All Napro Doctors are NOT Alike-slightly Updated

I struggled thinking about this post.  I want a happy ending.  Then I decided that maybe this post would launch discussion and that your comments would help complete the picture.  I am genuinely interested in your thoughts.

I often recommend that folks chart using the CrMS and take advantage of Naprotechnology.  I believe in the methods with all my heart-for those who are Catholic and those who aren't.  For those who struggle with IF and those that don't.  I put my stamp of approval on it.  Some people have asked my opinion and respected it enough to learn to chart and seek out a medical consultant.  On some level I am so happy about this.  But at some extent, I cringe because for those that really could benefit most from it, my advice often leads them to the same place.  Omaha.  And sometimes Omaha, though the best possible option, isn't an option at all.  It can be expensive, obviously, if the insurance coverage isn't there.  It can be time consuming if you have to be there for 2 weeks like I was (usually worst case scenario, just waiting and waiting for you to ovulate).  Some people simply can't take off work or don't have the money.  I know this.  And it makes my heart ache.

Now, I firmly believe with all my heart that even if one was to pay cash to see Dr. Hilgers, it would be worth it.  He saves time.  Lots of it.  And by being so quick, he often saves money (a big chunk spent now or a little here and there for a very long time).  But that is easy for me to say-afterall, my insurance covered him (miraculously)-both the one before I was married and the one I have now.  Some very good and discerning Catholic friends have drawn lines about how far they will go to treat their IF.  They will not basically mortgage their home, etc.  I respect that.  We all have to have boundaries or IF would lead us all off the deep end, financially and emotionally. 

So is it wrong that I suggest Napro and CrMS to these folks?  I have justified it saying it is always best to give them all the information so they can decide for themselves what is best.  It isn't for me to decide, but if I know something that might help, I have the responsibility to share it.  But I have seen, in some cases, my suggestion lead to heartache.  And that hurts me too. 

What I want is for Dr. Hilgers' network of doctors to be just that.  I want for folks to have someone nearer to them, more accessible financially and physically, that they can count on to deliver Dr. Hilgers' tried and true methods.  But I am increasingly discouraged at what is being delivered.  What I can't help but describe as Dr. Hilgers LITE (this is relatively limited experience, granted; I live in an area with 3 Napro docs that are all primary care physicians-none have received hard core training; I have listened to other's experiences as well online, through emails and discussion boards).  When I see folks given large (greater than 50 mg) doses of Clomid right off the bat or otherwise hyperstimulated.  When I see folks given progesterone that isn't progesterone in oil.  When I see folks getting blood drawn and run at local labs instead of shipped to Omaha.  When I see pregnant girls being told their placenta will take over production of the progesterone after 12-14 weeks and thus taken off their supplements without data.    I GET FRUSTRATED!   And I know I have read TCIE get frustrated about the Tamox situation which I don't know enough to comment on . 

I know Dr. Hilgers must get frustrated too.  I say this because I have friends who have had laps and ultrasound series done locally with someone who said trained in Napro.  These show no problems, yet these girls try for years to become pregnant unsuccessfully.  Finally, they send their charts in to Dr. Hilgers and what does he recommend?   An ultrasound series, a hormone series, a lab-with him in Omaha.  Clearly he thinks the way he does things is different.  And that is where you receive the benefit.  He does everything the best and he does it all at once-"one stop shopping" I consistently say.  But what about the folks that don't want to go Omaha?  Can't?  I struggle with this.

Systems change is a big part of my field.  We do trainer of trainers and try to spread "our methods" to others.  I must tell you, it often fails.  It is watered down.  Folks don't have the resources to devote to receive the training we have and to implement it with the same fidelity.  It seems so many things have to be aligned just so.  And so it fails.  It is a hard field to be in, certainly not for the faint of heart.  More like the eternal optimist.

I know that Dr. Hilgers doesn't desire to have the monopoly on IF treatment.  He is not at all that type of man.  He wants others to learn from him, to carry it out.  His actions have shown that.  After all he isn't going to live forever.  It seems the only person he can truly vouch for is Dr. Keefe in his office.  I imagine the amount of time and money that would go into the oversight to ensure that this network of professionals are truly carrying out his methods in the purest fashion would be too great.  He is only one man, after all.  But there is some responsibility.  They are respresenting his brainchild when they use the name Napro medical consultant.

I have an email out to Fertility Care regarding their medical consultants list on the website.  It has questions such as, why don't Dr. Stegman and others of that calebar share a special distinction that is noted on the site.  And what does it take to get the current distinction?  And to keep it?  I noticed one of the doctors locally that I have criticized in the past has been removed from the site.  I want to know why.  And why my current doctor (primary care) is not on there.  If they are not current, Fertility Care practioners should at least receive an email updating them to who has been removed and why in their area.  That seems like a simple step that may help?

I am not writing this post to attack any Napro medical consultant in particular and my experience is a mix of local and national.  I am not trying to make anyone feel bad or put anyone on the defensive.  My goal is to use our experience to educate each other.  I want everyone to be able to discern for themselves if they are getting care in a manner that Dr. Hilgers would give, if that is what they want.  If they are getting different, they should know about it.  I mean, even "local" medical consultants can be a good distance away.  And like me, maybe you are globally recommending something where all Napro medical consultants are not alike.  And then we are putting our name behind something.  I think I can answer some questions pretty well about "would Dr. Hilgers do this?" related to the experiences I have had, but there are also a lot of new things going on that are outside of my experience.  Certainly with all our experiences combined we can answer this with some certainty though?   And help each other discern?

