For anyone who has visited the plush offices of a private IVF consultant, arriving at the HQ of FertilityCare may seem underwhelming. Housed in a small, flat-roof extension of a Victorian building on a side street in Leamington Spa, Warwickshire, the rooms are small, sparsely furnished and anonymous; there is no sign of the obligatory pinboard crammed with snaps of babies — a reassuring testament to any clinic’s success rate. “We haven’t got round to putting that up yet,” says Dr Anne Carus, the medical consultant, apologetically. The company has been in its new offices for a only few months.
FertilityCare does not offer IVF to its clients, but is the UK’s biggest provider of NaPro Technology, or Natural Procreative Technology (NPT). Developed and still mainly taught at the Pope Paul VI Institute in Nebraska, NPT is offered to couples as an “ethical alternative” to assisted reproductive techniques. As it is a Roman Catholic organisation, the couples must be married. There is no egg selection, no donor insemination and no embryo wastage.
It has been embraced enthusiastically in countries with large Catholic populations, such as the US, the Irish Republic and Poland, and claims to have a success rate that equals or even betters that of IVF, but promises to be much less invasive. Now, after years on the fringes of fertility treatment, NaPro is slowly establishing itself in Britain.
“We do see couples for whom IVF and ICSI [a laboratory technique in which one sperm is injected directly into the egg] are unacceptable,” Dr Carus says. “We also see couples who have been through other treatment options and been unsuccessful.” Supporters of NPT say that its attractions are not only moral but tangible. “We look at identifying the underlying cause of why conception doesn’t occur,” says Ira Winter, a FertilityCare practitioner.
NPT aims to do this by treating couples holistically. After an initial medical meeting with an NPT consultant to discuss reproductive history and lifestyle, there follows a series of blood, hormone and sperm tests. Couples are then taught the Creighton Model FertilityCare System.
Originally designed as a form of natural family planning, the system tracks in detail a woman’s cycle, such as bleeding patterns and cervical mucus that may show ovulation or hormone surges. The cycle is monitored (patients are urged to stick with NPT for at least 12 months and ideally for up to two years) and a practitioner will be able to spot any abnormalities that may indicate atypical ovulation patterns, reduced hormone levels or other problems.
In partnership with the NPT medical consultant, the practitioner can use the information from the woman’s cycle to treat the cause of the problem with conventional medical techniques, Winter says, rather than “bypassing it” through IVF. The treatment may not always be successful but the team will discover the cause of the problem. Unexplained infertility is the explanation given for about a third of cases of couples who fail to conceive and seek conventional help, but “in NPT it is very, very rare”, she says.
The list of conditions that NPT claims to tackle is impressive: endometriosis, polycystic ovaries, low sperm count, lack of ovulation, recurrent miscarriage as well as “unexplained infertility” (only couples presenting with an absence of sperm, established menopause or bilaterally blocked Fallopian tubes that cannot be surgically corrected are considered medically unsuitable). The timings of treatments can be tailored to an individual’s cycle. Those working in NPT believe that general medicine and fertility practice is overly reliant on a “typical” 28-day cycle.
It was this that Louise McMullen, a part-time teacher living in Omagh, Co Tyrone, found attractive about NPT. After five years of trying to conceive naturally and several rounds of failed IVF, she felt that little attention had been paid to the cause of her infertility. “I used to wait for months to go to Belfast for a specialist appointment and then it would be five minutes, I’d be given some drugs and they’d send me away again,” she says. “I kept saying that I was sure there was something wrong hormonally and couldn’t I see an endocrinologist, but I was never referred.”
At first she was sceptical about NPT, but she was persuaded to visit Dr Phil Boyle, who has pioneered NPT in Europe from his clinic in Galway. Within two months of beginning her chart, Boyle had, she says, diagnosed her failure to ovulate and treated it with the infertility drug Clomid together with Mucodine to increase cervical mucus (she had previously been prescribed Clomid on its own unsuccessfully).
Crucially, she believes, he gave her an HCG supplement, a hormone to promote a healthy level of progesterone, to avoid the “hormone crash” that he observed in later cycles after ovulation. “Within five months I was pregnant,” she says. Not only did McMullen find NPT more successful — she has three daughters aged between 9 and 3, conceived using NPT — but it was also much gentler than conventional assisted reproduction.
Because NPT aims to restore fertility gently, medication is taken at relatively low levels and adverse sideeffects should be fewer than with IVF. “We want a single egg and a single birth, never multiples, which is safer for the mother and the child,” Winter says.
NPT has markedly lower fees than IVF: between £1,000 and £1,500 a year for medical and practitioner consultations compared with £3,000 to £5,000 per IVF cycle (in both approaches pathology testing and medication costs will add to this). McMullen’s husband, Eamonn, a GP, was so impressed that he completed an NPT course to help patients at his practice.
So why aren’t more people using it? The Government’s pledge to offer three free cycles of IVF to infertile couples hasn’t helped, says Winter, the FertilityCare practitioner. “We have clients saying, ‘We’ve seen what you are doing but we’ve got free IVF and we’re going to try that’.”
The biggest study of NPT effectiveness has come from an Irish trial that monitored more than 1,200 patients. The results, published in the peer-reviewed Journal of the American Board of Family Medicine, were of a live birth rate of 25.5 per cent, a figure that seems impressive given that in the UK the IVF success rate is about 23 per cent.
The problem, according to the NaPro practictioner Dr Kevin McCarthy, is that infertility treatment in the UK is weighted to make IVF almost inevitable. “Many couples say that they have consultations with a GP and then go to secondary care and quickly are on the IVF route. Before that they should be trying to find underlying causes.”
However, Geoffrey Trew, a consultant in Reproductive Medicine and Surgery at Imperial College, says: “It’s just not true that conventional fertility treatments ignore the woman’s cycle. In fact, that’s where we start. We do a lot of simple things to investigate infertility. There is a whole range of treatments from hormonal [supplements] to surgery, and it’s very frustrating for NaPro practictioners to say that patients are not thoroughly investigated.
“NaPro technology advocates treatment over a two-year period, making conception more likely — a significant number of people will get pregnant just by waiting anyway, with no treatment. We also treat cases of infertility that NaPro practitioners won’t take on. Both of these factors might explain their elevated success rate.”
And what of the stipulation that couples seeking treatment must be married? “I suspect that when people find out about the connection with Catholicism, they might end there,” McCarthy says. “It was a Catholic professor of gynaecology who developed it, but it really is good science for all faiths and cultures.
Ira Winter adds with a shrug: “I have the odd client who does NPT because they are Catholic, but unless they bring it up, we are not going to. Going home from IVF or NPT without a baby is awful, but the difference with us is that they have an answer. They have peace of mind.”
How does NaPro work?
NaPro Technology (NPT) treats the man and the woman. If a man’s sperm is found to have low motility and poor morphology (a high percentage of misshapen sperm), he will be put on a regimen of health supplements, such as vitamins C and E, and on medication for three to four months.
Using the Creighton Model System (see main article), the woman charts her cycle. The two hormones that most interest the NPT establishment are progesterone and oestrodiol and these will be monitored closely. Medication levels are tweaked for each individual to optimise fertility rather than send it into overdrive.
If the cause of infertility is found to lie with the woman, she is encouraged to keep successive charts to show how she responds to the medication.
