FAQ’s

How effective is NaProTechnology?

This table produced by Pope Paul VI Institute for the Study of Human Reproduction, Omaha, NE 2004. NaProTechnology is a registered trademark of the Pope Paul VI Institute for the Study of Human Reproduction. It can be freely used by any person or entity so long as its use reflects the medical concepts and values expressed in the textbook The Medical & Surgical Practice of NaProTechnology.

Download the “HOW EFFECTIVE IS NAPROTECHNOLOGY?” PDF 

More Information about NaProTechnology Effectiveness

What is Low Dose Naltrexone?

Q: Can naltrexone be used for infertility?

A: Naltrexone is currently approved for use in alcohol and opioid dependence.  It is an opioid receptor antagonist and blocks endorphin receptors to prevent them from working. There is a body of research supporting the safe and effective use of naltrexone for endometriosis, polycystic ovarian syndrome, PMS, Chron’s disease, chronic pain/fibromyalgia, and other conditions. It is not approved by Health Canada or the FDA for these indications, so is used in an off label fashion. The medication is widely available, inexpensive, safe, and appears to be well-tolerated. The doses used for gynecological conditions/infertility are within the 1.5mg to 4.5mg range taken at bedtime.

There is evidence to suggest three mechanisms of action in managing subfertility/gynecology patients:

1. Gonadotropin deficiency and ovarian hormone dysfunction related to beta endorphins.

Beta endorphin neuronal cell bodies are found concentrated in parts of the hypothalamus and pituitary gland.

Administration of opioid and agonists inhibit gonadotropin release. Naloxone, a similar opioid antagonist to naltrexone, increases gonadotropin release suggesting tonic inhibition of gonadotropin release by beta endorphin. Ovarian steroid hormones regulate beta endorphin secretion by the hypothalamus and also modulate gonadotropin release.

Beta endorphin is produced in a cyclic fashion during the course of the menstrual cycle with the highest concentration during the luteal phase, which is why it may have an effect on women with premenstrual syndrome symptoms. For use in PMS, the evidence favours naltrexone efficacy. In the ovary, the presence of endogenous opioids primarily produced by granulosa cells has been demonstrated within the follicular fluid, likely influencing oocyte maturation. Endorphin deficiency has been known to reduce fertility and improving levels may therefore improve fertility.   Beta endorphins are also secreted in parallel with ACTH in response to stressful stimuli. Patients with endometriosis and infertility who are compared to women of normal fertility show a statistically significant decrease in beta endorphin levels. In hypothalamic amenorrhea, cycles can be returned to normal with use of naltrexone.

Endogenous opioids exert a wide variety of actions within the reproductive system and are worthy of further scientific study. It has been used clinically for decades to treat various gynecological disorders, with or without subfertility, by Dr. Thomas Hilgers of the Pope Paul VI Institute for the Study of Human Reproduction and Dr. Phil Boyle of NeoFertility.

2. Immune modifying

Evidence is increasing that opioids regulate immune responses in part through their effects on cytokines and chemokines and cross-talk with the chemokine receptors.^, Conditions that contribute to infertility have been shown to have a possible autoimmune component.  Dr. Bernard Bahari and Dr. Jill Smith have studied its used in various autoimmune diseases.  Naltrexone has been used successfully in adult and pediatric Chron’s disease patients, for example.

3. Insulin resistance

Endogenous opioids have found to be elevated and may stimulate insulin secretion from the endocrine pancreas. This effect can be inhibited by opioid antagonists, resulting in a decrease of circulating insulin levels.  Polycystic ovarian disease patients have shown improvement with insulin sensitivity and increased incidence of ovulation events on naltrexone alone or with clomiphene.  Naltrexone has also been shown to reduce appetite.

References:

1. Impact of the opioid system on the reproductive axis. Bottcher et al. Fertil Steril.2017 Aug;108(2):207-213.
2. Hilgers, T.  The Medical and Surgical Practice of NaProTechnology. p. 547-70.
3. Safety and tolerability of low dose naltrexone therapy in children with moderate to severe Chron’s disease: a pilot study J Clin Gastroenterol. 2013 Apr; 47(4): 339–345.
4. Medical management of metabolic dysfunction of PCOS. Duleba AJ. Steroids. 2012 Mar 10; 77(4): 306–311.
5. Micromedex:naltrexone; premenstrual syndrome
6. https://www.neofertility.ie/media, Powerpoint by Dr. Phil Boyle on clinical use
7. Is Endometriosis an autoimmune disease?  Gleicher N et al, Obstet Gynecol 70:115-121, 1987
8. Polycystic Ovary Syndrome as an Autoimmune Disease: a new concept  Ali et al. Obstet Gynecol 95: 485, 2000.
9. Successful induction of ovuation in normogonadotrophic clomiphene resistant anovulatory women by combined naltrexone and clomiphene citrate treatment. Roozenburg, et al.  Hum Reprod 1997 Aug 12(8): 1720-2.
10. Naltrexone effect on pulsatile GnRH therapy for ovulation induction in polycystic ovary syndrome: a pilot prospective study.  Fulghesu et al. J Endocrinol Invest 2001  Jul-Aug; 24(7): 483-90
11. https://www.neofertility.ie/media, Powerpoint by Dr. Phil Boyle on clinical use

Can sleep disorders or sleep apnea affect fertility?

