Natural Procreative vs. In Vitro Reproductive Technologies: A Review

By: Yudi Liu

Editor’s Note: While on the FACTS elective for medical students, Yudi Liu summarized a unique narrative review of research [1] that highlights a modern, evidence-based approach to infertility. The review by Kiani et al is titled, “Complications Related to In Vitro Reproductive Techniques Support the Implementation of Natural Procreative Technologies.” Published in 2020, the authors juxtaposed assisted reproductive technologies (ARTs) with the natural approach to infertility afforded by NaProTechnology (NaPro)—a form of restorative reproductive medicine (RRM) that continues to gain popularity due to its ability to diagnose and target root causes of infertility.

Introduction

Infertility affects approximately one in five couples around the world, and most of them are offered assisted reproductive technologies (ARTs) such as in vitro fertilization (IVF) as the main option to address infertility. [1] Each year, half a million newborns worldwide are born through IVF. Yet, the limitation of IVF is that it does not treat the root cause of infertility, and it comes with the potential for various complications. On the other hand, natural procreative technology (NaproTechnology, NaPro) allows for root cause analysis of infertility. NaProTechnology focuses on improving gynecological health and restoring optimal reproductive function through medical and surgical procedures.[1]

“Each year, half a million newborns worldwide are born through IVF. Yet, the limitation of IVF is that it does not treat the root cause of infertility, and it comes with the potential for various complications.”

The goal of the research review by Kiani et al [1] summarized below was to identify some of the most common complications of ART, discuss the merits of identifying the underlying causes of infertility, and describe a comprehensive approach to infertility available through NaProTechnology.

Methods

This review article compiled research by searching PubMed for “assisted reproductive technology” and “infertility” or “NaproTechnology.” The authors assessed articles written in English and published through August 2019. The only articles chosen for the review were those addressing complications from ART and those addressing the NaProTechnology approach. [1]

Results

Maternal complications from ART

Disadvantages of assisted reproductive technologies can be categorized into maternal and fetal complications. Regarding maternal complications, the mortality rate of ART is higher compared to natural pregnancies. ART increases the risk of ovarian hyperstimulation syndrome and, therefore, increases the risk of multiple gestations, which may lead to miscarriage or loss of ovarian function. Patients also have a higher risk of ectopic pregnancies, which may lead to life-threatening situations requiring surgery. Hypertension in pregnancy causes up to 14% of maternal deaths, and patients undergoing ART have double the risk of hypertension complications such as preeclampsia and eclampsia when compared to natural pregnancies. A UK study also found a correlation between hormonal stimulations and an increased risk of fatal breast cancers. [1][2]

“ART increases the risk of ovarian hyperstimulation syndrome and, therefore, increases the risk of multiple gestations, which may lead to miscarriage or loss of ovarian function. Patients also have a higher risk of ectopic pregnancies.”

Fetal complications from ART

Some of the long-term health effects on the fetus associated with ART include an increased risk of low birth weight, preterm delivery, miscarriage, and perinatal mortality. The stillbirth rates of ART pregnancies were about eight times higher when compared to natural pregnancies. Extensive research has been done to study the genetic effects of long-term hormonal stimulation and its outcome on children. Studies have shown an increased risk of neural tube defects, gastrointestinal atresia, omphalocele, and hypospadias. A study from Japan found a link between ART usage and epigenetic defects such as Beckwith-Wiedemann, Angelman, Prader-Willi, and Silver-Russell syndrome. [1][3][4] These findings suggest ART (IVF) can affect fetal growth and organ differentiation, and increase the risk of endocrine-sensitive cancer later in life. [1][5]

NaProTechnology approach to infertility

To achieve pregnancy, NaProTechnology focuses on improving gynecological health and restoring optimal reproductive function through medical and surgical reproductive procedures. Due to NaPro’s focus on identifying the root cause of infertility, a genetic workup is often prompted earlier than in a traditional infertility workup. Research [6] has shown about 50% of couples experience infertility due to genetic causes, and incorporating genetic sequencing allows for a better look at different pathologies. Knowing the underlying causes of infertility helps couples make an informed choice between natural conception, ART, or adoption.

Procedures like IVF are costly, which can add financial burdens to a couple’s emotional stress related to infertility. NaProTechnology may be less expensive and has shown similar rates of live births when compared to ART; a 2008 study by Stanford et al showed 52.8% of couples had successful live births in the first 24 months. [1] [7]

“NaProTechnology focuses on improving gynecological health and restoring optimal reproductive function through medical and surgical reproductive procedures… and has shown similar rates of live births when compared to ART.”

Discussion

While assisted reproductive technology has achieved successful birth stories for many couples, they do come with complications and risks. NaProTechnology is a viable option that should be considered and presented to patients during their infertility journey, as it has lower rates of complications and similar efficacy as ART.

A limitation of Kiani et al’s literature review is that it could be influenced by confirmation bias. This review only mentioned the complications and risks associated with ART but did not review studies that may have shown complications related to NaPro. The scope of the study was also limited by its focus on addressing only female infertility using ART or NaProTechnology. A large percentage of infertility is due to male factors and how male infertility is typically treated, which can affect pregnancy outcomes. Additionally, this review did not include data on longitudinal follow up of children born to ART vs. NaPro methods; this makes it difficult to assess long-term effects and complications.

Editor’s Note: Follow the links below to learn more about NaProTechnology and RRM:

References

[1] Kiani AK, Paolacci S, Scanzano P, et al. Complications related to in vitro reproductive techniques support the implementation of natural procreative technologies. Acta Biomed. 2020;91(13-S):e2020018. Published 2020 Nov 9. doi:10.23750/abm.v91i13-S.10525

[2] Crosignani PG. Breast cancer and hormone-replacement therapy in the Million Women Study. Maturitas 2003; 46:91–2.

[3] Hattori H, Hiura H, Kitamura A, et al. Association of four imprinting disorders and ART. Clin Epigenetics 2019; 11:21.

[4] Niemitz EL, Feinberg AP. Epigenetics and assisted reproductive technology: a call for investigation. Am J Hum Genet. 2004;74(4):599-609. doi:10.1086/382897

[5] Tournaire M, Devouche E, Espié M, et al. Cancer risk in women exposed to diethylstilbestrol in utero. Therapie 2015;70: 433–41.

[6] Zorrilla M, Yatsenko AN. The Genetics of Infertility: Current Status of the Field. Curr Genet Med Rep. 2013;1(4):10.1007/s40142-013-0027-1. doi:10.1007/s40142-013-0027-1

[7] Stanford JB, Parnell TA, Boyle PC. Outcomes from treatment of infertility with natural procreative technology in an Irish general practice [published correction appears in J Am Board Fam Med. 2008 Nov-Dec;21(6):583]. J Am Board Fam Med. 2008;21(5):375-384. doi:10.3122/jabfm.2008.05.070239

ABOUT THE AUTHOR

Yudi Liu
Yudi Liu is a fourth-year medical student at Philadelphia College of Osteopathic Medicine in Suwanee, GA. She completed her undergraduate education at Georgia State University in Atlanta, GA. She plans to pursue residency in internal medicine and is passionate about patient education. She enrolled in the FACTS elective to learn more about natural family planning methods to help reduce skepticism regarding FABMs, so patients are better informed to make educated decisions along their fertility journey.

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