Thank you for reading a post that is very close to my heart. It is only one person's perspective and therefore incomplete until you respond.  I want to hear from you.  I want to know your thoughts and reactions.  I want to know if you know if you are getting Dr. Hilgers lite or not.  Or would you know if you are?  I want to know about your bad experiences and with who so other's don't experience the same.  I want to know who are the big names in Napro and where they are located.  How did you learn of them?  They don't seem to be listed on the site any differently.  Does anyone know what criteria it takes to get on the list?  Is there monitoring to stay on the list (I have an email out to find this out from the source).  Do you agree with my list of criticisms?  Or do you think it is okay if doctor's who are Napro do these things?  Maybe they don't matter?  Maybe you don't want your blood sent out?  Do you want to add anything that isn't Napro or is Napro lite?

Part of my goal with this blog is to share my experience-how I was able to VERY quickly and inexpensively find out the problem and treat it successfully by going directly to Dr. Hilgers.  (And my case was not easy, not at all open and shut).  I want to document my effective experience so if you are not getting similarly quick and effective care, then you question why and figure out how it can happen differently for you; you can discern if your doctor is the best doctor for you.  (And I know the answer for everyone can't be-go directly to Omaha).

Update: I am so frustrated I didn't update this earlier to include the response I received. It did explains levels of training, recognize that there is a problem, and that it is being worked on. Unfortunately, I no longer have access to that email. I apologize. If anyone asks Omaha and gets a response, please let me know and I will post it here.


Anonymous said...

I'll be really interested to see what others post! I want to know the answers to all your questions too.

I was going to a practice that I felt was like NaPro lite. They did initial monitoring, but then just prescribed clomid and a bunch of stuff without monitoring to see what was going on. Sadly, I think I would have been better off at an infertility clinic for that first portion of the testing/experimentation. I blogged about it here: http://inallthingsgood.wordpress.com/2009/11/24/at-a-crossroads-and-at-my-wits-end/

I have an appointment with Dr. Stegman next month. From what I have heard from others, it seems like he is the real deal, more like Dr Hilgers. But I don't know if that is what most people think???? He is under my husband's insurance, and I can drive to his office in a few hours, rather than the flight to Omaha.

WheelbarrowRider said...

Thank you for your comment, and I read your blog post as well. I have heard WONDERFUL things about Dr. Stegman from some pretty knowledgable folks-he is definitely top tier and some even think better than Hilgers! He is definitely thought of highly. I think a few hr drive and insurance coverage makes this a hands down winner for you. For me, that is how Dr. Hilgers was-insurance covered and short drive. But for others not as fortunate...

Sew said...

Yes, I hear Dr. Stegman is basically Dr. H. :) Did we post at the same time, because I just wailed at how I can't get my p7 blood results without a doctor to sign off on them first. They close in 1/2 hour! Yippee....

I am not okay with shipping my blood. I have no desire to even touch that with a stick. :)

Sew said...

I did have a doctor that was close to me that wanted to send my labwork to Omaha and I rejected. It was too expensive and insurance would not pay anything. So as good as he was, I continued to no longer work with him because it was too cumbersome of a process for me.

So I drove 4 hours away to someone who would draw my labs at the local lab and read them etc...

So I don't have to have the Napro Regular, Napro Light is fine by me. :) hahaha

But I get the napro regular on the blogs! :) hahaha I'm not a case that needs napro regular, I don't think at least..... I could be VERY wrong. :)

Anonymous said...

Dr. Hilgers thought of the need to provide distinction between doctors who have done training and those who adhere to a more strict form of practice and continuing education.

So ask your doctor if after becoming a medical consultant they pursued accreditation with the AAFCP. If not, why?

Its true not all doctors are alike..which those suffering with infertility find out often over long journeys.

I am a medical consultant in Phoenix, AZ pursuing AAFCP certification.

Second Chances said...

This is interesting and something I haven't thought much of since I was able to go directly to Dr. Hilgers. Our insurance coverage was amazing and we know we were very blessed to be able to do this. But he does have me on Clomid days 5-9. I'm wondering now what the usual protocol is?

Also, I think we have to keep in mind that nothing is perfect, and while Dr. Hilgers may have trained many many doctors, they are still free to make their own decisions for their patients. This could probably sometimes be good but mostly be bad.

Let's keep spreading the NaPro word because even though it's flawed it's sometimes the only alternative to immoral treatment. And those who are disappointed by it should still be encouraged that they are not seeking illicit means.

WheelbarrowRider said...

