Experiência preliminar no uso do registro de fertilidade em um coorte de pacientes de infertilidade num Serviço de ginecologia e obstetrícia

Javiera Valdivieso, José Antonio Arraztoa, Manuel Donoso, María Teresa Gana, Horacio Figueroa, Benjamín Bustos, Ximena Maella
In: 2357-6308 · 2015 · W7134364448
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A retrospective cohort study of 131 infertility patients found that restorative medicine achieved a 25.2% pregnancy rate, with endometriosis identified as a cause in 14.5% of cases.

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This retrospective cohort study evaluated the efficacy of NaProTechnology, a restorative medicine approach utilizing fertility charting and targeted medical or surgical interventions, among 131 infertility patients treated between 2006 and 2014. The research identified various etiologies for infertility, including anovulation, male factors, and endometriosis, ultimately reporting a global pregnancy rate of 25.2% over a mean treatment duration of 12.6 months. The authors concluded that while this longitudinal method is effective for achieving pregnancy, its success is significantly compromised by early discontinuation of fertility charting and requires further optimization of medical treatments. Relevance to endometriosis: listed as one of the identified causes of infertility in the patient cohort (14.5%), though the paper's main focus is on the broader application of natural procreative technology rather than specific management of the disease.

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Abstract

Objective: to study the results in patients undergoing infertility treatment with a focus on restorative medicine (NaProTechnology) at a department of obstetrics and gynecology. Methodology: retrospective cohort study conducted by the gynecology and obstetrics department at Universidad de los Andes (Santiago, Chile) in infertility patients from a suburban area of Santiago de Chile, who received treatment between 2006 and 2014. All couples received instructions on how to recognize their fertility period according to a local teaching model based on the Creighton Model FertilityCare System. They also received medical treatment to induce ovulation and/or widen their fertile period, or surgical treatment. The main outcome was the number of pregnancies. Results: 131 patients received instructions. The mean age was 33.6 years. Seventyeight patients (59.5%) consulted due to primary infertility; 53 (40.5%) due to secondary infertility. The duration of group infertility was 4.1 years. The mean use of the method was 12.6 months (median, 9 months). The infertility causes identified included anovulation (50.4%), tubo-peritoneal factors (18.3%), endometriosis (14.5%), uterine factors (9.2%), cervical factors (8.4%) and masculine factors (19.1%). There were 33 pregnancies (25.2 global). The crude proportion of pregnancies at 24 months was 22.9% and the proportion adjusted by the life table at 24 months was 40 per 100 couples. Conclusions: the focus on restorative medicine is effective to achieve pregnancy but it requires a long-term longitudinal treatment. Early discontinuation of fertility charting affects the efficacy of this focus. More research is warranted to optimize medical treatment.
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Abstract

Objective: to study the results in patients undergoing infertility treatment with a focus on restorative medicine (NaProTechnology) at a department of obstetrics and gynecology. Methodology: retrospective cohort study conducted by the gynecology and obstetrics department at Universidad de los Andes (Santiago, Chile) in infertility patients from a suburban area of Santiago de Chile, who received treatment between 2006 and 2014. All couples received instructions on how to recognize their fertility period according to a local teaching model based on the Creighton Model FertilityCare System. They also received medical treatment to induce ovulation and/or widen their fertile period, or surgical treatment. The main outcome was the number of pregnancies.

Results

131 patients received instructions. The mean age was 33.6 years. Seventyeight patients (59.5%) consulted due to primary infertility; 53 (40.5%) due to secondary infertility. The duration of group infertility was 4.1 years. The mean use of the method was 12.6 months (median, 9 months). The infertility causes identified included anovulation (50.4%), tubo-peritoneal factors (18.3%), endometriosis (14.5%), uterine factors (9.2%), cervical factors (8.4%) and masculine factors (19.1%). There were 33 pregnancies (25.2 global). The crude proportion of pregnancies at 24 months was 22.9% and the proportion adjusted by the life table at 24 months was 40 per 100 couples.

Conclusions

the focus on restorative medicine is effective to achieve pregnancy but it requires a long-term longitudinal treatment. Early discontinuation of fertility charting affects the efficacy of this focus. More research is warranted to optimize medical treatment. Article Details

References

Practice Committee of American Society for Reproductive Medicine in collaboration with Society for Reproductive Endocrinology and Infertility. Optimizing natural fertility: a committee opinion. Fertil Steril. 2013;100(3):631-7. Guzick D. Human infertility: an introduction In: Adashi EY Rock J, Rosenwacks Z, editors. Reproductive, Endocrinology, Surgery and Technology. Philadelphia: Lippincott Williams & Wilkins; 1996. Hilgers T. What is NaProTechnology? . In: Hilgers T, editor. The medical and surgical practice of NaProTechnology. Omaha, NE. USA: Pope Paul VI Institute Press; 2004. Hilgers TW, Prebil AM. The ovulation method--vulvar observations as an index of fertility/ infertility. Obstet Gynecol. 1979;53(1):12-22. Hilgers TW, Stanford JB. Creighton Model NaProEducation Technology for avoiding pregnancy. Use effectiveness. J Reprod Med. 1998;43(6):495-502. Stanford JB, White GL, Hatasaka H. Timing intercourse to achieve pregnancy: current evidence. Obstet Gynecol. 2002;100(6):1333-41. Tham E, Schliep K, Stanford J. Natural procreative technology for infertility and recurrent miscarriage: outcomes in a Canadian family practice. Can Fam Physician. 2012;58(5):e267-74. Stanford JB, Parnell TA, Boyle PC. Outcomes from treatment of infertility with natural procreative technology in an Irish general practice. J Am Board Fam Med. 2008;21(5):375-84.

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