FABM Spotlight: The Creighton Model and NaPro Technology
August 26, 2021
By Keisha Pierre-Lys, DO
Editor’s Note: This inspiring interview provides insight into the applications of fertility awareness-based methods (FABMs) in women’s health. Dr. Keisha Pierre-Lys interviewed a woman whose use of FABMs transformed her health, life, and family. Through this story, learn how physicians were able to diagnose and treat several root causes of subfertility, helping Sharlene* become healthier and even start a family.
Her journey also highlights the importance of finding physicians trained in these methods. Aware of this gap in women’s health, the FACTS team created and recently launched a unique resource, the Physician/Clinician/Educator Directory, where medical professionals and educators may list their practice so patients have an easier time finding what they need in their local area. If you are a trained FABM clinician or educator and would like to be included in our directory, you may apply here.
Sharlene is a 32-year-old patient-turned-practitioner who had always wanted a child, and through the use of fertility awareness-based methods, she was able to conceive and deliver her first child! She was first introduced to FABMs or natural family planning (NFP) in her early twenties. At that time, she decided to start with the Creighton Model approach. With this FABM, women learn to record observations of their cervical mucus and track external signs of fertility that reflect internal hormonal shifts. The method can be used to prevent or achieve pregnancy, and as an aid to address multiple medical problems.
Charting Clues Spark Answers
At first, she used the Creighton Model to track her cycles and learn more about her body. During this period of exploration, she saw the first signs of subfertility while tracking her cycle for many months prior to marriage. After marriage, it was several months before she realized she was having trouble conceiving. Although she was still in denial that she could be struggling with infertility, she knew something was wrong.
Sharlene consulted with her first Napro (NaProTECHNOLOGY-trained) physician on her journey towards fertility. Shortly after that, she was able to conceive her first pregnancy. Unfortunately, she suffered a miscarriage 6-7 weeks into the pregnancy. During her time of grief, she was approached and asked to consider becoming a Creighton practitioner. She knew this was a calling for her and was inspired by her grief and loss. Sharlene wanted to share her story and help women going through the same struggles she went through, and help them conceive as well! She found the comfort and support she also needed by teaching the Creighton Model and supporting other women and couples.
Finding the Root Cause
During her training as a Creighton practitioner, Sharlene learned the importance of progesterone in luteal phase defects, and since progesterone was not supplemented during her pregnancy, she always wondered if that was a source of her miscarriage. Continuing her journey, she found her second Napro physician, a Napro-trained surgeon. This physician found another potential root cause of Sharlene’s infertility: endometriosis.
The FACTS elective teaches about “silent endometriosis,” where the only symptoms could be difficulty getting pregnant, miscarriages, and sometimes an autoimmune association. So far, Sharlene had two of the three criteria for silent endometriosis. Yet, she did not have the more typical presentation of endometriosis with dysmenorrhea, painful intercourse, and other “classic” symptoms. Luckily, she followed the advice of her Napro-trained surgeon, who was able to diagnose Stage 2 endometriosis and remove some adhesions.
In addition to surgery, she was started on letrozole, progesterone supplementation, and estradiol post peak. Despite this, Sharlene was still not getting pregnant. Her surgeon moved, and a few years later, she met with a third Napro physician. Through lab work and ultrasound, she was diagnosed with polycystic ovarian syndrome (PCOS) and borderline insulin resistance, and metformin was added. This new physician connected her to another Napro-trained surgeon who confirmed the diagnosis of endometriosis and performed additional surgery for that as well as a bilateral wedge resection for PCOS.
“It’s just a matter of time before you get pregnant!” This statement from her physician filled Sharlene with hope. Of course, there was skepticism, as it had been nearly eight years since the start of her fertility journey. But when the couple was nearing a stage of acceptance and decided to chart their last cycle of attempting to conceive … she conceived!
A Worthwhile Journey
Her journey had many ups and downs and, in the end, she delivered a healthy baby girl! Sharlene had a family history of thyroid disorders. Along her fertility journey, she had thyroid antibody testing and learned she also had Hashimoto’s thyroiditis. With this autoimmune condition, she now had all three of the elements found in silent endometriosis. She received prednisone for the first 12-14 weeks of pregnancy to decrease inflammation.
From tracking her cycle, to surgery for endometriosis and PCOS, to medical treatment for thyroiditis, Sharlene’s story exemplifies the vast contributions of fertility awareness and the value of having physicians trained in FABMs and this approach to women’s health.
This woman’s story also brings to light the emotional aspects of infertility, the underdiagnosis of endometriosis, and the fact that subfertility is not usually a straight and narrow path. Through the FACTS course, students learn about the importance of biopsychosocial factors of infertility. Families go through so much mentally and emotionally, and when they finally come to a point of acceptance, the stress is diminished, and fertility tends to increase. Regarding the underdiagnosis of endometriosis, women may spend up to twelve years from the onset of symptoms to the time of diagnosis. That is too many years of suffering, and common causes of infertility could be addressed sooner by educating physicians and patients on the different signs of endometriosis beyond dysmenorrhea. Sharlene had silent endometriosis but never knew it because we are all taught to mostly look for “painful periods.” Training more physicians in FABMs will help decrease the time to diagnosis of endometriosis.
Sharlene started off with progesterone deficiency and, in time, was diagnosed with endometriosis, PCOS, and Hashimoto’s thyroiditis. Luckily for her, she was adamant about getting to the underlying issues impacting her health, and if treatment of these conditions enhanced her fertility, great. We need to teach this approach and make sure women (and men!) understand FABMs are not just for preventing pregnancy, but they are also a valuable tool to help women learn what is normal, and when they may need to seek assistance. FABMs have a substantial and growing role in women’s health.
* Names were changed to protect patient privacy.
ABOUT THE AUTHOR
Keisha Pierre-Lys, DO
Keisha Pierre-Lys, DO is a resident at Ascension Lourdes Family Medicine Residency Program in Binghamton, NY. In 2015, she earned a Master of Science in Biomedical Sciences at Rowan School of Osteopathic Medicine. Dr. Pierre-Lys then completed medical school at Ohio University Heritage College of Osteopathic Medicine. She conducted this interview while on the FACTS fertility awareness elective during her fourth year in medical school. She was elated to learn women’s health through such a unique perspective and plans to use FABMs as an option in clinical practice as well as for personal use.
The FACTS CME Course is HERE!
The FACTS 4-part CME Course – Fertility Awareness Based Methods (FABMs) for Family Planning and Restorative Reproductive Women’s Healthcare prepares you as a medical professional to present more comprehensive options for family planning and women’s health monitoring and management of a range of reproductive health concerns. Through online lectures, live case study discussions, and readings, this course will explore the broad applications of modern Fertility Awareness-Based Methods (FABMs) and their role in pregnancy prevention, infertility, and women’s health.
The course is divided into four parts; you may elect to do any or all of them and they may be completed in any order. Each part is worth up to 14 AAFP-approved CME credits.
• Part A, An Introduction to Modern FABMs for Family Planning
• Part B, Special Topics in FABMs for Helping Couples Achieve or Avoid Pregnancy
• Part C, FABMs for Restorative Reproductive Medicine and at Various Stages of Life
• Part D, Medical Applications of FABMs
Click here to download the full lesson schedule for the course.