I am so thrilled for the thoughtful comments you all have posted! Anonymous, I am fascinated to know that there is medical consultants and then there are those accredited. It seems the website only denotes those that are medical consultants and thus they would appear the same?! Good for you for pursuing certification and thank you for reading my blog!
TCIE, You are probably right about the CD 21 draw, I think I got overexcited and shouldn't have included that one. I believe that was a friend doing a mix of both and that came from a reg ob despite her showing the charts. I didn't mean to exagerate-especially because that takes away from the fact that there are real errors occuring. Sorry to muddy the waters. I agree that I have heard glowing reports about Dr. Stegman. What is his distinction? Why isn't he 4 star on the website?! Maybe I am asking too much of the website. ? I love your list of the A list docs-you are the best for posting this! I am wondering where they are located. When I was there a doc from St. Louis observed my u/s series. He was so interested. I wonder if anything became of it-did he make the A-list lol? Does anyone know a name for this man? TCIE, I am also wondering about the distinction you list. On the website you get 2 choices-fertilitycare practitioners and medical consultants. That is it. Sew, I totally respect your desire for Hilgers lite-as long as you know that is what you are getting. I just am advocating for folks to know. Then it is totally their call. But I think that when people get lite expecting full strength, then it makes Napro look inconsistent at best and ineffective at worst to those trying to decide if it is worth it to spend their resources of time and money. Everything shouldn't have to be so difficult to determine! Can I get an AMEN? lol I am the biggest Napro/Hilgers advocate on the planet and that is why the muddied waters frustrate me so. I think my old ob/gyn was fired from the site. lol Maybe that is why he isn't there. I was recommended via email to find out if the Napro doc you see is active in the AAFCP and/or presenting at the conferences. My guy wasn't even attending the conferences. Boo. I vote for a 5 star rating system next to each ones name (initial training complete, updated training, active in AAFCP, present at conferences, Dr. Hilgers in training).

WheelbarrowRider said...

Second chances, you are so right-it is way better than immoral means and it is even way better than other moral means (other forms of NFP) when in comes to treating IF, in my humble opinion. I def do not plan on "throwing the baby out with the bathwater." I am clearly pro Napro, regardless.
I seem to have been incorrect on the clomid thing per TCIE. She is super knowledable, so I should apologize for scaring anyone that is on CD 5-9.
TCIE or anyone else that may know (anonymous, are you still there?), can you explain why a doc might do these days instead of others? It seems all reg ob/gyn do those days. I was told Dr. H does 3,4,5 and longer (more days) if that isn't working but not more (than 50mg). I was told that by his nurses, but I guess that didn't mean that he doesn't sometimes use other days. Can you enlighten us as to why it might vary? I apologize for this mistake and I really do welcome the correction. I am learning a ton, as I hope the others following are as well.

Anonymous said...

Please note that a doctor who is a member of the AAFCP uses the term CFCMC (certified fertility care medical consultant)

If a medical consultant after training but not member of AAFCP can be called CNFPMC(certified natural family planning medical consultant

Also note that doctors like myself with young children may not always be able to attend the conferences away from home. Thus we can listen to all lectures recorded on CD.

Why clomid on CD 5-9 versus 3-7? This is a good question. I need to ask Dr. Hilgers this one, but heres my stab at it. Often times a "high dose" clomid program is reserved for women with PCOD. The starting dose is 50mg and is started day 5 instead of 3(If clomid is started earlier in the cycle this leads to more rapid follicular growth. Women who have PCOD already have many follicles in development, so the clomid serves more to stimulate ovulation for release of the egg. It should be noted that while ovulatory rates for women on high dose clomid are high, pregnancy rates are not. Ultimately Dr. Hilgers feels surgical wedge resection results in best pregnancy rates by making ovaries more receptive to clomid.

Leila said...

I know Doctor anonymous (she is a friend of mine, and our kids go to school together), and she is wonderful!!!!!!!!! I hope she will be a regular contributor!!! :-) God bless you! You are a gift to so many!

Mrs. Mike said...

Interesting topic and one I agree with wholeheartedly. Nothing much to add except possibly to add Dr. Michael Parker in Columbus, OH to the list. Don't see anywhere that he is AAFCP or CFCMC but he is a truly gifted surgeon and Ob/Gyn and faithful to NaPro protocol as far as I experienced.

prayerfuljourney said...
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Chasing said...

Wow, really interesting discussion. Thanks Dr Anonymous for the clarification. Although I don't know a whole lot about the NaPro training program, it's probably worth mentioning that there the docs that provide surgical intervention go through a post-residency fellowship (specialization) in Omaha. I think the fellowship lasts a year (correct me if I'm wrong). I'm a patient of Dr. K's (long distance).

mrsblondies said...

Thanks so much for posting this. Napro definitely needs to be more widely know and we need to be able to recommend the top of the line doctors (or at least let people know so they can make the decision) for those who can't go to Omaha.

I'm a long distance patient of Dr. Hilgers, and there aren't any Napro doctors closer than 4-6 hours away, so I've never seen any other NAPRO doctor. I was very lucky to have Dr. Hilgers and Creighton Hospital both in-network on my insurance and all my bloodwork covered at 100%. One thing that I'm haven't been able to do is the ultrasound series and I really wish that I could get that done locally since the timing on getting the series done did work out for Omaha since my cycles have some irregularity.


Hmmm... I was in Omaha last week and one of Dr. Hilgers' nurses asked an interesting question. She wondered if people were blogging about NaProTechnology. I think I'll send her a link to this post. :)

Thank you, WheelbarrowRider. Your post has not only encouraged me as I approach surgery in March (reminding me of how blessed I am to be a patient of Dr. Hilgers), but has also encouraged me to get the word out about REAL NaProTechnology.

As for other NAPRO doctors, I guess there is little I can bring to the discussion. My first NAPRO doctor is still my guiding light. She is the one who led me to Dr. Hilgers and, hopefully, she will be the one (God willing) who delivers our baby! :)

Rebecca said...

