3.1 Descriptive data

Naprotechnology and in general fertility restorative medicine, as a medical science, can be defined as procreative medicine based on the recognition of the woman’s menstrual cycle. This medical subspecialty constitutes a medical and scientific approach that seeks to solve reproductive and gynecological disorders, both in women and men, by identifying the main causes that affect true reproductive health ⁽⁷⁾. From this point on, the aim is to correct possible alterations and restore health and fertility ⁽⁸,⁹⁾.

Infertility is not a disease; it is a symptom of one or more possible organic or hormonal diseases. The physician’s action should focus on diagnosing the male and/or female causes of the possibly temporary situation of infertility or sterility ⁽¹⁰⁾.

The woman makes a graphic record of her cycle by means of a standardized method of observation, recognition and recording of the flow (especially cervical mucus and vaginal bleeding) ⁽⁸⁾. The chart that collects her notes is used as a tool to plan the necessary medical studies, directing them to the specific moment of the cycle that we wish to study. In this way, the woman is an active part in the control and follow-up of her gynecological and reproductive health. This monitoring of cervical mucus can also reflect suboptimal hormone levels and short or variable luteal phases ⁽¹¹⁾.

It is not simply a natural method that helps the natural recognition of the cycle, identifying the fertile window to seek or space the pregnancy; it is rather a medical approach that uses, as one of its tools, a natural method of fertility recognition. Thanks to this information, problems can be identified and treatments can be carried out at specific times of the menstrual cycle. The aim is therefore to improve the physiological conditions of each menstrual cycle to facilitate natural conception ⁽¹²⁾.

Specialists in this science recommend the use of the Creighton Model FertilityCare System, a systematization of the Billings ovulation method, although it is neither an exclusive nor an exclusive preference with respect to other natural methods of fertility recognition. Formally, we usually speak of Naprotechnology when the Creighton Model is used and of fertility restorative medicine when any other natural fertility awareness method is used. In addition to this tool, Naprotechnology also uses hormonal analysis, ultrasound or other medical procedures that can help and complete the diagnosis.

Naprotechnology identifies possible problems, cooperates with the menstrual cycles, corrects as far as possible the deficiencies detected, all while respecting human ecology and nature. Faced with the initial problem, it seeks the solution from the integral health of the woman and the man, promoting the true sexual health of marriage: the health of the woman, the health of the man and the health of the male-female union that we call marriage. The perspective of the studies carried out by Naprotechnology does not focus exclusively on women, although their sexual cycle is more complex than male fertility, which is linear. Both modes of fertility converge in the fertility of marriage.

It is worth remembering the WHO definition of sexual health: “A state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence” ⁽¹³⁾. We highlight only two details:

María Isabel Valdés summarizes Naprotechnology in her doctoral thesis as being aimed at the study of reproductive dysfunctions associated with infertility, the most frequent being a decrease in the production of cervical secretion, intermenstrual bleeding or spotting, short or variable luteal phase, as well as altered levels of the ovarian hormone’s estrogen and progesterone ⁽¹⁴⁾.

At present, the study of male infertility is not present in medical practice. Men with subfertility and infertility problems are too often referred to artificial reproduction units, where they are offered the options of artificial insemination, in vitro fertilization or gamete donation. Agarwal states that about 30% of men seeking help in this area have a seminal disorder of unknown etiology. Therefore, there is a growing need to find the causes that lead to infertility ⁽¹⁵⁾.

Rarely are they offered as a first option the opportunity to investigate in depth the causes of their problem, and to give them a specific treatment. This procedure evades the correct medical perspective: to look for the cause of the infertility or subfertility problem and to employ the necessary means to cure it. Assisted reproductive techniques, Boyle notes, focus on achieving pregnancy, regardless of the underlying pathology ⁽¹²⁾.

Naprotechnology assumes that infertility is not a disease, but one of the symptoms of one or more possible underlying organic or hormonal diseases ⁽¹²⁾. Experts note that it rarely has a single cause; therefore, it must be analyzed and diagnosed from a multifactorial perspective. The idiopathic cause (or unknown cause) is insufficient for the scientific rigor of a discipline such as medicine. Aristotle already spoke of science as cognitio certa per causas (certain knowledge for its causes), and this scientific ideal should never be lost sight of in daily work.

Naprotechnology was developed in 1976, thanks to the studies of Thomas W. Hilgers, an obstetrician and specialist in reproductive medicine ⁽¹⁶⁾. In 1985, he opened the St. Paul VI Institute for the Study of Human Reproduction in Omaha, Nebraska (USA). In 2004, he published the book The Medical and Surgical Practice of NaProTechnology⁽¹⁷⁾.

