NaProTechnology is a new approach in obstetrics and gynecology based on the Ovulation Method of Natural Family Planning (NFP). With this revolutionary new approach of understanding and treating the menstrual cycle, we have new ways of addressing problems of the menstrual cycle. One area where NaProTechnology is particularly helpful is when problems of ovulation occur.

The Conventional Approach

The conventional concept of an ovulation disorder is when there is a failure to produce an egg which can then combine with the sperm to achieve pregnancy. Why does this occur? Some women produce excessive prolactin, a hormone which is normally used to produce breast milk. High levels of prolactin prevent ovulation. This can be corrected with a drug called Parlodel which reduces the prolactin level.

Other women may be hypothyroid, meaning they produce limited amounts of thyroid hormone (an oversimplification). The brain tries to stimulate the thyroid gland with thyroid stimulating hormone, which may be elevated in hypothyroidism. Treatment with thyroid medication can correct this problem. If none of the above applies, then ovulation can be stimulated either with an estrogen antagonist (blocker) called Clomid, or with protein hormones which directly stimulate the ovary, which are called gonadotropins. Finally, if all else fails, IVF may be offered.

NaProTechnology

NaProTechnology is more comprehensive, because the goal is not only to achieve ovulation, but to achieve good ovulation. By correcting defective physiology, either medically or surgically, the artificial reproductive technologies such as IVF are not necessary. And with this new and broader approach, we are able to develop a much wider range of treatment modalities to help with more subtle difficulties in ovulation. I will bring a few of these ideas together under the title of "The Ovulation Toolbox."

The traditional drug of ovulation stimulation is Clomid. Clomid is a weak estrogen agonist (enhancer) and partial estrogen antagonist (blocker). It binds to its target site, but only acts weakly. Thus, if no estrogen is around at all, Clomid acts as an estrogen agonist since it will cause more estrogen action than none at all. On the other hand, if a large amount of estrogen is around, then Clomid acts as an estrogen antagonist since it occupies the receptor and causes only a weak response. This drug causes side effects and does not always work. Even worse, and perhaps critical, is the decrease of cervical mucus that is caused by Clomid.

Understanding the selective action of estrogen is essential, because when it doesn’t work, there are other selective estrogen receptor modulators could also be used to stimulate ovulation. Another option would be Tamoxifen. Tamoxifen is also an estrogen antagonist which is a reason why it is used to prevent breast cancer, and also stimulate ovulation like Clomid. Although Clomid can cause thinning of the endometrium, Tamoxifen may actually stimulate growth of the endometrium and there may be better mucus production.

We can also look to other situations of ovulation compromise, one such common cause occurs in women who do excessive amounts of exercise. When they do excessive amounts of exercise and lose too much weight (for example marathon runners or belly dancers) they may stop ovulating and stop having menstrual periods. A potential mechanism for this can be excessive release of corticotropin releasing hormone which is the brains response to excessive stress. This results in an increased production of natural opioids called endorphins. Endorphins cause reduced production of gonadotropin releasing hormone, which is what stimulates the ovaries, and therefore, the result is reduced ovulation. This mechanism could be blocked with a drug called Naltrexone, which is a weak opioid blocker. It can result in increased ovulation and increased cervical mucus.

The ideas presented here are just the beginning. NaProTechnology focuses attention on natural procreative techniques that cooperate with the menstrual cycle. This broadening of perspective leads new and novel mechanisms by which ovulation can be treated, only a few of which have been described. These treatments can be entered into The Ovulation Toolbox.

--Paddy Jim Baggot, M.D.