I have been deeply disappointed in my experience with NaPro doctors. I found them through the fertility care website for my city. My mom had very severe endometriosis and was told that there was “no hope” that she would ever conceive. I have been having symptoms of endo since my early 20’s and after my husband and I had been ttc for three months I went to see a doctor from the fertility care website. I presented with a family history and every single symptom and instead of scheduling a surgical consult, she referred to start NaPro charting without any further medical intervention. My husband and I practiced NFP for two years so it’s not like I had no clue when I ovulated. We had to start all over, while my symptoms got worse and my chances of conception were no better. I went back to her after four months of charting and “fertility focused intercourse” and she patted me on the leg and told me that she was sure I would be pregnant in three months. Of course I wasn’t. My Napro consultant was no better. The best she could do was recommend a B6 vitamin.
After a year of this bullshit I went to the only other doctor listed on the website and she immediately sent me for a surgical consult. My laparoscopy converted to a laparotomy because my endo was so severe. One of my ovaries was the size of an orange and it had fallen behind my uterus and fused to my large intestine. Now I don’t know what to do. My NaPro consultant is obviously worthless and the obgyn who performed the surgery doesn’t really practice NaPro or claim to and I have basically lost all faith in this alleged “magic” of Napro Technology. If I’m not pregnant in six months I will have some very hard decisions to make.

WheelbarrowRider said...

Alive in Hope, I am so happy it helped you appreciate the real deal. It really is a blessing you have access to Dr. H!
I am so incredibly sorry for your experience! I was also told I didn't have endo b/c I could say I had pain during sex (idiot!). I wasn't having sex for goodness sakes! If you can believe it, when I did (premarital) I ran happily to the ob without stopping to tell him and immediate got in for surgery. My sister also has endo, huge red flag, so the doc was an idiot for overlooking that and my symptoms. Good for you to push through the BS and get treatment! I must tell you, there absolutely IS magic to Napro, but as I mentioned all docs are not the same! The charting is helpful, but in your case you think you could have done it simultaneously to getting some help! Please don't give up. Keep charting, keep ttc and see if any of the top dogs listed here are close enough and covered. If not, start throwing out napro docs that are and we will see what people know of them. That is what we are here for-to help you sort through the BS faster!

WheelbarrowRider said...
This comment has been removed by the author.
Percolating Petals said...

I see a wonderful NaPro general physician who specializes in infertility and PCOS. Thus far, I've been pleased with the treatment, except for Femara's huge price tag. It feels like a useless drug. Most of the drugs recommended by the doc have not been covered by insurance. At least he has gone the medical approach instead of pushing surgery right off the bat. I credit him for finding out that my hormone levels were VERY low; most likely my idiot OB/GYN would have never figured that out. I also appreciate that my cycles are less painful than before.

That said, should my doctor ever recommend that I go to the Paul VI center, my husband and I would decline. We have gone to this NaPro doc for over a year. Although my cycle is better, no pregnancy has resulted. I would rather direct my energy towards adoption, where we would have a better chance of becoming parents. Plenty of women have gone to the Paul VI center for treatment and still never conceive. I just don't think I can take any more medical letdowns. Maybe it's the cynic in me.

Second Chances said...

Just wanted to throw this out there: MANY MANY MANY women have conceived successfully by going to the Pope Paul VI Institute. Although many don't, many do! This is why they are so successful. I just didn't want that to be overlooked.

Percolating Petals: maybe you would benefit from surgery to see if you have endo? Although the drug route is good, it usually follows surgery. I'm surprised they haven't recommended that?

Maria Therese said...

I have suffered from endometriosis stage four for many, many years. When I was single years ago and complained to my primary physician back then about my painful periods, she replied "Take Three Aleve!" She did pick up on the fact that I had an ovarian cyst on my ovary, which showed up on a CAT scan when I had kidney stones. She told me we would keep watching it, sent me for ultrasounds, and eventually to a GYN/OB to see if I needed surgery. Three times I visited the GYN/OB, she gave me the scary CAT-125 test, and internal exams. But never did she suspect I had endometrios or mention I needed surgery. When I asked her if she thought I might need surgery, she told me "No. We will keep watching the cyst." My last appointment with her was canceled. I never went back. This happened in 2004-2005 when I was still single and around thirty eight years old.

I wasn't diagnosed with the endometriosis until eight months after marriage. After getting married and moving to a new city, I had to find a new primary physician. When I had my first annual physical with her, I mentioned the ovarian cyst. I wasn't sure if it was still there or not. She sent me to a GYN/OB, I had ultrasounds done, and sure enough the cyst was still there! My first surgery was scheduled. On Feb. 12, 2008 my surgeon came to my hospital bedside and told me I had endometriosis stage four and might be infertile.

On my post operative visit, this surgeon told me he recommended birth control to treat endometriosis and wanted to give me a referral to see a fertility specialist in nearby RI who did IVF. Hubby and I were against using birth control to treat the endometriosis and IVF. We knew there had to be a better way.

I did a search online at the Pope Paul Institute and found a Napro doctor two hours away from me. During my first visit in August he was very kind and answered all my questions. He recommended diet, exercise, taking supplements, and prescribed Naltrexone. This wonderful Napro doctor even took the time to look over my typed out list of questions and write out answers to each question! I couldn't believe it!

We do the whole charting thing. I tried the whole diet and exercise thing. But months passed and I still wasn't getting pregnant. It was very discouraging and frustrating! Still my Napro doctor encouraged me to keep trying.

I had a second surgery in April 2009 with a surgeon that this Napro doctor recommended. This time they not only found endo on my ovaries, endometriomas (how fast do these things grow back??), endo in my bowels, and a fibroid in my uterus. But right after that surgery I started skipping periods. Since then I've skipped periods three times and had to take progesterone suppositories to bring on the period.

