For this week’s Featured Research we have a review of “Outcomes from Treatment of Infertility with Natural Procreative Technology in an Irish General Practice” by Stanford et al. As always, click through to the articles for a complete description of the original studies.
by Liz Escoffery, FCP
Treatment of Infertility with Natural Procreative Technology in an Irish General Practice
What is unique about Natural Procreative Technology and why study its outcomes?
The medical care of infertile couples has shifted heavily in the past 50 years from primary care providers to reproductive endocrinologists. While a popular option, assisted reproductive technologies (ART) have major disadvantages including their invasiveness and risks, including higher rates of prematurity and multiple gestation. Natural Procreative Technology (NPT) is “an integrated and systematic approach to infertility that is suitable for primary care settings”.  It heavily involves the patients’ participation in the process as the woman learns to chart her reproductive cycles through a referral to a trained FertilityCare Practitioner and abnormalities can be detected through cycle-timed testing methods (blood draws, follicular ultrasound, HSG, post-coital test, and others). The couple is then treated accordingly with medications, procedures, and fertility-focused intercourse.
What are some common NPT treatments?
The goal of all NPT treatments and therapies is to “correct the underlying abnormality, with the goal of optimizing physiologic conditions for conception in vivo, including induction or stimulation of ovulation, medications to enhance cervical mucus production, and hormonal supplementation”[i]. NPT aims to restore the body to a healthy state that is capable of achieving and maintaining pregnancy. NPT also has an extensive surgical dimension which was not focused upon for this particular study, but that a primary care provider could refer to if the need for surgery if indicated.
How successful were NPT treatments compared with ART treatments?
This 2008 study used data from 1,239 infertile couples who came to Dr. Phil Boyle’s medical practice between February 1998 and 2002. The outcomes from this small-scale study showed that NPT and ART are comparable in their live birth rate results. One major difference in the assessment of success between the treatments is that while ART treatments best convey success on a per-cycle rate, NPT is a longer, restorative process which can require 12-24 months to sufficiently know the outcomes of treatment. Through life-table analysis, 27.1 of every 100 couples had conceived by 12 months, and 52.8 by 24 months. ART success is comparable, such that there were 23.8 live births resulted from every 100 women treated by ART procedures. 
What can physicians and medical professionals take from this study?
Common diagnoses included that 50% of couples had abnormal levels of progesterone and estradiol during the luteal phase, 25.7% had suboptimal cervical mucus, and others had diagnoses of anovulation, polycystic ovarian syndrome, endometriosis, and male factor infertility. Unexplained infertility and unexplained recurrent miscarriage were common diagnoses upon entering the study (47.2% and 11.6% respectively), but after NPT evaluation, only 7 couples of 630 with these unexplained diagnoses did not know the reason for their difficulty conceiving or maintaining pregnancy.
Overall, primary care providers can benefit from including NPT techniques in their practice, but further studies are necessary to fully understand the differences in outcomes and preferences of NPT for couples facing infertility and recurrent miscarriage.
This post is 1 in a series of 2, the second which was published 4 years later in 2012, based on “Natural Procreative Technology for Infertility and Recurrent Miscarriage: Outcomes in a Canadian Family Practice”.
 Pg. 376.
 Pg. 376.
 The Human Fertilisation and Embryology Authority, Pg. 381.
Liz Escoffery, FCP is a FertilityCare Practitioner and the founder of Indy FertilityCare. She has been working with women and couples wanting to learn the Creighton Model of FertilityCare locally and long-distance for almost 3 years. She earned a Bachelor of Arts in Political Science from the University of St. Thomas in 2011 and is currently pursuing a Master of Arts degree in Theology at St. Meinrad.