Pregnancy & NaProTECHNOLOGY

***** Do not take unless under medical supervision *****

NaPro providers offer many types of pharmacological treatments, many of which are often  inexpensive and/or able to be purchased without a prescription. Below are some examples: 

• Prenatal Vitamin If you are trying to achieve a pregnancy, you begin taking a prenatal vitamin. My preferred brand is KLAIRE Labs Prenatal & Nursing. 
• Progesterone Replacement: if you are diagnosed with low Post-Peak progesterone levels, I would typically start with 200 mg of bioidentical progesterone  which you will take at bedtime on P+3 through P+12. This will help make your endometrial lining "secretory" so that if a baby is conceived, the embryo will be nourished and grow well, and you will maintain a healthy pregnancy moving forward. See more information about bioidentical progesterone below.
• Estrogen Replacement: if you are diagnosed with low peri-ovulatory estrogen (low estrogen around ovulation) we will replace your estrogen using bioidentical estradiol  in the form of a transdermal patch (a patch placed on the skin). Typically we start with a 0.05 mg patch, which you will wear continuously and change 2x/week. This will help build up and thicken your endometrial lining.
• NAC (N-acetyl-cysteine) some studies (see bottom of this page) indicate NAC can help to decrease endometrial implants, which in turn can help decrease period pain. NAC may also promote healthy ovulation and increase pregnancy outcomes. NaPro providers will vary somewhat in their personal preference for dosing regimens. I prefer 1200 mg taken in the AM and 600 mg taken in the PM, but only for FOUR days/week. Please do not take this supplement unless I have specifically recommended it for you. 
• Cervical Mucus Enhancers: Vitamin B6 SR 500 mg, the “sustained” or “extended” release formulation is very important. If this is not sufficient, we may add on Guaifenesin which is an over-the-counter medication for cough/colds. Lastly we may try an antibiotic called amoxicillin. All mucus enhancers should be done under medical supervision.  Please do not take this supplement unless I have specifically recommended it for you. 
• CoQ10, either Pure Encapsulations or Klaire Labs would be my favored brands. Co-Q10 is somewhat expensive. A dose of 200 to 300 per day is generally recommended to be combined with Vitamin D (at least 2,000 IU daily) and Omega 3's (at least 2-3,000 mg daily) to improve egg health. I may recommend this for you if your AMH is low or we have found that your peri-ovulatory estradiol is low. Please do not take this supplement unless I have specifically recommended it for you. 
• Omega 3's, Pure Encapsulations O.N.E. Omega are favored. This supplement may be helpful to both bring down your cholesterol and also improve egg health. This brand offers 1250 mg in one capsule. I may recommend 1-2 capsules daily. Please do not take this supplement unless I have specifically recommended it for you. 
• Myoinositol /D-Chiro Inositol, there are so many options for this supplement. Generally, I prefer Pure Encapsulations and KLAIRE products, but I am sure there are many others that work well. This can help decrease high insulin levels, which is often associated with both Infertility and PCOS. The dose is 2000mg/50 mg twice daily (2000 of myoinositol/50 mg of dchiro inositol). If this is a financial hardship, I am happy to prescribe metformin for you. Oftentimes, it will be more effective anyway. 
• Meftormin can also be added to help reduce insulin levels and also there is some literature that he will help promote ovulation. 
• Letrozole is a medication we may use to help stimulate ovulation. First we must demonstrate this is an appropriate medication for you. Generally speaking, letrozole will grow the follicle that is maturing your egg.  One way to know this medicine would be appropriate for you is if we demonstrate your peri-ovulatory estradiol is low or, if we demonstrate your follicles are not growing to the appropriate size via an Follicular Ultrasound Series. 
• Aspirin 81 mg is recommended during pregnancy in women who have a history of preeclampsia, which you can read about here. Aspirin and Lovenox are recommended for women who have been diagnosed with antiphospholipid syndrome (APS), which you can read about here.  Most of the experts such as ACOG , the Society for Maternal-Fetal Medicine and the American Society of Reproductive Medicine do NOT yet recommend the use of daily aspirin for patients with recurrent pregnancy loss and no history of preeclampsia or APS. However, this literature is somewhat controversial. 

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WHAT DO WE FIND IN THE RESEARCH ABOUT ASPIRIN? 

BENEFITS: 

The EAGeR trial was a randomized control study, which included 1228 women. The study was initially published in 2014, and indicated daily aspirin did NOT improve pregnancy outcomes in women with a history of RPL. However, the data was recently re-analyzed by the authors, who took a closer look at the compliance of the women during the trial in taking their aspirin. The data indicated that among study participants who were compliant in taking their aspirin for 4-7 days per week, there was a significant improvement in the live birth rate of 15 births per 100 women. You can read more here. 

RISKS: 

Many years ago, it was agreed upon among medical professionals that women should avoid aspirin and NSAIDS (eg: ibuprofen, naproxen, Aleve, etc...) during pregnancy. The biggest concerns were congenital anomalies, abnormal kidney development, which leads to low amniotic fluid, gastroschisis, and/or congenital heart malformations. You can read about this here, More recently, a number of studies have been published suggesting low dose aspirin does not put the baby at any increased risk of harm. Please see here and here. However, a meta-analysis, which looked at 22 publications, agreed aspirin did not increase the incidence of congenital anomalies, but the authors did feel the data indicated babies were at a significantly higher risk of developing gastroschisis, which you can read here. 

Another meta-analysis published in 2023, looked at 21 published trials which included 373,926 women. The authors concluded that daily low dose aspirin increased the risk of bleeding during and/or right after delivery, which you can read about here . Another large Swedish study, which included 313,624 was published in 2020 demonstrated the same increased risk of bleeding and postpartum hemorrhage to mothers, and they also reported that babies were at an increased risk of brain hemorrhage, which you can read here.

Again, only bioidentical hormones supplementation is offered. I commonly prescribe prometrium capsules, which are taken orally. The generic brand is just as good and ot costs much less. Prometrium (micronized progesterone) is truly a  bioidendical hormone formulation which can be purchased through a regular retail pharmacy. This medication is generally well-tolerated. Some common side effects are quite pleasant, eg: you may feel more relaxed or sleepy and your might find your mood may improves. Some more unpleasant side effects may be: next-day fatigue, nausea, headaches, or dizziness. Most often the unpleasant side effects can be easily managed by taking the medication right before you lay your head down on the pillow and/or changing to a compounded formulation. Please know prometrium and generic progesterone capsules contain peanut oil, so you CANNOT take this if you have a peanut allergy.

Sometimes the Prometrium or generic micronized progesterone that is  purchased will include a package insert which will "warn" of possible birth defects. However, this warning refers to progesterone substitutes that are often prescribed in oral contraception pills, not the bioidentical progesterone we are prescribing.  NaPro providers, who were trained at the St. Paul VI Institute, have been safely prescribing micronized progesterone to many, many women to support pregnancies for over 35 yrs and they have not encountered problems. 

If the oral medication is not strong enough or if the side effects are bothersome, we can try a vaginal suppository. This will be prescribed for you by a specialty pharmacy called a "compounding pharmacy". You can see a list of compounding pharmacies by viewing Handout #21 here.

Sometimes we will have to use progesterone injections. I will ask you to watch this instructional video and choose someone such as your spouse or a close relative who is willing to administer the injections to you. I would also recommend injections be administered in the upper-outer quadrant of the buttocks (shown in the video) and that you alternate sides. Common side effects of the injections are: soreness, itching and/or mild bruising at the injection site, especially if the injection is done too quickly.