FAQs : Life FertilityCare Programme
1. What are NaPro and FertilityCare?
2. Why do we have to be married?
3. We have children already, does that exclude us?
4. We've had several miscarriages, all investigations have been normal, can you help?
5. How can something this simple help? We haven't conceived in 5 years
6. We've failed with IVF; surely we need something more than NaPro?
7. My wife is 37, we've been told IVF is our only option, how do we know if NaPro might help?
8. Do you use prescription medicines?
9. My husband felt marginalised by IVF; will he be excluded by FertilityCare and NaPro?
10. Will we be seen by the same clinic staff each visit?
11. Can we discuss our situation confidentially before committing to the programme?
12. What does it cost? Is it available in the NHS?

Background information : Life FertilityCare Programme
a) How does the system work?
b) What is different about this approach?
c) What are the markers women chart?
d) How do you learn to chart cycles?
e) Is it worth the effort?
f) How will all this help us have a baby?
g) But we haven't conceived in 3/5/7 years?
h) So what chance of conceiving do we have?
i) How long do couples stay with the programme?
j) Is stress a factor in infertility?
k) Isn't this just all too simple?
l) IVF is considered to be technological medicine. If that failed how can NaPro and FertilityCare work?
m) What happens if I have endometriosis, pelvic adhesions or a blocked Fallopian Tube?
n) I've been told I ovulate irregularly, can we use this system?
o) Where can we find a teacher/practitioner to teach us how to chart?
p) Where do we have to go for Medical Clinics?
q) Where else are FertilityCare and NaProTechnology services available?
x) Why do couples find themselves on the brink of IVF but feeling there must be less invasive options available?
y) Why is IVF referral so prevalent?

References

1. What are NaPro and FertilityCare?
NaPro is short for NaProTechnology, a medical approach to supporting natural fertility cycles.
FertilityCare is a way of charting natural observations associated with fertility accurately. It gives useful, relevant information about your fertility status.

2. Why do we have to be married?
We believe children should ideally be brought up by both parents in a committed relationship of marriage.

3. We have children already, does that exclude us?
No, some married couples with one or more children experience difficulty conceiving a subsequent longed for child.

4. We’ve had several miscarriages, all investigations have been normal, can you help?
We have helped couples in this situation. By ensuring good quality ovulation and adequate hormone levels before conception the chance of a successful pregnancy appears to be increased. Of course there are no absolute guarantees of success.

5. How can something this simple help? We haven’t conceived in 5 years.
Standard medical practice puts the emphasis on technical approaches to conception. Couples coming to FertilityCare and NaPro want the emphasis on natural conception through intercourse, even if medical support is also required.

6. We've failed with IVF; surely we need something more than NaPro?
Some couples have conceived with NaPro having failed with IVF. All fertility clinics have some couples fail with them who subsequently conceive elsewhere.

8. Do you use prescription medicines?
Yes. Medications used depend on the assessment of cycles and the identification of areas needing assistance. We use medication that has been used in fertility support for many years generally. Our unique approach times the medical support to the charted events of cycles.

9. My husband felt marginalised by IVF; will he be excluded by FertilityCare and NaPro?
FertiltyCare is an approach to fertility awareness and relationship teaching that treats the couple as a unit. No man or woman is fertile alone. Fertility is integrally involved in the couple’s relationship. Men are an essential and valued part of the fertility process.

10. Will we be seen by the same clinic staff each visit?
We have a small staff who are appropriately trained in the techniques we use. Generally you are seen by the same staff on each occasion.

11. Can we discuss our situation confidentially before committing to the programme?
Yes. The co-ordinator will request basic information about fertility so that we can assess if our approach may be of assistance. In addition a consultation for further medical assessment prior to joining the programme can be arranged. If this is requested or it is advised due to your particular circumstances, a fee is payable. All information is treated in the strictest confidence.

12. What does it cost? Is it available in the NHS?
Costs are substantially less than for the assisted reproductive technologies. A charge is made for charting materials and teaching support from a practitioner. Medical consultations are on a pay-as-you-go basis. The fee structure is available from the website at www.lifefertilitycare.co.uk Additional costs vary but can include scanning, blood tests, surgical referral if indicated and medications.