Do you get up in the middle of the night to go to the bathroom? Do you snore? Do you get a good quality sleep at night?  Sleep disorders or sleep apnea can affect hormone levels, and can occur in women with gynecological concerns or men with low testosterone levels.    This can affect insulin resistance and contribute to  subfertility and long term health complications.

Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5799701/

Non-apnoea sleep disorder increases the risk of subsequent female infertility- a nationwide population-based cohort study

https://pubmed.ncbi.nlm.nih.gov/29136234/

Objective assessment of obstructive sleep apnea in normal pregnant and preeclamptic women

https://www.tandfonline.com/doi/full/10.1080/10641955.2018.1498879

Is this just another natural fertility charting system or natural family planning?

No, the Creighton Model FertilityCare System is an evidence based medical model  which makes it  such a unique reproductive diagnostic chart. The FertilityCare System is a medical evidence based model, developed by an obstetrician and gynecologist, and provided to you  by allied health care professionals.

These allied health professionals are educated during a year long education program and must be in good standing with two professional bodies in order to practice, the FertiltyCare Centers of America and the American Academy of FertilityCare Professionals.

Why don’t you use more diagnostic tests or devices in the Creighton Model FeritilityCare System?

Over decades of experience and scientific research studies, it has been determined that cervical mucus presence alone is sufficient to understand the health of the woman’s reproductive system.  With stress already playing a role in the health of the woman’s reproductive system, why add more stress and  expense  with the addition of devices or tests?  Medical devices may not work when you run out of electricity or battery but charting with cervical fluid presence never runs out of power.

Moreover, cervical fluid is an excellent indicator of estrogen levels in the woman’s body, so if it not present, it  quickly suggests what underlying problem might be present.  While basal body temperature does increase slightly after ovulation due to progesterone rise, it can be delayed by 1-6 days. Therefore, it is not as reliable or predictable, and is a retrospective indicator of fertility.

Isn’t it easier to use the LH urine strips to determine ovulation instead of charting cervical fluid?

While it might be seen as more technological or less time consuming  to use a qualitative urine strip, remember that it is not as important to ask IF you are ovulating but IS the ovulation a healthy one?  LH strips give a false impression that you are indeed ovulating or that the egg/ovum is being released from the ovary.  NOT SO!  LH  strips only indicate one thing—that your LH level is increasing!

LH rise does indeed happen within the 48 hours of the time  of expected ovulation but it does not tell you that ovulation/follicular rupture has occurred for certain.  The  only definitive way of detecting follicular rupture is by ultrasound, where the follicular rupture of the egg can be visualized along with visulization of a secretory endometrium.

Some women suffer from a condition called Luteinized Unruptured Follicle or persistent luteal cysts (see our brochure section on ovarian cysts for more information).  This cyst forms when the egg is retained and not released from the follicle.  This means that although your LH level may rise it is NOT possible to achieve pregnancy!  In the Creighton Model FertilityCare System, we refer to peak day as an “ovulatory event”, because as you can see, true “ovulation” can only be detected through ultrasound—not charting or LH urine strips.

Why is the birth control pill not recommended?

During my undergraduate pharmacy years, the phrase “pill for every ill” was frowned upon professionally.  We were taught to identify non-drug treatment options, and only recommend over the counter or prescription medications if the underlying cause could not be treated.  For example, consider a patient with insomnia.  Does the patient have poor sleep habits?  Are they taking another drug that could be causing the insomnia?  Is there a stressful situation that is affecting their sleep?  These are valid questions, and to prescribe a sedative without such evaluation would be unprofessional and unethical.

Now consider the woman who sees her doctor for symptoms of menstrual pain, irregularity, unusual or heavy bleeding, PMS, or options to avoid pregnancy.  Most of the time the patient will walk out with a prescription for the birth control pill. The truth is that the medical and pharmacy professions can do better when informing women on all options to avoid pregnancy or how to seek out the underlying cause of gynecological disorders.  Unfortunately, women come into the office with a hormonal disorder or disease and they leave with it, regardless of the technological advances available in diagnostic imaging, surgical procedures and medication availability.  Women deserve better care, which is why Dr. Thomas Hilgers, an obstetrician/gynecologist,  developed a  women’s health science and educational technology thirty years ago.  The Creighton Model FertilityCare System and NaProTechnology cooperates with the menstrual and fertility cycles.  It has been proven in medical studies to be just as effective as the pill for avoiding pregnancy and offers medical and surgical treatment for gynecological concerns.   

