Gene Paulo R.Uy PYSIOLO August 31, 2010 Dr. Maghirang NaPro Technology Pregnancy is something that people value and cherish if they have not yet experienced it or if its their first time. There is nothing better than bringing new life to the world or adding a new member to the family. However, some couples have problems in conceiving or making a new baby, this is called Infertility. Infertility primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term. There are many biological causes of infertility, some which may be bypassed with medical intervention. But when we say Infertility, we do not always mean that a woman is unable to produce a child or a woman is incapable of producing egg cells, sometimes, its the man's fault if the couple cant conceive a child. Male Infertility is the inability of a male to achieve a pregnancy in a fertile female. In humans it accounts for 40-50% of infertility. Male infertility is commonly due to deficiencies in the semen and semen quality is used as a surrogate measure of male fecundity. The first step to deciding what the best way to treat infertility is figuring out who has the problem in the first place. Most problems in males have to do with sperm. It could be the amount of sperm being produced, or lack of amount, or it could be the lifespan of the sperm. Other complications and reasons for infertility are problems in the way the sperm is delivered. In some cases the male could have erectile dysfunction, ejaculation issues, or a blockage in the ejaculatory ducts. The male also might not be producing enough sperm, or the sperm he is producing is malformed in some way. In women the problems are more in numerous, and vary widely. The most common cause would be a problem during ovulation. This could prevent the development of an egg and also could block the fallopian tubes. These problems could be caused by endometriosis, adhesions, or scaring, pelvic inflammatory disease, or poor ovary reserves. Ovarian it avoids the need for conception to occur by any means other than the natural way It goes without saying that once a medical problem has been diagnosed and treated. pelvic adhesions. NaProTechnology (abbreviation of the term “Natural Procreative Technology”) is a new reproductive science that uses the physician's medical and surgical energies in a way that works cooperatively with a woman's natural reproductive function. evaluating and treating recurrent spontaneous abortion. and anovulation. Surgical techniques for endometriosis. Best of all. but it can be because of other factors too. amenorrhea. one way of doing so (and probably one of the best ways) is by NaPro Technology. Without the Creighton Model System. polycystic ovarian disease. Often it is a defect in the anatomy of the female that restricts the egg from being implanted. preventing preterm birth. Nebraska. endometriosis. uterine leiomyomata. Effects of hypothalamic-pituitary-ovarian dysfunction. follicular and luteal phase deficiencies. Applications in infertility evaluation and treatment (and its effectiveness). pelvic adhesive disease. it is touted as a revolutionary breakthrough for helping couples who desire to achieve a pregnancy naturally. women who get pregnant as a result of NaProTechnology are frequently able get pregnant again. ovarian cysts. osteoporosis. Here is a summary of what is done or what is presented in NaProTechnology: Targeted hormone assessment of the menstrual cycle. this has important health benefits that can be realized during the pregnancy and well beyond. The Creighton Model System is a standardized gynecologic charting system that is an integral part of NaProTechnology. For the same reasons. Created at the Pope Paul VI Institute for the Study of Human Reproduction in Omaha. Sonographic classification of human ovulation disorders. and thyroid system dysfunction. Perinatal applications: progesterone use during pregnancy. and diagnostic laparoscopy.failure can because of aging. the physician who practices . and unusual bleeding. ovarian wedge resection. Many factors are involved in the reason for infertility. and you need to see a doctor to have those problems diagnosed. There are many medical or natural ways of curing Infertility. postpartum depression. and tubal occlusions. because the focus of NaProTechnology is diagnosis and treatment. Evaluation and treatment of premenstrual syndrome. cancer detection. A medical consultation with a physician who is trained in NaProTechnology can be conducted at the same time. Spontaneous abortion is defined as the spontaneous loss of pregnancy prior to the 20th gestational week of pregnancy. Over the years. a couple would start this program by learning how to chart the menstrual cycle according to the Creighton Model system. Often it has been thought to be “nature’s way” of ending a pregnancy which was doomed to fail in any regard. The bottom line is that these techniques result in a "functional" and/or "structural" diagnosis that can then be addressed medically or surgically and the end result is natural conception. These include genetic. the risk of miscarriage