical skills necessary to do some
basic and most advanced reconstructive pelvic surgeries.
Over a decade ago, the Society of Reproductive Surgeons, a group within the
American Society of Reproductive Medicine, began to recognize this deficiency
and foster the development of postgraduate fellowship programs which would
have, as one of their major emphases, training in pelvic surgery, microsurgery,
laser surgical applications, and so forth. These training programs have grown

slowly over the past 10 years, but it is in this area that Surgical
NaProTECHNOLOGY has its major focus.
Surgical NaProTECHNOLOGY is a specialized form of gynecologic surgery
whose primary aim is to reconstruct the uterus, fallopian tubes and ovaries in such
a way that pelvic adhesive disease can be eliminated and not caused by the surgical
procedure itself. It is, in a sense, a near-adhesion free form of surgery.

"Near-Contact" Laparoscopy
Diagnostic laparoscopy is a technique which is not universally well taught in the
training programs of obstetrics and gynecology. Often, laparoscopic technique is
learned by the young physician as they undergo laparoscopic sterilization
procedures. However, the use of the laparoscope for the use of diagnostic purposes
is actually significantly more complex.
One of the techniques that is important in doing good diagnostic laparoscopy is
something that is referred to as near-contact laparoscopy. In this situation, the
laparoscope must be brought in close contact with the tissues in order to actually
see what is going on. A good example of this is shown in Figures 65-25 through
65-27. In the upper photograph, the uterus, tubes and ovaries are observed and
there are two small defects observed on each side of the uterus. In the next
photograph, a closer view of one of the defects is seen but one could miss the
endometriosis that is present on this view. In the third view, however, the
laparoscope is brought right in contact with the opening of that defect and the dark
red area in the background is endometriosis. It becomes quite visible when the
laparoscope is placed close to the tissues. Near-contact laparoscopy is a
fundamental technique of Surgical NaProTECHNOLOGY.

[Figures 65-25 through 65-27 from the NaPro textbook. Two peritoneal pockets can be
observed in 65-25. Upon closer evaluation in 65-26 and 65-27, the endometriosis deep
in the pocket can be observed. The findings of endometriosis in peritoneal pockets of
this kind is so common that it is to be expected.]

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Excising Endometriosis
Surgical removal of endometriosis carries with it the best chance for success, both
in terms of pain relief and in subsequent pregnancies. However, if the surgeon is
not adequately trained to be able to provide a good surgical approach which will
remove the endometriosis while preventing subsequent adhesions, the chances for
success are quite limited.
In Figures 70-1 through 70-5, an area of endometriosis on the front portion of the
uterus is excised and it is repaired using a suture called Prolene. The Prolene suture
is a permanent suture which is very non-reactive. In addition, the superficial tissues
are inverted inwards so that, at the conclusion of the procedure, one has a surgical
closure which is smooth, glistening, there is no abrasive tissue present, and the
suture itself is completely nonreactive. This is illustrated best in Figure 70-5.

Fig 70-1

Fig 70-2

Fig 70-3

Fig 70-4

Fig 70-5

[Figures 70-1 through 70-5, p 952 from the NaPro textbook. In this example of
endometriosis on the anterior uterus and posterior bladder, an incision is made around
the area of endometriosis into the peritoneum using a microcautery. The endometriosis
is excised and the peritoneum is repaired using a 4-0 Prolene, running imbricating
suture leaving a smooth glistening peritoneum exposed.]

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Wedge Resection for Polycystic Ovaries

Women who have polycystic ovarian disease, have very large ovaries which have
multiple cysts within them. They do not function very well and their menstrual
cycles are long and irregular. They do not ovulate on a regular basis, thus,
infertility is quite common in this situation.
In 1950, the pregnancy rate following ovarian wedge resection was 66 percent.
However, when Clomid was introduced in the mid 1960s, the pregnancy rate was
only about 30 percent, but everyone got the impression that it was a better form of
treatment and the medical profession adopted it. More recently, using in
vitro fertilization techniques, the pregnancy rate is only 23 percent and there is
continued emphasis on this being an even better treatment.
Much of this occurred as a result of surgical techniques which were used for the
ovarian wedge resection and caused a large number of pelvic adhesions. However,
this has been completely eliminated with the use of Surgical
NaProTECHNOLOGY techniques. The technique used for ovarian wedge
resection is illustrated in Figures 75-3 through 75-7 and 75-8 through 75-11. Here,
an incision is made into the ovary using a carbon dioxide laser. The wedge of tissue
is removed and the ovary is repaired using the Prolene suture once again and
inverting the edges. When the final result occurs, as illustrated in Figure 75-11, this
results in excellent healing and no adhesions.

Fig 75-3

Fig 75-4

Fig 75-5

Fig 75-6

Fig 75-7

Fig 75-8

Fig 75-9

Fig 75-10

Fig 75-11
[Figure 75-3 through 7-11, pp 1025-1026 from the NaPro textbook. Steps in an ovarian
wedge resection performed on a polycystic ovary.]

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Preventing Adhesions

The prevention of adhesions at the time of surgery involves multiple surgical steps.
These are explained in detail in the Medical and Surgical NaProTECHNOLOGY.
While these techniques were evolving over a period of 20 years, there was a
remarkable decrease in the formation of adhesions with utilization of these
techniques. This is summarized in Figure 81-1 which shows the historical
advancement of the prevention of postoperative adhesions with the use of Surgical
NaProTECHNOLOGY techniques. What is most noteworthy is the decline in the
total adhesion score from 33.3 to 6.0 in the period of time from 1994 through 2004.
This was a significant improvement over the previous 10 years where the reduction
in adhesion scores went only from 33.8 to 18.1.