It is a quick and easy solution to simply prescribe the pill. Many times, health care professionals avoid taking the time or effort to fully investigate a woman’s concerns.  The pill masks or supresses symptoms, and does nothing to prevent long term consequences.  For example, polycystic ovarian disease involves metabolic dysfunction that is made worse with the use of birth control, such as weight gain, hypertension, sleep apnea, blood glucose, insulin, lipids and cholesterol. If left untreated, it can lead to infertility, cardiovascular disease, and increased risk of breast and uterine cancer.  Endometriosis is another condition which can lead to pelvic pain and  infertility.  In fact, endocrinologist Dr. Jerilyn Prior writes that the pill harms women by disturbing the formation of sensitive hormonal brain pathways, especially up to age 25.

To illustrate further, a patient once called me with extremely heavy flow during her period, lasting for days, and cycling approximately every 20 days.  She became anemic. Doctors in hospital insisted that she start the pill. She was not comfortable with taking the pill for various reasons, one being that she wanted to know the reason why she was bleeding heavily and frequently.  The patient was sent home, and a few weeks later she proceeded to faint from her blood loss while at the pharmacy. She was taken by ambulance to the hospital, and this time insisted they rule out an underlying cause, such as a uterine polyp or fibroid. In the end, it was her family doctor who diagnosed two clotting disorders, one being Von Willebrand disease. Had she simply taken the pill as she was told, this may have gone undiagnosed.  All too often, women are dismissed for their menstrual  or fertility problems.

The birth control pill is usually comprised of two hormones, artificial substitutes for estrogen and progesterone.  These synthetic hormones work to suppress the woman’s reproductive system in order to supress her fertility.   There are three main ways that the birth control pill works: to prevent ovulation by suppressing pituitary hormones FSH and LH, altering the characteristics of the cervical mucus so that sperm cannot penetrate the cervix, and by interfering with the lining of the uterus and its biochemical mechanisms called “cell-talk”, so that if conception does occur it would be difficult for the human blastocyst to implant.  The first two mechanisms are contraceptive in nature, while the third mechanism stops an early pregnancy from continuing. Breakthrough ovulation occurs at least 1-6% of the time, which is when the third mechanism comes into play.  

There are other concerns with taking the birth control pill.  Bottom line, it just isn’t good for women.  Many women discontinue using the pill due to its adverse drug reactions.  These include initial problems with weight gain, migraines,  nausea, breast tenderness, lack of libido, carbohydrate intolerance, liver and gallbladder problems, to more serious problems such as breast cancer,  blood clots and strokes, hypertension, migraines, and depression. Furthermore, it can worsen infertility or polycystic ovarian disease. 

Why expose women to such products if we can correct or cure the problem through cooperating with the body or offer them a natural and effective way to plan their families?  Women deserve to be informed and receive the best care possible.

Which natural fertility charting system is best for me?

When comparing the different natural systems, they will have different levels of capabilities,  professionalism, and future potential to be of service.

Education of instructors

• Is the program considered a health care profession?
•  Where does the education program take place and how long is it?
•  Is the curriculum and its content published?
•  Are certification and accreditation standards established (and by whom), available and implemented?
• Does the program deall adequately with advanced case management?
• Are the instructors exposed to both didactic teaching and supervised practice?
• Are pregnancy evaluations done?
• Are instructors re-evaluated or re-certified to test their skills over time?
• How are the program educators and supervisors trained? Is the training specific to the model that they are training instructors for?

Versatility

•  Can it identify both pre and post ovulatory infertility?
• Can it accurately identify days of fertility?
• Can it be used both the achieve as well as avoid pregnancy?
• Can it be used in a variety of applications such as regular vs irregular cycles, breastfeeding, premenopause, post-birth control pill, infertility?

What is the education format for learning and is it the most conducive to learning?

• Is the teaching individualized?
• Is there good follow up?
• Is the program taught to a group in a classroom setting?
• Are there good teaching aids? 

Has the system been evaluated scientifically?

• What studies have been done?
• What signs have been evaluated and what are the results?
• Are the studies model specific?
• Do the signs indicate ovulation and /or fertility?
• What are the caliber of the studies?
• Are they kept up to date with what has been done in these areas?

Is there a scientific relationship between the key elements in the system?

• How often is the indicator actually present?
• Is fertlity intimately or distantly connected to the sign or signs?
• Does the sign indicate fertility, ovulation, post-ovulation?
• Will it accurately define both fertility and infertility?

Have mode-specific use-effectivess studies been done?

• What are the caliber of the studies?
• Does it measure both the effectiveness to avoid, as well as achieve pregnancy?

Does the system have scientifically established and validated medical applications?

• Chronic discharges
• Effects of stress
• Infertility
• Ovarian cysts
• PMS
• Targeted hormone evaluation
• Abnormal bleeding
• Progesterone replacement
• Dating the beginning of pregnancy

Does the system’s educational approach have third party recognition?

• Certification
• Accreditation
• Third party reimbursement