During my last visit with my Napro doctor I told him about my period skipping and he prescribed femara. I have taken in two cycles so far. I am not sure it is doing anything. The Napro doctor and I both came to the same conclusion that I don't seem to be ovulating anymore. He wonders if I might have PCOS. I am not sure.

My next visit with the Napro doctor is in March. I am wondering if he can help me anymore with the not ovulating and not getting my period thing? Or maybe hubby and I should plan a trip to the Pope Paul Institute and see if Dr. H can offer some insight what happened to my period and can recommend anything. The problem is, it probably won't be covered by insurance and right now we don't have any extra $$$.

So what to do?? Ladies, how much do you think being able to ovulate and have periods have to do with your diet? A lot? Have any of you ever had similiar problems of skipping periods and not ovulating? What seemed to help you? If you have a chance, I'd love to hear from any of you! Thank you so much!

May God Bless us all!

WheelbarrowRider said...

dang it! I want to send you straight to one of the Napro big guns! Why can't I win the lottery?! Does Dr. H support others doing laporotomies besides himself?! I believe he never would have made you wait! He never mentioned diet to me and though others have found it helpful, I am a big believer in surgery myself. I wonder also if you have PCOD because of the skipping periods... Ovarian wedge could prob only be done by Dr. H? Or do others do this? Please please please check your insurance to see if anyone mentioned on this post (comments) by name is on your insurance. What part of the country are you in? I have one idea-send your charts and a letter to Dr. H. He will review your info and records for under $100. Tell him in your letter he isn't on your insurance and ask him for a recommendation that is closer and that is. He will tell you what his initial thoughts are. Normally he says to come to Omaha, but maybe if you put out there right away it isn't an option...? I am thinking the benefits of doing so would outweight the cost. Ladies/dr. anonymous, please HELP our dear friend, Maria, with suggestions! Hugs and prayers to you!

Maria Therese said...

Thank you so much for the hugs and prayers! I am in Massachusetts. By the way, what is PCOD? Poly Cystic Ovary D? My first surgery was done by a secular OB/GYN and it was a laporotomy. The second surgeon I was referred to by the Napro doctor and it was the belly button surgery.

Another peculiar thing happened to me. I was wondering, has anybody with endometriosis ever had this happen to them? In October I experienced an ache near my left ovary and I had spotting (brown and a little bit of red) for three days. After that happened it seemed I stopped ovulating and getting the period!

Has anybody had surgery for endometriosis and had their periods start skipping? And stop ovulating? I also have to mention I am forty three. But my hormones were checked by the Napro doctor (day 3 estrogen/fsh) and he said that the hormones showed I am not near menopause.

Sorry for going on about this, but I am feeling discouraged, frustrated, and looking for some answers!! Thank you so much for any help, advice, prayers you can give me! Anybody is welcome to email me at:

Thank you so much! I really appreciate this!

P.S. One thing I have started to do is try to decrease my consumption of sugar. I quit drinking pepsi and now drink water with lemon. I've also started exercising. It's too soon to tell if any of this is going to help!!

Anonymous said...

Hello Folks,

First, I would like to reclaim respect for "idiot" OB/GYN's. Many of them are doing what they were trained to do. They don't know the difference. We need to pray for them and invite them to learn more about women's health.

That said, It is important to be an advocate for your health care and move on as necessary.

I think it needs to be said that infertility is a very difficult problem. One that even the institute has only begun to understand. There is much work and research that needs to be done in this area.

Endometriosis is one of these areas that is being studied but still not completely understood. It is a challenging disease for both patient and doctor.

For Maria, I'm not sure if she is charting CrMS, this certainly would aid one in understanding the bleeding episodes and is the basis of naprotechnology. Were the charts used to come to the conclusion that she is not ovulating? Can do hormonal blood testing along with follicular ultrasound.

PCOD is a diagnosis that is made using multiple guidelines. A reversal of the fsh/lh ratio, usually long(greater than 38 days) and irregular cycle. Also an elevation in testosterone or DHEA. May have insulin resistance. Also the ovaries have a very distinct appearance surgically. Along with infertility this is how one can come to the conclusion they have PCOD.

At 45, a complete infertility evaluation is not recommended for the goal of achieving pregnancy, simply because the chance of pregnancy at this age is so low. Can pursue a workup for health and peace.
Certainly, age 43 reduces ones chances. This requires discernment about how best to proceed.
If medical, would go with the institute to save time and delay in diagnosis and treatment.
Also, assuming semen analysis has been done?

God Bless you all. God can work through these doctors if that is what He wants you do to. He is the ultimate family builder. Some are called to build family through adoption.

WheelbarrowRider said...

Maria Therese, you are correct in thinking that PCOD is another way to refer to polycystic ovaries. Dr. Anonymous, you are absolutely correct and praying for these doctors is a much more appropriate response than calling them idiots. Sometimes my emotions get the best of me...and adoption is certainly an amazing way to grow your family is that is how one is called. There are many beautiful adoption stories among these blogs.

K and T said...

I have never heard of this type of treatment before reading your blog... I actually have a lot of back reading to do b/c it's all totally over my head.... I didn't know there were other options.... I did IUI and IVF... I did shots and ultrasounds and blood work.....
I will no longer "try"..... we are not NOT trying.... we just have our hands full at this point....
I think it is GREAT that you are blogging about more options that are available.
This is your blog, your space, and your passion.
Keep on keeping on. :)

Leila said...

K and T,
NaPro is one of the best kept secrets out there! I hope you refer any of your IF friends to these types of blogs.... We need to get the word out. There was a nice news story on the NaPro approach that you can see here:


Maria Therese said...

