Whether it is because of religious reasons, ethical reasons or the cost, for some women doing round after round of IVF is not really an option. And even if that is an option, if there is an IVF alternative that doesn’t involve shelling out thousands of dollars, an egg collection and the minefield that is growing embryos, you’re in, right?
That’s why when I came across NaProTECHNOLOGY I had to have a second look. I mean, all of the above PLUS apparently it has comparable rates to IVF… winning!
What is NaProTECHNOLOGY?
NaProTECHNOLOGY stands for Natural Procreative Technology and from now on I am just going to refer to it as ‘NaPro’. It was developed with support from the Catholic Church as a method of treating infertility and one of its key features is its very detailed diagnostic process in order to identify abnormalities in the reproductive system. Knowing it has been advocated for by the Catholic Church can give you some idea regarding the foundations and practices of this technology. And if you are adverse to Catholicism, don’t let this put you off just yet.
NaPro considers infertility as a symptom of an underlying condition or disease and not the actual disease itself. Through a prolonged period of tracking and monitoring it aims to identify exactly what is wrong in the ovulatory and reproductive cycle. Once these abnormalities are identified, where possible they are corrected, either by surgery or medication. Abnormalities commonly identified include decreased production of estrogenic cervical mucus, irregular bleeding or spotting, short or variable luteal phases, and low levels of estrogen and progesterone (1). Common treatments include clomiphene (also known as Clomid), support of luteal hormonal production with HCG or progesterone, and medications to enhance cervical mucus production. By ‘fixing’ these abnormalities and causes of infertility either through hormone support or surgery, it is believed that conception can then ‘naturally’ occur.
NaPro goes hand in hand with the Creighton Model FertilityCare System (CrMS) which essentially uses methods of observing and documenting cervical mucous to identify when ovulation occurs as well as identify abnormalities with ovulatory functioning. But before you start thinking it, CrMS is SO much more standardised and complex than just determining ‘egg white’ or not and extensive training is given to women who have been recommended to use this method.
From what I have learned from women who have used NaPro, the diagnostic process is much more thorough than that of the traditional IVF journey. Although it uses much of the same technology as IVF, such as regular blood tests, laparoscopy and ultrasounds, the monitoring of your cycle is done on a much more frequent process in order to accurately identify when ovulation is going to occur and make sure that the hormonal environment is ideal. For example, in a tracking cycle instead of having bloods on day 7 and then again on day 14 when ovulation is meant to occur, you might actually have blood tests and/ or ultrasounds every couple of days throughout your cycle.
The above is just a very short explanation of what I understand NaPro to be. If you would like more detailed information you might find it useful to check out the founder of NaPro, Dr Hilgers, book on NaPro.
Success Rates
Like IVF, the success rates of NaPro will alter with diagnosis. For a woman who has low estrogen and a cervical mucous problem, she will have a much higher chance of success than the couple with a very low sperm count (though the NaPro website does state that even couples with significant male factor infertility can have success with NaPro).
From the research I have done, I have seen only one large study done investigating NaPro (1). This 2008 study followed 1072 women over a period of 3 years after they commenced NaPro.
What they found was that after 12 months on the NaPro system 26% of women had successfully conceived and after 24 months 33% of women had conceived. For an extra year, only 1% extra of women had conceived, with a cumulative rate of 34%.
But as any woman who has experienced the pain of a miscarriage will tell you, the real thing that matters is that ‘take home baby’ rate. After 24 months of NaPro fertility treatment 26% of women were able to have a live birth.
It should be noted that the above data is ‘crude’ proportions and numbers. That is, the numbers I have reported is what actually happened in the study. Because of things like dropout rates and other factors, the authors believe that ‘adjusted’ proportions can be calculated, but again, certain assumptions are made to calculate these rates and caution should be maintained when reading these inflated success rates.
Interestingly another, much smaller study was done in a Canadian Clinic (2). Only 108 women took part however, after 24 months the live birth rate was higher (38% vs 26%) as well as the number of conceptions (47% vs 33%). While the average female age was similar in both studies, the average length of time that couples tried to conceive before starting NaPro was much longer in the larger study (5.6 years vs 3.2 years) and many more women (33% vs 8%) had been trying to conceive using traditional fertility treatments in the larger study.
So who is NaPro for?