increases proportionately to the number of previous miscarriages experienced. there has developed a somewhat more aggressive approach over the last 5 to 10 years towards evaluation and management of women with spontaneous abortion. A variety of factors underlie the occurrence of miscarriage. a definite cause has been difficult to determine. Frequently.5 to 3 times better than IVF (23. It is now well recognized that a definition of recurrent pregnancy loss includes two or more consecutive spontaneous miscarriages and that this warrants a full evaluation. However. in some . According the Pope Paul VI Institute. Usually.8%). miscarriages have been observed as a somewhat “normal” finding. Unfortunately.5% versus 38. Furthermore. endocrinologic (hormonal). the evaluation of infertility will include a targeted hormone evaluation of the menstrual cycle and an ultrasound series to evaluate ovarian function (this cannot be done without the Creighton Model System). At the same time. Pregnancy losses which occur during this period of time are said to occur in about 15 percent of pregnancies. immunologic and microbiologic variations. NaProTechnology success rates are 1.4%-81. it is becoming more and more recognized that there appears to be an association between infertility and spontaneous abortion. All miscarriages are the result of a pathophysiologic reproductive event. We are slowly coming to recognize that no miscarriage can be considered normal. A surgical evaluation is sometimes needed as part of a complete investigation. anatomic. It is the current challenge of medicine to find those underlying causes and.NaProTechnology would have inadequate information for the diagnosis and treatment of reproductive problems. Thus. she has a markedly decreased preovulatory estrogen profile and a markedly decreased postovulatory progesterone and estrogen profile. thus preventing miscarriage altogether. it can be easily treated.” Conception occurred in this cycle and ended in miscarriage. if pregnancy occurs. the woman will miscarry. It has also been shown that women who have short post-Peak phases are also at risk for miscarriage. In this cycle. a Creighton Model chart in a woman who achieved a pregnancy and subsequently miscarried is shown. . In the picture below. This condition is easily identified in a woman charting her cycles and. It has now been shown that those women who conceive and subsequently miscarry often have these limited mucus cycles. various aspects of evaluation have been completed including hormonal and ultrasound studies. the post-Peak or luteal phase is inadequate to support a pregnancy.cases. a hormonal profile taken in a woman with a short post-Peak phase is shown. where the post-Peak phase is only five days in duration. In the picture below. The follicle that was being monitored by ultrasound is also very small and is consistent with a condition known as the “Immature Follicle Syndrome. Hormonally. This woman clearly exhibits a “limited mucus cycle” as a biological marker of her Creighton Model cycle. In this chart. underlying causes that are common occurrences are often overlooked. she also extensively promoted the use of progesterone therapy for its treatment. This history dates back to the time of Hippocrates. For example.The condition now referred to as premenstrual syndrome (PMS) has a long and varied history among medical investigators. Dr. which promoted the theory that this condition was caused by either a progesterone deficiency or an imbalance in the estrogen-progesterone ratio. respectively. so that those women who suffer from premenstrual syndrome are also given full access to opportunities. Katherina Dalton brought attention to this condition with her first book on PMS. murder convictions and felony charges have been reduced to manslaughter and misdemeanors. Feminists have voiced concern about this trend indicating that the use of PMS as a defense in criminal or civil matters could result in a negative impact on women’s push toward equalization with men. PMS is a condition . Another point of view suggests that this condition has held back many women over the years. PMS has been locked in with various political and legal perspectives. While its medical and pathophysiologic components have been difficult to crystallize. and the first reference in a scientific journal was by Franc in 1931. because of the argument that the accused woman suffered from PMS. Later. Furthermore. This should prompt interest and concern about finding the underlying causes and treating them effectively. In 1964. Feminists plead that generalizations about women should not be made when assessing the legal or political aspects of this condition. By treating these hormonal abnormalities cooperatively with either cooperative progesterone replacement therapy or targeted HCG support (which should also improve both progesterone and estrogen production) and/or with the use of naltrexone as an opiate receptor antagonist. crying easily. a physician can target the postovulatory phase of the cycle with an adequate hormonal evaluation. Now we go to Postpartum