I just wanted to add please that yes, we are charting with the Creighton Method. We have been charting this method since Dec. 2007. We were married in June 2007.

Also I wanted to add that I've always had painful, heavy periods. I've always been regular too, never late. My periods used to come every 26-28 days, mostly on day 27. I believe I used to ovulate on a regular basis too - I would always feel that pinch, the pain on the side I was ovulating on and it would last for days. It has only been since April when I had my last surgery that I've started skipping periods and not ovulating on a regular basis anymore.

No, my husband never has had semen analysis due to the costs. I suspect I'm the one with the problem though. I feel like I'm the most barren women on earth.

The three times I have skipped a period I've waited awhile and then taken progesterone suppositories for ten days. A few days later the period would arrive. But isn't this making my body dependant on the progesterone to bring on the period??

I love my Napro doctor and have no complaints about him, he's the best! But I am not sure what we can do anymore about bringing my cycle back naturally, helping me to ovulate naturally, and increase the chances of me being able to get pregnant. My heart and arms ache so much for a baby so having these diminishing fertile signs is really breaking my heart!!

the misfit said...

I wouldn't blame yourself for recommending a doctor in Omaha to friends who can't go - they are adults and can decide whether the trip and the expense are worth it. (For me they are not and never will be, and I have never had any trouble telling people so, and he has been recommended to me by probably dozens.) There is an obvious variance in treatments between the Catholic doctors. That may mean that some patients are getting substandard treatment.

But I think we need to be careful about putting any doctor (Catholic or not) on too high a pedestal. Dr. H has made great strides in treating infertility, but his treatment is far from perfect (just ask the bloggers he's treated who haven't gotten pregnant after several YEARS). The Catholic doctors who don't use his methods precisely have success rates of their own. He may prefer PIO, but I know of at least one blogger who kept her baby after several miscarriages with just progesterone suppositories (and honestly, I had never before heard that those were supposed to be ineffective). Some people request high-dose clomid after being on lower doses of other things, and it not working. Or, they just want to make the best try to begin with, and don't mind the "risk" (ha!) of multiples. I understand that all of his methods are reasoned and he works very hard, but other doctors have reasons too, and the other guy isn't necessarily wrong in any disagreement with Hilgers. Actually, one of my chief objections to his practice (apart from its location) is that it's held up by Catholics as the magic bullet to infertility. It isn't, and he's only a man. Some of the things he does are goofy and he's just tinkering. His patients have complaints like everybody else's patients. He's thorough, but I'm sure he makes mistakes. And not being a doctor, I think my best posture is a healthy skepticism - try anything reasonable, but don't put FAITH regarding infertility in any human being. Making rational decisions, sure, but "Dr. Hilgers says" has always struck me as a worrisome argument regarding infertility treatment.

Percolating Petals said...

Just to clarify: My OB/GYN belittled our decisions and was very antagonistic towards my husband and me. He didn't even make strides towards grudging respect.

Yes, surgery is a possibility. However, my insurance considers my NaPro doctor out-of-network and covers nothing. So if a surgery is recommended, I will have to make a heart-wrenching decision between an expensive surgery with no guarantee...or our savings for international adoption.

I am very happy for the women who have found hope and conceived thanks to PPVI center. I have just met more women who had unsuccessful trips.

Sew said...

Wait. You sent your blog to omaha.

Gosh, I use my blog just to rant about IF to my girlfriends and hormonal rages to complain when I don't get my way...hahahah

I hope my blog doesn't get in the hands of my dr.

Girl, it's our own secret world out here....I hope we aren't exposed.... :)

WheelbarrowRider said...

Misfit, I always appreciate anyone who respectfully disagrees (and to clarify, I actually agree with a lot of your points). Dr. Hilgers is only a man, but I do believe he is a man that is doing God's work. And definitely he is tinkering in some aspects due to his the fact that he is a researcher-he is always looking for new things and some produce results and others don't. But most things he does are tried and true. No, they don't work for 100%, but they do work for a huge majority that go there and he has ideas for why it doesn't (i.e some need to see Dr. Toth as well, etc). Thanks for your great post.
Sew, I know I emailed you, but for the benefit of others here let me first apologize and second clarify. (I am not as good as St. Therese who would just let it be!) I am so sorry if my actions hurt others in anyway. I never meant to expose anyone that meant to be private. I emailed the fertility care site asking for clarification on their medical consultant system. I don't know why I felt the need to explain why I was asking and rather than repeat my post I linked to it. I didn't dream she'd reply that she sent the email to Dr. H for his reply, hence yes he may be reading this post on my blog. I should have thought about the consequences of this; obviously there are good points and bad. For anyone who wants me to remove them from my blog roll or delete their comments on this post and/or others, simply email me. I hope you will still follow mine anonymously and comment. I am so sorry if this frustrates any of you. I was speaking to a nurse during my cycle review (as someone already mentioned, those in the office have been told that there is blogging going on about Napro etc. That wasn't from me. I imagine someone told them that is how they found their office). Anyway, I shared with that nurse my blog as she was very interested. Again, I should have thought of how that affects others and I apologize. I think that ideally Dr. Hilgers himself (or office staff) will have their own blog linked to their new website and those that want to comment and ask questions can come to him. I don't know, but that may be the best of both worlds? I think I am going to remove my blog roll to the right regardless.

Anonymous said...