From the above data it seems that women who have not previously trialed traditional fertility treatments were more likely to succeed using NaPro. It’s not necessarily the fact that these women have tried IVF (or similar) that makes the success rates lower but if the reason for fertility was going to be ‘easy’ to resolve it would likely to have been resolved at the fertility clinic and she wouldn’t have even looked at NaPro.
The average age of the women who were able to conceive was 35 years, though like IVF, these ages varied and well, we do know that the younger the eggs the better.
I have also read that you should be prepared for the NaPro journey to take around two years, which does seem like a long time, though for a lot of women IVF can take just as long and a lot longer. So if patience isn’t your strong suit this is worth considering.
Although NaPro does not involve egg collection or creation of embryos in the lab it still utilises medications and science and is not altogether ‘natural’. For example, if you are diagnosed as having an estrogen deficiency you will likely take the same injectable medications that you would take during a normal IVF cycle to increase this. So if this is why you would like to use NaPro than it probably doesn’t have much advantage over IVF. Though to be fair, presumably you would use less of the medication as you are aiming to produce one egg every month, not the ten or so you would be aiming for (maybe) on a standard IVF cycle.
Regardless though, of how long you have been on your ‘journey’ or how old you are, if you are looking for an alternative to IVF it might be worth further investigation. After all, what can another appointment matter!?
What I like about NaPro
There are two main things I like about NaPro:
- As the NaPro literature states IVF ‘bypasses’ what is abnormal with the reproductive system and instead of treating that abnormality uses the egg collection and embryo creation process to provide a ‘fix’ to that abnormality. Some say IVF is like putting a bandaid over the problem (though I still think that if that bandaid is going to get you your take home baby that is a good thing right?)
- As the diagnostic process is SO detailed according to the 2008 study, the ‘diagnosis’ of ‘unexplained’ infertility is pretty much eliminated. In my mind, if you are experiencing infertility there must be a reason for it. ‘Unexplained’ just means that they haven’t found that reason, not that it doesn’t exist. NaPro through its thorough diagnostic process takes the time to work out exactly what this problem is.
Questions I still have with NaPro
The research still seems to be limited on NaPro, and from what I have seen a fair proportion of the information provided is from Dr Hilgers in his book (who created NaPro and therefore, in my opinion, has an invested interest) or by groups of the same people. Like all fertility treatments it would be beneficial for it to be studied by a wider community from a variety of geographical locations and ethical approaches.
The success rates on NaPro websites seem higher than the success rates in the articles I have read. I know, there are always different ways to interpret research and well, we shouldn’t judge on this alone, as fertility clinics can be some of the worst culprits at producing misleading success rates.
Ok, this is a really soft reason and totally judgemental but the NaPro website looks a little outdated (I know right, pot, kettle, black!). But if I’m going to spend two of my dwindling fertile years investing into a system, I would want to know that that system is a professional team, that reinvests back into its self and cares enough to present it’s best self. If they can’t update their website, does that mean they can’t stay on top of fertility technological advancements as well?!
In summary
If you have religious or ethical beliefs and IVF does not sit well with you NaPro might very well be worth considering. Be cautious though and read up on it as depending on your medical diagnosis the success rates may vary and IVF be more likely to lead to that take home baby.
Additionally, if you have been down the IVF route too many times than you care to remember and still have been diagnosed as ‘unexplained’. NaPro may also be worth a try. After NaPro intervention only .5% of women have the ‘unexplained’ diagnosis (1) which does seem a lot lower than many of the women undergoing normal IVF.
I am not sure if I would use NaPro, maybe I would have if I came across it at the beginning of my ‘journey’. Or maybe I still would have been too impatient and had more faith in the IVF crew. Who knows. Although it does seem promising for a certain group of people, like all fertility treatments, there is no ‘one size fits all’ and careful consideration is needed to determine if this will be the right one for you.
Reference:
Stanford, J., Parnell, T. and Boyle, C. (2008) Outcomes From Treatment of Infertility With Natural Procreative Technology in an Irish General Practice. The Journal of the American Board of Family Medicine. 21(5) 375 – 384.
Tham, E., Schliep, K. & Standford, J. (2012). Natural procreative technology for infertility and recurrent miscarriage: Outcomes in a Canadian family practice. Canadian Family Physician 58:e267-74