Depression. which is one of the major problems faced by the teenagers today. In spite of its evaluation over the years. along with beta-endorphin levels. headaches. At the present time. led to divorce and child abuse and has created numerous aberrant stereotypes about the behavior of women. At . psychological and social changes associated with pregnancy and childbirth. in comparing targeted hormonal supplementation (cooperative progesterone replacement therapy) with Prozac. depression. fatigue and insomnia. infertility. postpartum depression (PPD) has remained an enigma. Virtually no life event rivals the hormonal. By charting one’s cycle. up to 32 percent of women may alter their future childbearing plans by resorting to either adoption. are decreased late in the cycle. fluoxetine (Prozac) is considered the treatment of choice for women with premenstrual syndrome. sterilization or abortion. If they occur within three days of the onset of menses. In women who have premenstrual syndrome. both progesterone and estrogen levels. Pregnancy. bloating. Because of depressive episodes. and the postpartum period challenge a woman’s mental health. miscarriage or pregnancy loss. the targeted hormonal therapy is significantly more effective. However.C. carbohydrate craving. breast tenderness. The diagnosis of PMS at the Pope Paul VI Institute includes the following list of symptoms: irritability.that has destroyed relationships. weight gain. a high degree of success can be obtained with hormonal treatment. The important aspect of diagnosis is that these symptoms must begin at least four days prior to the onset of menses. other symptoms have also been documented in this group of patients. In addition to these 10 core symptoms. they are considered to be normal premenstrual molimina. The earliest documentation of postpartum mental illness was provided by Hippocrates in 400 B. The risk of suicide in postpartum psychosis is high (up to five percent) and up to four percent of women with postpartum psychosis may attempt infanticide. dysphoric mood. . Nearly twothirds of these patients will suffer subsequent non-puerperal psychotic episodes. Symptoms include the following: fatigue. Postpartum mood disorders are common. 20 percent of women will suffer from depression. feelings of worthlessness or guilt (especially failure at motherhood). Postpartum psychosis is a psychiatric emergency that often warrants hospitalization. Its onset is usually within the first three weeks following delivery and often within just a few days. but up to 50 percent may go unrecognized and more go untreated. Dr. changes in appetite or sleep. recurrent thoughts of death/suicide. psychomotor agitation or retaliation. During the course of that visit. Many seek treatment from primary care providers. sleep disturbances and obsessive ruminations about the baby. Katherina Dalton visited the Pope Paul VI Institute because of our interest in premenstrual syndrome. It can be extremely variable in both severity and duration. with nearly 40 percent (or more) of women experiencing them. The prognostic implications are different from postpartum depression. and excessive anxiety over the child’s health. rapid mood swings ranging from depression and irritability to euphoria. The symptoms include delusion. The risk of psychiatric hospitalization within the first three months postpartum is seven times more common than at other times in a woman’s life. Recognition and treatment of depressive disorders in pregnancy and during the postpartum period is critical for the healthy outcomes of both the mother and infant. A traditional approach to therapy in this condition usually involves either psychotherapy or the use of antidepressant medications.some point in their lives. she seemed to think that postpartum depression was a very common problem. It is a major depressive episode that usually begins within the first four weeks following delivery. In addition. Postpartum depression is identified as a major depressive disorder with postpartum onset. loss of interest in usually pleasurable activities. Most episodes are related to a psychotic condition of bipolar disorder or major depression. Postpartum psychosis is a more severe postpartum syndrome. In 1988. she commented on her long experience with the use of progesterone in the treatment of postpartum depression. hallucinations. At the time. The fetal age of the pregnancy is measured from the time of conception or the estimated time of conception (ETC). These discussions prompted an interest in the use of progesterone support for the treatment of postpartum depression. two weeks longer than it is. Pregnancy can be measured in two different ways. we thought that because progesterone support during pregnancy in our high-risk pregnancy population was common. this condition has actually been very rare. The most common and most often used in clinical obstetrics is the measurement of the gestational age of the pregnancy.1 percent. The use of progesterone for the treatment of postpartum depression symptoms can be very dramatic. as precisely as possible. The