You're right, there is a lot of "NaPro Lite" out there, and it does not taste just like NaPro Regular ;) BUT a big distinction should be made between the Drs who have NO NAPRO or CrMS training and are just NFP Drs and those who actually received the training. It's the non-trained ones that are handing out the Tamoxifen like it's candy.

Clomid has a bunch of different protocols, though, so I'm not sure I agree that prescribing it CDs 5-9 or over 50 mgs is necessarily a bad thing. (Many protocols are for 25 mgs days 3-5, for example, but that it specific to the person's situation.) I was anovulatory before Clomid - and I ovulated 1 egg on 50 mgs for 8 consecutive cycles. On the 8th, though, I ovulated on CD 43. So it was losing its effect. I then moved to 100 mgs.
Starting someone out on 100mgs is probably a little overzealous, but taking it days 5-9 is not a huge issue.

As for the labwork, there is merit to sending it into Omaha in certain situations, particularly if local labs reveal "borderline" results. But I don't personally think it's necessary for everyone.

This is a good post. I don't think you should stop recommending NaPro in general... but maybe HIGHLY recommend certain Drs over others ;)

Anonymous said...

Amen to the wedge resection!!! I am the BIGGEST fan of that :) Dr Stegman did mine, and despite the fact that I feel like I constantly have to DEFEND him and his surgical techniques to Drs outside of NaPro (they all think both he and I are crazy for doing this surgery that they've never even SEEN performed during their career!), I always tell EVERYONE that it was by far the best treatment I have had TO DATE.

Anything that could get MY ovaries ovulating ON THEIR OWN without meds... on CD 14, and only a FEW DAYS after surgery??? It's a miracle procedure!

I want to warn against is a specific group - I don't want to mention them by name, because that's not really professional, but many of the blogger girls go there or have gone there - they are NOT NaPro, yet they do "read" the charts and base their treatments off of the charts. But without Dr Hilgers' training, they don't even qualify as NaPro Lite. They are NOT NAPRO. Period.

And the explanation I was given about the difference between Clomid 5-9 and 3-7 was the same thing Anonymous (Dr) said above.

Thank you for joining in our discussion, Dr! And thank you even more for becoming a Medical Consultant of NaPro Technology! God Bless you!

Anonymous said...

Just a quick plug for Creighton charting, specifically for Rebecca:
I'm truly sorry for the frustration you experienced in your medical treatment with NaPro. But to clarify, Creighton is not to identify when you ovulate. It is much, much more than that. My NaPro Dr calls it the "MRI" for fertility. They (Drs) can read many, many things from the chart, including risk for endometriosis - which it sounds like your 1st Dr didn't see right off the bat. But expecting to get proper NaPro treatment immediately without them having any of your Creighton charts to go from, is like asking a Dr how many follicles you have without having an ultrasound.
Having the experience with NFP is awesome, and probably gave you a huge leg up when you started charting Creighton. But it is different, and specific - these Drs were trained in how to read the Creighton charts. I hope that makes you feel a bit better. I know new IF patients who call for an initial consult with my Dr are usually put-off by that "2 cycle" charting requirement, but it is truly helpful for them to treat you most efficiently.

Chasing said...

My two cents- I've been having good hormone results since Femara, so I'm pleased.

With respect to the pros and cons of PPVI, besides the fidelity to church teaching I am also pleased with their medical approach. As someone who works in health care, I appreciate the commitment to research over there. They've done a lot of research just to formulate the charting approach. As with some of the other "experimental" treatments (e.g., T3, etc.), they are trying these approaches in a research scenario. There may not be a lot of research out there on these approaches, but they are adding to the research body. Research is critical to quality, effective and appropriate health care. A huge problem in health care is the "I feel" statement. Medical treatment (and health care in general) needs to be based on research, otherwise someone could decide that the only appropriate treatment for reflux (for example) is cold showers and go into the doctors office and demand that that's the only way to treat it instead of Rx and diet changes. The fact that PPVI addresses "newer" or "different" treatments in a research setting, will help in the long run because it will identify whether or not said treatments are efficacious. Medicine, in general, can't fix every ailment in every person. However, having a physician who is committed to peer reviewed research and best practice is one of the ways we support our health and fertility.

Sissy said...

I don't have much experience with NaPro, but I think the way you presented it was informative and interesting. I don't think anyone would be too upset by the way you write about your experiences and what you think might help. My husband and I decided that I would do anything that my own OB/GYN would prescribe except shots and then, if we didn't get pregnant, we would move on. I did about 7 or 8 rounds of Clomid in various combinations with other things, but it never took. So we moved on.

Rachel said...

Great post. I'm glad I discovered your blog today--such a great conversation!

I think that no matter what we need to keep recommending NFP--particularly CrMS and Naprotechnology--to anyone who will listen. It's frustrating that the existing medical establishment is so pro-IVF and other unethical infertility "treatments" and so ignorant of how female fertility operates. The only way to change that is to encourage these doctors in their work!

I also wanted to add to the list of 4-star Napro doctors. Perhaps the doc you saw from St. Louis was Dr. Gosser, of St. Gerard Obstetrics & Gynecology. He's my doctor, and he's awesome. He's currently in practice with a Dr. Dixon, and Dr. Stegman actually was in this practice years ago, before he moved and started out on his own. Dr. Gosser is highly regarded locally by the NFP community, and I know that he and Dr. Dixon spend a full day each week in surgery.

I'm just beginning diagnosis and treatment with him of my issues, but I know that my CrMS instructor keeps encouraging me that Dr. Gosser is the 'real thing' in Napro.