FertilityCare and NaProTechnology are not provided by the NHS.

a) How does the system work?
b) What is different about this approach?
c) What are the markers women chart?
d) How do you learn to chart cycles?
e) Is it worth the effort?
f) How will all this help us have a baby?
g) But we haven't conceived in 3/5/7 years?
h) So what chance of conceiving do we have?
i) How long do couples stay with the programme?
j) Is stress a factor in infertility?
k) Isn't this just all too simple?
l) IVF is considered to be technological medicine. If that failed how can NAPRO and FertilityCare work?
m) What happens if I have endometriosis, pelvic adhesions or a blocked Fallopian Tube?
n) I've been told I ovulate irregularly, can we use this system?
o) Where can we find a teacher/practitioner to teach us how to chart?
p) Where do we have to go for Medical Clinics?
q) Where else are FertilityCare and NaProTechnology services available?
x) Why do couples find themselves on the brink of IVF but feeling there must be less invasive options available?
y) Why is IVF referral so prevalent?

FertilityCare and NaProTechnology were developed in the USA by Consultant Obstetrician and Gynaecologist Dr. Thomas Hilgers. FertilityCare is a system of charting fertility markers. Women are aware of these to differing degrees but little attention is paid to them in standard practice as there has been no way of reliably recording them.

NaProTechnology is a system of medical support to fertility cycles that relies on charting observations for maximum benefit. Only appropriately trained doctors can implement NaProTechnology.

a) How does the system work?
Fertility is complex. Each cycle is unique involving a new egg each time. Cycles do not always follow exactly the same pattern. Prior to and during treatment, each cycle is evaluated individually for its effectiveness. Medication used to support and improve effectiveness is accurately timed to the unique events accompanying each cycle.

b) What is different about this approach?
Most fertility support assumes an average cycle of 28days and egg release (ovulation) around the 14th day. Many women’s cycles are different. Cycles may vary from 21 days to 90 days or longer. Even in a regular 28 day cycle ovulation does not always occur around the 14th day.

Charting unlocks your individual and unique pattern!

c) What are the markers women chart?
Hormonal fluctuations each cycle determine the length and nature of periods, the number of days to ovulation, the cervical mucus flow that anticipates fertility and the post-ovulatory lengths of cycles. This information, accurately charted, gives a valuable ‘handle’ on cycle events, enabling comparison with cycles of proven fertility.

d) How do you learn to chart cycles?
FertilityCare practitioners, thoroughly trained in this system, instruct and support couples in the learning process following a standard but flexible follow-up routine. Like anything new, a little time and effort is required initially. Experience shows us that confidence builds rapidly. Practitioners are contactable for advice at a mutually convenient time between appointments if necessary.

e) Is it worth the effort?
Couples often comment to us how much they learn about their fertility through the charting process. Men appreciate being included in the chart recording. After all fertility is a joint exercise! This learning process can be a good opportunity to strengthen relationships, as well as pursue the opportunity to conceive.

f) How will all this help us have a baby?
A couple are not equally fertile throughout a woman’s cycle. Sperm can live 3-5days when cervical mucus is present, the egg lives for up to 24 hours. Intercourse on some days is more likely to lead to conception than on others. Some couples conceive using charting techniques alone. Others require more assistance.

g) But we haven't conceived in 3/5/7 years?
Some couples experience subfertility or infertility. Charting alone with well-timed intercourse may be insufficient to lead to conception but may uncover abnormalities of cycles. For example ; reduced or absent cervical mucus flow, abnormal bleeding patterns, brown bleeding following a period, unusually short or long cycle phases, all can be relevant to potential fertility. Charting also allows accurate timing of blood tests which may uncover subtle abnormalities of hormone levels, previously undetected.

i) How long do couples stay with the programme?
Couples who stay with the programme for 12 effective cycles give themselves the best chance of success. However for a variety of reasons couples may choose a different length. Ultimately the couple decide with appropriate medical advice.

j) Is stress a factor in infertility?
Stress is well recognised as having an adverse effect on fertility. Our programme encourages the couple to review lifestyle, diet, relationships etc and to take positive control of areas of their lives recognised as having room for improvement. It can be possible to improve your quality of life and doing it jointly can benefit your fertility!