Phil Boyle, the family physician who brought Naprotechnology to Europe, summarizes this medical work in three successive phases ⁽¹²,¹⁸⁾:

The study of Naprotechnology arrives in Spain in 2014, thanks to María Victoria Mena, specialist in gynecology, Creighton Model instructor and Medical Consultant in this subject. The following year Helena Marcos, instructor of the Creighton Model and other natural methods of fertility recognition, and Medical Consultant in Naprotechnology, opens the second practice in Spain.

A few months later, the effort of some couples who began to collaborate in its diffusion joined her. The initiative takes shape in the portal www.naprotec.es that offers information and advice since 2016. In 2017, the Spanish Association of Naprotechnology, Naprotec, was constituted to continue this work of counseling, accompaniment and diagnosis.

This association seeks to coordinate the work of counseling and accompaniment to couples interested in this science. This goal is specified in three important notes:

3.2. Numerical data: results of Naprotechnology in Spain (years 2015-2021)

Naprotechnology has a history of more than four decades, although there is not much published data. Stanford et al. reported the result of one of the first systematic studies on the subject. They studied 1,072 couples with a mean age of 35.8 years conducted between 1998 and 2002. Approximately 40% of the couples went on to conceive a child, with a miscarriage rate of 1.4% ⁽²⁰⁾.

We set out the data below, limiting ourselves to a specific geographic space and time: Spain, between the years 2015 and 2021.

In these seven years, the counseling offered by Naprotec (www.naprotec.es) and the Spanish Association of Naprotechnology, has attended 5,100 marriages. Currently, the average age of the people who receive information is 33.8 years old for women and 35.8 for men. In the last two years, the average age has decreased, which shows that Naprotechnology is reaching a younger public. The Naprotec association has activated a program for young university students and another for teenagers. Drs. Mena and Marcos have treated 1,560 married couples in their Naprotechnology practice ⁽²¹⁾.

Regarding the population, that requests information before going to the Naprotechnology specialists, and as shown in Graph 1, 75% suffer from sterility or primary infertility, they have no living children, and 25% already have a child. Thirty-three percent have had some reproductive technique before seeking information about Naprotechnology, either in vitro fertilization or artificial insemination or in vivo fertilization.

Source: Naprotec; 2019.

Graph 1 Previous assistance to artificial reproduction techniques 

Focusing on the population that is in medical consultation with Naprotechnology specialists, between 2015 and 2021, 300 pregnancies have been counted, of which 201 live children have already been born. Now there are 99 ongoing gestations ⁽²¹⁾. The main purpose of Naprotechnology is not only to achieve pregnancy, although the aim is to facilitate its achievement, but above all to improve overall health to facilitate fertility.

Of great interest is the study carried out by Venancio Carrión in chapter 8 of his book La naprotecnología y más allá (Naprotechnology and beyond), which gathers data and information on 55 couples treated by Mena and Marcos. These patients were treated in Spain between the years 2015-2019 ⁽²²⁾.

Different topics are analyzed in the study, of which we highlight the following:

b) Symptoms that patients detect before seeking Naprotechnology.

Graph 2 shows the symptoms identified by women who have a problem of sterility or infertility. Many of the phrases present us with situations that women have assumed to be normal; my period hurts; one day I should take an analgesic to alleviate or relieve the pain, etc. Practically half of the women surveyed identify that their cycle is irregular and recognize irritability or mood swings days before menstruation.

Source: prepared by the authors.

Graph 2 Symptoms identified by women who have a problem of sterility or infertility 

c) Diagnosis of women and men.

As we can see in Graph 3, the hormonal cause is the most relevant. In Graph 4, we can see that it is mainly due to unbalanced estrogens and progesterone.

Source: prepared by the authors.

Graph 3 Diagnosis of the woman 

Source: prepared by the authors.

Graph 4 Male Seminogram 

Any sterility or infertility study should also consider the situation of the male. In this regard, one of the basic studies is the semen analysis. In most cases, a normal semen analysis is found, although in some patients there are also indicators of subfertility as shown in Graph 4.

Based on this study we can formulate the following conclusions ⁽²²⁾.

• We can see how Naprotechnology and/or Fertility Restorative Medicine are a real answer to sterility/infertility diagnoses. If the married couple is maintained for, the necessary time and performs all the studies that are requested, a good diagnosis can be reached.

• Age is not a limitation, as the study focuses on the health of the woman. Any menstruating woman can be studied.

• We have seen that older people are not the ones who have needed more time to achieve pregnancy, even if they have used reproductive techniques. There is therefore hope that we can dedicate our efforts to a good study that will get to the causes, without feeling pressured by age.

• Hormonal imbalance is the most common cause in the different women in the sample. Much can be done by regulating estrogen and progesterone levels.

• Naprotechnology can study cases of sterility or infertility, whether they are primary or secondary situations; an example of this secondary infertility is repeated miscarriages.

