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Comparative Study
. 2012 May;58(5):e267-74.

Natural procreative technology for infertility and recurrent miscarriage: outcomes in a Canadian family practice

Elizabeth Tham  1 , Karen Schliep, Joseph Stanford
Affiliations
Comparative Study

Natural procreative technology for infertility and recurrent miscarriage: outcomes in a Canadian family practice

Elizabeth Tham et al. Can Fam Physician. 2012 May.

Abstract
in English, French

Objective: To study the outcomes of women with infertility or miscarriage treated with natural procreative technology (NaProTechnology or NPT), a systematic medical approach to promoting conception in vivo; and to compare the outcomes with those previously published from a general practice in Ireland.

Design: Retrospective cohort study.

Setting: An urban Canadian primary care practice in which the physician had a part-time practice in NPT.

Participants: Couples with infertility or recurrent miscarriage who received treatment in the practice between August 2000 and July 2006.

Intervention: All couples were taught to identify the fertile time of their menstrual cycles using the Creighton Model FertilityCare System (CrMS) and completed a standard NPT evaluation. Many also received additional medical treatment to enhance conception in vivo.

Main outcome measures: Live birth was the primary outcome; secondary outcomes included conceptions, multiple births, low birth weight, and prematurity.

Results: A total of 108 couples received NPT and were included in the analysis, of which 19 (18%) reported having 2 or more previously unexplained miscarriages. The average female age was 35.4 years. Couples had been attempting to conceive for a mean of 3.2 years. Twentytwo participants (20%) had previously given birth; 24 (22%) had previous intrauterine insemination; and 9 (8%) had previous assisted reproductive technology. The cumulative adjusted proportion of first live births for those completing up to 24 months of NPT treatment was 66 per 100 couples, and the crude proportion was 38%. The cumulative adjusted proportion of first conceptions was 73 per 100 couples, and the crude proportion was 47%. Of the 51 couples who conceived, 12 couples (24%) conceived with CrMS instruction alone, 35 (69%) conceived with CrMS and NPT medical treatment, and 4 (8%) conceived after additional surgical treatment. All births were singleton births; 54% were born at 37 weeks' gestation or later; and 78% had birth weights of 2500 g or greater.

Conclusion: Natural procreative technology in a family physician's office was effective in treating infertility and miscarriage with outcomes that were comparable to those in an NPT general practice in Ireland. Larger multicentre prospective studies to compare NPT directly to other forms of infertility treatment are warranted.

Objectif: Vérifier lees issues chez des femmes qui sont traitées pour infertilité ou fausses couches par une approche médicale systématique favorisant la conception in vivo, soit la technique de procréation naturelle (NaProTechnology ou NPT); et comparer ces issues aux résultats d’une étude effectuée dans une clinique de médecine générale d’Irlande.

Type d’étude: Étude de cohorte rétrospective.

Contexte: Un bureau de médecine de première ligne en milieu urbain au Canada où le médecin utilisait la technique NPT à temps partiel.

Participants: Des couples traités au bureau entre août 2000 et juillet 2006 pour infertilité ou fausses couches répétées.

Intervention: Les couples ont appris à identifier la période fertile de leur cycle menstruel à l’aide du Creighton Model FertilityCare System (CrMS) et ils ont complété une évaluation NPT standard. Plusieurs ont aussi reçu des traitements médicaux pour favoriser la conception in vivo.

Principaux paramètres à l’étude: Les naissances vivantes étaient l’issue principale; les issues secondaires incluaient la conception, les naissances multiples, les faibles poids de naissance et la prématurité.

Résultats: Un total de 108 couples ont reçu le traitement NPT et ont été inclus dans l’analyse; d’entre eux, 19 (18 %) ont déclaré avoir déjà eu au moins 2 fausses couches inexpliquées. Les femmes étaient âgées de 35,4 ans en moyenne. Les couples avaient tenté de concevoir pendant une moyenne de 3,2 ans. Vingt-deux des participantes (20 %) avaient déjà accouché; 24 (22 %) avaient déjà eu une insémination intra-utérine; et 9 (8 %) avaient eu recours à des techniques de reproduction assistée. La proportion cumulative ajustée de premières naissances vivantes chez ceux qui ont complété jusqu’à 24 mois de traitement NPT était de 66 pour 100 couples et la proportion brute était de 38 %. La proportion cumulative ajustée de premières conceptions était de 73 pour 100 couples et la proportion brute, de 47 %. Sur les 51 couples qui ont conçu, 12 (24 %) n’avaient eu que la formation CrMS, 35 (69 %) avaient eu cette formation et le traitement médical NPT et 4 (8 %) avaient eu un traitement chirurgical additionnel. Toutes les naissances étaient uniques; 54 % étaient survenues après au moins 37 semaines de gestation; et 78 % des nouveau-nés pesaient 2500 g ou plus.

Conclusion: Cette technique de procréation naturelle au bureau d’un médecin de famille s’est montrée efficace pour traiter l’infertilité et les fausses couches, les issues étant comparables à celles d’une clinique de médecine familiale irlandaise utilisant le NPT. Il serait opportun d’entreprendre des études multicentriques prospectives plus larges afin de comparer directement le NPT à d’autres formes de traitement de l’infertilité.

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