k) Isn't this just all too simple?
As has been said before, fertility is complex and medicine has incomplete knowledge of all aspects of it. However sometimes in overlooking the most straightforward of observations valuable information is lost. Only if information is obtained and recognised can it be acted on. This approach obtains relevant information from charting and acts on that information where appropriate.

l) IVF is considered to be technological medicine. If that failed how can NaPro and FertilityCare work?
Our emphasis is on improving the couple’s own fertility potential not by-passing the process of reproduction as with assisted techniques. We try to ensure that both the structure and the function of the reproductive system work as well as is possible. That means surgical referral is sometimes necessary. Improving the environment for conception and then ensuring good quality ovulation and well-timed intercourse can tip the balance in favour of conception.

m) What happens if I have endometriosis, pelvic adhesions or a blocked Fallopian Tube?
These conditions may reduce the chance of natural conception. Advice regarding further appropriate treatment, which may be surgical, is given on an individual case by case basis.

n) I've been told I ovulate irregularly, can we use this system?
Yes. Regular ovulation with its associated hormonal surges is necessary to improve the opportunity of conception. Investigation to establish the cause of infrequent ovulation is necessary to plan a suitable management plan.

p) Where do we have to go for Medical Clinics?
Medical clinics, registered with the Healthcare Commission, are held in Liverpool and the Midlands, with easy access from the M40. Appointments, approximately 45-60mins in length, are generally every three to four months.

q) Where else are FertilityCare and NaProTechnology services available?
The availability of these services is spreading. Provision is currently available outside the UK in USA, Ireland, Australia, Canada and South Mexico.

Further information is available on the following websites:
lifefertilitycare.org.uk United Kingdom
fertilitycare.net Ireland and Europe
fertilitycare.co.uk United Kingdom

x) Why do couples find themselves on the brink of IVF but feeling there must be less invasive options available?
Busy NHS infertility clinics cannot provide the time or staff to individually teach or monitor the parameters of a woman’s cycle. A 'one size fits all' approach is therefore adopted. If conception does not occur the next step is IVF.

y) Why is IVF referral so prevalent?
There are few other options within the NHS. IVF is big business, well-funded and drug companies have a vested interest, despite overall success rates being ~22% (hfea.org.uk). There is very little research in Europe or the USA dedicated to improving knowledge and treatment supporting natural conception.

HILGERS TW, PREBIL AM: The Ovulation Method – Vulvar observations as an index of Fertility/Infertility. Obstet Gynec. 53:12, 1979

HILGERS TW, ABRAHAM GE, CAVANNAGH D: Natural Family Planning. I. The Peak Symptom and Estimated Time of Ovulation. Obstet Gynec 52:575, 1978

HILGERS TW, ABRAHAM G, PREBIL AM: The length of the Luteal Phase. Int Rev Nat Fam Plan. 13: 99, 1989

KARANDE VC, KORN A, MORRIS R et al: Prospective Randomised Trial comparing the outcome and cost of In Vitro Fertilisation with that of a traditional Treatment Algorithm as First Line Therapy for couples with Infertility. Fertil Steril 71: 468-475, 1999

HOWARD MP, STANFORD JB. Pregnancy Probabilities during the use of the Creighton Model FertilityCare System. Arch Fam Med 8 391-402, 1999

HILGERS TW, DALY KD, PREBIL AM, HILGERS SK : Cumulative Pregnancy Rates in patients with apparently normal fertility in Fertility Focused Intercourse. J Repro Med 10: 864-866, 1992

HILGERS TW, HILGERS SK, PREBIL AM, DALY KD. The Creighton Model FertilityCare System: A Standardised Case Management Approach to teaching Book I. Pope Paul VI Institute Press, Omaha, Nebraska. 2002

HILGERS TW, HILGERS SK, PREBIL AM, DALY KD. The Creighton Model FertilityCare System: A Standardised Case Management Approach to teaching Book II – Advanced Teaching Skills. Pope Paul VI Institute Press, Omaha, Nebraska. 2003

BOYLE PC. NaProTechnology and Infertility : A Family Physician’s Approach, Chap 49 The Medical and Surgical Practice of NaProTechnology. Pope Paul VI Institute Press 2004

HILGERS TW: The Medical and Surgical Practice of NaProTechnology. Pope Paul VI Press, 2004

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