gestational age of the pregnancy is measured from the first day of the last menstrual period. of course. it is easy to teach her to record the first day of the last menstrual period so that when that . on average. the obstetrician has focused on the first day of the last menstrual period for two reasons. the beginning of pregnancy so that the estimated time of arrival (ETA) can be calculated (sometimes referred to as the estimated date of confinement – EDC). One of the most important aspects of obstetrical care is to date. it may have had an impact on the overall incidence of postpartum depression in our patient population. the pregnancy is 40 weeks in duration (on average) instead of the actual 38 weeks. it will be 38 weeks long or two weeks shorter than the gestational age dates. Historically. Studies were then undertaken to understand the role of progesterone therapy for women with PPD. The fetal age. the menstrual flow itself is a fairly dramatic symptom which the woman can be expected to remember. is the actual age of the pregnancy. is that the obstetrician has not yet learned how to accurately date the beginning of a pregnancy. In other words. states vigorously that “precise knowledge of the age of the fetus is imperative for ideal obstetrical management!” (emphasis in the original). In this way of dating the pregnancy. When measuring the pregnancy in this fashion. And yet. In addition. First of all. it dates the pregnancy. one of the puzzles of modern obstetrics.In our own clinical experience. even with all of the available technology. The standard textbook of obstetrics. The incidence of postpartum depression at the Pope Paul VI Institute is only 2. The other way of measuring the dates of the pregnancy is to measure the fetal age. Williams Obstetrics. The administration of progesterone later in pregnancy has been considered to be justified because of an observed decrease in circulating progesterone with the onset of labor. There is evidence of support in the concept that progesterone given in early pregnancy may be useful in some women with recurrent miscarriage and that the measurement of serum progesterone levels in early pregnancy can be an adjunctive marker for the further assessment of pathologic pregnancies. modern obstetrics has paid little attention to the white flow. reduce uterine contractions and help prevent preterm labor. and association of premature labor with decreased progesterone concentrations and the observation that progesterone has a tocolytic effect. In some countries. However. one can date the pregnancy according to its true date (or true beginning) or in fetal age terms. Its initial use was in patients who had habitual spontaneous abortion caused by luteal phase deficiency.information is elicited by the physician. Therefore. This is measured by evaluating the acts of intercourse that occur during the time of fertility and establishing an estimated time of conception through this approach. Now we move to Progesterone Support in pregnancy. the obstetrician and many women have missed the point that the cervical mucus discharge is very much a flow in the same fashion as the menstrual flow. one can date the pregnancy accurately from the actual or estimated time of conception. Luteal phase deficiency is due to a failure of the function of the corpus luteum in the production of progesterone from the corpus luteum is indispensable during the first seven weeks of pregnancy. When one is charting the Creighton Model FertilityCare™ System (CrMS). Surgical removal of the corpus luteum during this period of time results in pregnancy loss and progesterone replacement can help maintain the pregnancy. Progesterone support in pregnancy has been in use for nearly 60 years. in the midst of all of this. Unfortunately. they refer to menstruation as the red flow and the mucus discharge as thewhite flow. however. it is available. at a later time. This idea has received a considerable boost from the recent wide-spread publicity given to two papers which showed a significant reduction in preterm delivery rates with the prophylactic administration of either progesterone or 17 alpha- . therefore. having received its start with publications dating back to the 1940s. It is thought that the administration of exogenous progesterone might. in reality.org/wiki/Infertility http://en.wikipedia.com/infertility-insurance/infertility-whats-is-wrong-with-me/ http://www. I consider it to be one of the best treatments or routes an infertile couple should take.com/naprotext. the use of progesterone (or 17 alpha-hydroxyprogesterone caproate) for the prevention of preterm labor has appeared in the medical literature for nearly 30 years abortion.hydroxyprogesterone caproate.htm . Sources: http://en. Overall. I would say that NaProTech is the way to go. since it is very safe and efficient since it uses the natural resources or the natural ways of the human body (particularly the women). While this was portrayed as a “major breakthrough” by the national media.naprotechnology.wikipedia.org/wiki/Male_infertility http://adviceoninfertility.