The Challenge of Finding Physicians Familiar with FABMs
By: Abigail Kuplicki
Director’s Note: During October, we recognize Pregnancy and Infant Loss Awareness Month. Today, we highlight the story of George and Fiona,* a couple who, following a move, struggled to find physicians trained in the medical protocols associated with the Creighton Model. Former FACTS elective student, Abigail Kuplicki, discusses the trials and tribulations that many couples experience due to the lack of clinicians trained in fertility awareness-based methods (FABMs). In this patient interview, Fiona shares her frustration and heartbreak at having to use her miscarriage experience to advocate for her care with physicians not trained in Creighton. If you are a physician, clinician or educator trained in a FABM or restorative reproductive medicine, please apply to be listed on our directory to make it easier for people like George and Fiona to find the care they desperately seek.
George and Fiona* shared their experience using the Creighton Model System (CrMS) before and after a long-distance move. Initially, Fiona began using an app to chart her cycles and identified a pattern of tail-end brown bleeding. Fiona was concerned that she might not be ovulating, so she tried ovulation strips as a double-check. However, the strips also failed to confirm ovulation. Fiona sought care from an OBGYN in Michigan, where she is originally from, but was disappointed to only be offered hormonal birth control to address the bleeding. However, after moving to Omaha, Nebraska, in 2021, Fiona discovered the Creighton model through the Saint Paul VI Institute, a medical group that specializes in the CrMS. The institute required her to chart using Creighton for three months prior to her first visit. Although Fiona found it difficult to chart on her own, she was interested enough in the Creighton Model to keep up with her chart. She began working with a physician who discovered that Fiona had both low estrogen and progesterone. Together they decided her best treatment option would be post-peak hCG to support her body’s natural production of both hormones without having to supplement with synthetic hormones. After beginning treatment with hCG, Fiona felt it helped substantially with her symptoms.
In January 2022, George joined Fiona in Omaha. The couple decided to start working with a CrMS teacher to better understand the details of charting and further involve George in the daily charting process. Despite a steep learning curve, they successfully avoided pregnancy for over one year using the Creighton model before trying to conceive. During that time, the couple moved back to Michigan but found it extremely challenging to transfer their care to the metro Detroit area, where they found fewer physicians familiar with Creighton.
“Despite a steep learning curve, the couple successfully avoided pregnancy for over one year using the Creighton model before trying to conceive.”
The Saint Paul VI Institute connected George and Fiona with a CrMS teacher about 40 minutes from their Michigan residence to continue teaching sessions. The couple appreciated that their new teacher was able to pick up where the other had left off, though they found the process of starting with a new instructor a bit awkward. To further complicate their transition back to Michigan, it was difficult to find a physician trained in CrMS to continue Fiona’s testing and treatment.
The closest CrMS physician to George and Fiona was almost three hours away, so they decided instead to see a physician familiar with other fertility awareness-based methods (FABMs). While this physician was able to read her chart, he was unfamiliar with the hCG treatment Fiona was receiving. However, he was willing to keep her on the medication and vaginal progesterone, which she had started in Omaha. Shortly thereafter, the couple began trying to conceive and soon had a positive pregnancy test. Unfortunately, given Fiona’s hCG treatment, a urine pregnancy test was always positive so the couple knew they needed blood work to confirm pregnancy. However, the physician’s office would not schedule a visit until either eight weeks gestational age or a confirmatory blood test, which was unlike her experience in Omaha, where she had had no problem scheduling appointments. Conversation with her new physician’s office staff was disappointing. Fiona eventually got the necessary blood work to confirm pregnancy, but unfortunately the couple miscarried several weeks later.
After the miscarriage, the couple switched to a different doctor who was familiar with FABMs but not trained in CrMS. Although Fiona believed that hCG worked best for her symptoms, she eventually stopped taking it because “it’s not practical to continue with the physicians here.” Over the years, it has been a consistent struggle to advocate for herself and access care with clinicians trained in FABMs.
Fiona also cited another challenge related to her treatment. She remarked that she was to undergo an endoscopy due to other reasons, which required a negative urine pregnancy test on the day of the procedure. Had she still been on hCG, the test would have been positive regardless of pregnancy, which would have complicated matters among medical professionals unfamiliar with hCG treatment and other medical protocols used in restorative reproductive medicine.
“Over the years, it has been a consistent struggle to advocate for herself and access care with clinicians trained in fertility awareness-based methods.”
Fiona continues to take post-peak vaginal progesterone, prescribed by her new physician, but sometimes feels like she has to “use the miscarriage” to advocate for her care, even though she knew she had low progesterone before the loss. George described their care as “quite self- directed” and “a pain” since moving to Michigan. He loved CrMS before moving because the doctors in Omaha were “able to fix these problems right away.” Fiona said, “I am keeping information that’s relevant to that medical model, but the physicians aren’t treating me,” and “I have to be my own…advocate.” They are both frustrated and have considered switching to the Marquette Method, which uses urine hormone test strips because their doctor might be more likely to accept these objective measures over her cervical mucus observations. In the meantime, however, the couple continues to use CrMS charting to avoid pregnancy.
Throughout this interview, I heard the story of how one couple successfully avoided and achieved pregnancy using the CrMS and yet struggled to continue this model of care after moving to an area with a scarcity of CrMS providers. George and Fiona’s story exemplifies the need for all physicians to be knowledgeable about FABMs, a major aim of FACTS. Patients should receive more comprehensive fertility care based on accurate charting, care that does not require a couple to first suffer miscarriage or infertility. The knowledge gained through the FACTS elective will certainly guide my future practice as I hope to work in a region with low access to physicians. As a future family physician, I may encounter patients with similar issues, and I feel more equipped with the tools and knowledge to treat them.
“George and Fiona’s story exemplifies the need for all physicians to be knowledgeable about FABMs, a major aim of FACTS. Patients should receive more comprehensive fertility care based on accurate charting, care that does not require a couple to first suffer miscarriage or infertility.”
*Names have been changed to respect the privacy of the interviewee and her family. All information is shared with permission.
ABOUT THE AUTHOR
Abigail Kuplicki
Abigail Kuplicki is a fourth-year medical student at Wayne State University School of Medicine in Detroit, MI. She completed her undergraduate studies at Michigan State University with a B.S. in Nutritional Sciences and a B.A. in Arts and Humanities. Abigail plans to pursue residency in family medicine and took the FACTS elective to learn more about the use of FABMs for women’s health. She plans to support future patients in their use of FABMs for family planning, infertility, and health maintenance.