Jasmine said...

I do think that getting quality NaPro Technology is important. Granted everyone is on a different path during their IF journey, and not everyone will want to go to Omaha. I think that is for each couple to discern because going to Omaha becomes a big part of the cross of IF. Some people are called more quickly to adoption. Others need to have answers to why they are having problems conceiving. I really believe the full work-up with proper NaPro gives those answers and can be very helpful dealing with the spiritual struggle of IF since it removes the seeming randomness of the suffering.

And my experience wasn't the go to the PPVI and get fixed quick. It still took quite some time, but without the PPVI, I don't think our daughter would be here given the complexity of our IF.

Now one of my concerns is when you have NaPro Lite doctors deviating from NaPro in particular when it comes to preventing miscarriages, treating PMS, and other hormonally related health issues. I think Dr. H and his NaPro colleagues have come up with a pretty effective treatment that does require effort and cost on the patient's part, but the trade-off is huge. I understand that each doctor has to make individual judgements and is capable of their own contributions, that they don't have to be NaPro robots, but I do think a lot of patients get short-changed with NaPro lite. What about the potentially health protective benefits of balancing hormones with proper luteal phase support? Correcting improper post peak estrogen and progesterone may prevent osteoporosis, fibroids, endometriosis, diabetes, even cancer. Now a lot of us IF couples suffer from the endo, PCOS, and fibroid conditions, but leaving the hormones to run wild on their own, seems to me to be setting ourselves up for greater complications down the road. So NaPro lite in this area is a major issue with me. I think part of being pro-life is taking care of the fertility we've been given, even if the current form is that of sub-fertility or infertility. Who better than the IF couple realizes the true gift of fertility?

As a PPVI long distance patient, CrM practitioner, and IF sufferer, well anyway, that's my two cents!

B said...

Wow! I don't even know where to begin. First of all, I used to laugh at bloggers! ha. I make fun of my best friend who is all about it. However, I just happened to google Dr. Hilgers and somewhere along the way I found WheelbarrowRider. Thank the Lord for direction in our lives!!!!

My husband and I struggled to get pregnant, tried the pills, shots and even IUI. With the IUI, we got pregnant but it ended with an ectopic pregnancy in March 2010. That was a living hell, but I have really come to peace about it through the introduction of Dr. Hilgers to me. My cousin who struggled for 8 YEARS (wow!) to get pregnant, was introduced to Dr. Hilgers and she is now on baby #2! Praise the Lord! She is now one of his practitioners here in Alabama:)

My hub and I practiced NFP but this NaPro/Creighton Method is definitely more detailed and precise. My charts were sent off in early June to Dr. H and I am awaiting his letter, which should come sometime in July, I'm told.

So ladies, I'm beginning my journey! It's amazing the peace that has come across my life just sense starting this new path. I have calmed and am now trusting. Don't worry...I'm still a little impatient at times, but I'm feeling blessed to have another option besides my old path.

Thank you for all your insight. I am praying for all of you. So far I have read Mrs. Blondies blog and am on Feb of WheelbarrowRider and I can honestly say that now I am addicted to blogging! ha:) Keeping you all in my prayers:)

B :)

B said...

One more thing...I have no blog but for now you can email me at spunkybw@gmail.com Maybe I will get a blog one day.....


B:) said...

I have a blog! I set one up just for following you wonderful ladies and hopefully becoming prayer buddies. However, I have no idea how to use it, etc. So, wheelbarrowrider, I'm now following you but I got lost after that! ha I'm definitely not blog savy!

Anonymous said...

I just had the wedge resection done in Omaha by Dr. Keefe 5 weeks ago! I LOVE her! She is so AMAZING and I feel so blessed to have found her. I do live in Omaha so the decision was an easier one to make but my insurance sadly did not cover the procedure. I already see a difference and feel it was worth the expense. It fixes so much more than my inability to have children.

Anonymous said...

I am currently a patient of Dr. Stegman and he is wonderful. I am sorry to say that he will be leaving his practice and moving. He will only be doing in-hospital obstetrics in St. Louis. Those women and babies will be blessed.

kaykristo said...

Any recommendations of a great Napro doc near Michigan? Is Dr. Michael Parker from Gahanna, Ohio good? Like Dr. Hilgers?

Christian_Crunchy_Mom said...

I have nothing but wonderful things to say about Dr. Michael Parker in OH - he helped my husband and I to conceive 2 beautiful daughters. And was officiating at the natural hospital birth of DD#1. I don't have any comparison to Dr. Hilgers, but I got 300% better diagnostics, treatment and kind understanding from Dr. Parker than I did from any of the 3 prior Ob/Gyn's I had seen.

Christian_Crunchy_Mom said...

kaykristo, here is the page of NaPro medical consultants in Michigan. I don't have any personal experience with them. Perhaps you can google their names to find out what others have to say about them. You could also search nearby states to see who else would be within reasonable driving distance.


Courtney said...

I've been meaning to email you for months, but hadn't found contact info. I just wanted to let you know that through your blog, and this post specifically I found Dr. Parker. My husband and I have been married for a year a half, and started trying to have a baby in February. Seven cycles and one chemical pregnancy later we had our first appointment with Dr Parker. We are still having tests done, and waiting for results at the end of the month. However, I feel hopeful again we will have a baby by the end of 2013. After our chemical I felt all hope was lost.

Stacy Peterson said...
This comment has been removed by the author.
Katy Pilmer said...

I currently see Dr. Hilger's son in Houston and he is phenomenal.