I received an email a few months ago from a woman named Rita, explaining that she and her husband were experiencing infertility. Almost two years of no conceptions, with no explanations as to why. Rita and her husband had heard about NaPro and wanted to learn more about it. They reached out to me wanting to learn how to chart and begin working through the potential causes for their infertility. We emailed back and forth until we had time scheduled for an introductory session. Along the path of correspondence, I shared as much knowledge as I could with them. The details matter when it comes to fertility and I wanted them to know that I was on their side and in their corner from Day1.
None of us knew it at the time, but this couple's story was about to change dramatically.
Shortly before we were supposed to meet and go through the introductory session, I got an email from Rita. She had just taken a pregnancy test at home...and she was astonished to find a plus sign staring back at her. Rita was pregnant and she was writing to cancel her intro session.
Without the benefit of any charting, I knew that I should dig a little to figure out if Rita's infertility was potentially caused by something that could increase her risk of miscarriage in pregnancy. If that was the case, then she would need to see a doctor immediately for treatment.
A couple using 2 whole years of fertility-focused intercourse without any conceptions is definitely infertile. But what CrMS and NaPro recognize - more importantly - is that at 6 months of fertility-focused intercourse, this couple would have earned the formal diagnosis of infertility. With that diagnosis, doctors would have been researching and treating any underlying cause for their infertility. From the NaPro perspective, you don't wait for something bad to happen (miscarriage) and you don't expect infertility to magically cure itself when there is a physiological cause for it. You can imagine how important this approach would be for an older couple! Even without advanced maternal age though, the NaPro approach allows infertile couples more opportunity to determine root causes, more effective treatment protocols, and more of a chance to be healed where possible.
Rita and her husband didn't have the benefit of learning the potential causes of their infertility like NaPro patients who have charted their cycle. This unexpected plus sign on their home pregnancy test prevented them from knowing what the risks were ahead of time or how to proceed with treatment to keep baby as safe as possible. And sadly, many doctors wouldn't even consider this kind of pregnancy a risk. In fact, many OB/GYNs won't even schedule a pregnancy test or office visit as early as this couple learned they were pregnant. And to be in an "early risk" category with most doctors, you have to miscarry three times before they will even consider clinically looking into the cause. I'm sorry, but the loss of one child is devastating enough, let alone three! Why do any babies have to die when we can see the risk for miscarriage ahead of time and treat it? I will never understand any other approach. It's just barbaric to let babies die when you can prevent tragedy, in my opinion.
With that in mind, I had a quick phone conversation with Rita the day that she emailed me about her positive home pregnancy test and we talked through some details regarding her menstrual cycle. From everything she shared, from my own personal experience as a NaPro patient, and from my training as an FCPI - it really sounded like Rita's cycle screamed low progesterone, or endometritis (an infection in the uterus), or both! That said, I'm not a diagnostician and we didn't have a chart or lab work or cultures to prove my intuition. Low progesterone is the cause of many early miscarriages, but most doctors don't know how to treat it. So I just went with my gut and made an immediate referral to the nearest NaPro doctor.
At this point, I asked Rita to trust me. My goal is never to scare someone by talking about what constitutes a miscarriage risk, but I think there is a lot of value in providing the truth to people so that they can make informed decisions about their health care - especially when time is of the essence. Rita lived over an hour away from the nearest NaPro doctor though. I asked her to contact the doctor anyway. It was Friday evening at close of business. Yes, I was asking for a LOT out of her. She knew so little about me, what I do, what my training entails, and how necessary this recommendation was. I silently cringed and said a prayer in the silence across the phone, hoping for a miracle. I told her that if I were in the same situation, knowing what I know, I would want the doctor to help me figure out how urgent the need to be seen was.
To make a long story short, Rita called that doctor immediately. And the doctor did want to see Rita ASAP. And Rita received very necessary progesterone supplementation before and after finding out she had very low blood serum progesterone levels.
And that's how we saved a baby in the beginning of June 2015! But it gets better...
Thankfully, Rita is successfully maintaining this pregnancy with bio-identical progesterone support, which she'll likely have to continue throughout her pregnancy as the doctor continues to monitor her levels. It used to be a widely held belief that the placenta "takes over" progesterone production in sufficient amounts at 12-13 weeks for every pregnant woman and that any supplementation used in the first trimester is unnecessary for the rest of the pregnancy. But we now know that some women continue to have progesterone issues throughout pregnancy...and we have 40 years of clinical data that show us this in thousands of pregnancies. Instead of risking miscarriage, it's better for a doctor to continue monitoring levels to make sure that they remain on the rise and at the right levels as the weeks of gestation progress.
There is no doubt in my mind that Rita's low progesterone was the cause (at least in part) of her infertility and that it presented a real and present danger to her unborn child. Perhaps she had an ovulation defect that caused the low progesterone? Perhaps she had a luteal phase defect that caused it? Perhaps she had both, or one caused the other? Either way, it's not fair to risk her child's life and withhold progesterone! I've seen situations like this end poorly, when progesterone was not provided quick enough. It's always terrible.