After these global data, we cite four clinical cases of patients treated by these specialists in Spain, as an example of how diagnoses and treatments are carried out in this specialty.

4.1. Unity body soul

It is the first unity that we discover in ourselves, in every human being. We can speak of body-soul, body-mind, incarnated spirit, sensitive intelligence... Following Luke we can speak of a spirit informing matter, matter that exists as such only informed by a body ⁽²³⁾.

Are we a body or do we have a body? ⁽²⁴⁾ One thing and the other. Neither of the two co-principles of the human being makes full sense on its own since both are substantially united. We can affirm that in a certain sense we have a body, without denying that, at the same time, we are a body.

St. Thomas Aquinas, taking up the Aristotelian doctrine, recalls that nihil est in intellectu quod prius non fuerit in sensu, that is, there is nothing in the intelligence that is not first in the sense. However, what we perceive through the senses possesses a meaning that goes beyond themselves, beyond their materiality. Physically, the eye perceives certain wavelengths that reflect certain bodies, those who are reading this article. Nevertheless, I do not say: I have certain physical bodies in front of my eyes, but there are some people who are looking at me and listening to me. The mere external and internal senses and intelligence are integrated and interrelated. Thus, we come to perceive “human bodies”.

We never see man’s body as a simple body, but always as a human body, that is, as a spatial form charged with references to an intimacy ⁽²⁵⁾.

Taking the question to the phenomenon of falling in love and marriage, we can ask ourselves: Whom did my wife fall in love with? With a body of one meter ninety, blond hair and blue eyes? Evidently not. However, she also fell in love with my body; it is a constituent part of myself.

4.2. Unity in sexuality; beyond genitality

Human sexuality is a dimension of all that embodied spirit, of that indissoluble union of soul and body. It is therefore an integral, complex dimension, with a biological or physical component, united to the affective or spiritual component. Therefore, we have insisted so much on the unity of body and soul, and on our relationship with a specifically human body.

The conjugal relationship itself is a specifically human reality, which goes beyond the mere biological relationship. Philosophical anthropology outlines some intuitions that show this specificity: 1. The incongruence of the male and female excitation curves. 2. The absence of periods of estrus. 3. The difference between arousal and emotion (25).

The phenomenon of caresses also shows us that sexuality is not mere genitality. It is not a simple touching, as I can touch a table or the keys of a computer. It is a touch with a meaning, an affectivity. However, it is still something physical; I touch the other person in his or her body.

4.3. Marital unity

The anthropological subject of fertility or infertility is not the isolated man, nor only the woman; it is the man-woman union, marriage. “For this reason a man shall leave his father and mother and be joined to his wife, and the two shall become one flesh”, we read in the book of Genesis (2:24). Beyond the religious content of this statement, we find a reality that we experience daily in our lives. In marriage, what happens to one spouse also affects the other.

Many married couples, when they tell their friends that they are expecting a child, say the phrase “We are pregnant”. Are they really? Strictly speaking, it is the wife who is pregnant, not the husband. However, it is a reflection, almost natural, of that marital unity.

5.1. The good of the child

It is legitimate and fully understandable that a married couple wishes to have offspring. Children are always seen as a good, and in this perspective, Naprotechnology is helping many couples to make this desire a reality. In addition, this with full respect for the dignity of every human being, in the respect for life and in the way it is engendered.

5.2. The good of physical health

An important goal for this science is the physical health of both the woman and the man. As we said earlier, infertility is not a disease but a symptom, a warning that, quite probably, some physical, bodily element is not functioning properly.

In medical, nursing and pharmacy schools, there is a strong emphasis on preventive medicine, and the result of this orientation are numerous public health campaigns. Why not also apply it to sexual health, to true sexual health, beyond the ideological use that is often made of this term?

5.3. The good of marital health

Difficulties unite us in a special way with those with whom we have shared them. In addition, infertility/sterility problems affect in a special way the relationships between spouses, straining or strengthening them. Naprotechnology, by its very respectful and constructive dimension of marriage, helps to face this situation as an issue that affects both spouses, and in which both walk together.

5.4 The spiritual good of man

Man, in his inner self, recognizes when he has acted well and when he has not. He has a conscience that gives him a practical judgment about his actions. In addition, he knows when he has acted respecting his nature as an incarnated spirit, and when he has allowed the physical, bodily part to dominate the transcendent, spiritual part. We understand as human health that which derives from this specificity of man and his nature. Naprotechnology, by respecting the human laws that we discover in his nature, leaves in his conscience the satisfaction of having done things well.

5.5. Ethics put into practice

The good is not a pure entity of reason, the destination of our intellectual contemplation. The good is that which attracts the will and impels it to act. Therefore, this ethical analysis must lead to concrete realities, either to facilitate the diagnoses offered by Naprotechnology, or in the realization of the treatments indicated for such diagnoses.