NaProNaPro tehnologija tehnologija zamjena za IVF? zamjena za IVF?

Boris Boris UjeviUjevi

Tanja Tanja TurudiTurudi

NaProTechnologyNaProTechnologyNatural Natural Procreative Procreative TechnologyTechnology

Osnove Osnove NaProNaPro tehnologijetehnologije

50 godina prolog stoljea dr. John Billings je otkrio cervikalnu sluz (sluz vrata maternice)

tijekom menstrualnog ciklusa nastupaju promjene u vrsti i koliini sluzi

ona se jo zove "plodna sluz" jer je nuno potrebna da ona se jo zove "plodna sluz" jer je nuno potrebna da bi dolo do trudnoe

ena zato, ako primjeuje sluz, zna da je u "plodnim danima" i da moe zatrudnjeti, a ako sluzi nema, zna da ne moe zatrudnjeti, jer je bez nje zaee nemogue

Osnove Osnove NaProNaPro tehnologijetehnologije

cervikalna sluz se lui pod utjecajem spolnih hormona

cervikalna sluz je savren instrument za mjerenje plodnosti, ali ne samo plodnosti ve i svakog odstupanja od normalnog stanja koji moe biti rezultat od normalnog stanja koji moe biti rezultat hormonalnog poremeaja ili nekog oboljenja

NaPro tehnologija se temelji na praenju cervikalne sluzi i biljeenjem svih promjena u vaginalnom iscjetku

Osnove NaPro tehnologijeOsnove NaPro tehnologije prate se promjene na stidnici prilikom

uobiajenih svakodnevnih aktivnosti ne istrauje se unutranjost rodnice standardizacija u promatranju i biljeenju -

objektivni kliniki znakovi objektivni kliniki znakovi

Osnove Osnove NaProNaPro tehnologijetehnologije

Fertility care system je praenje i biljeenje enskog ciklusa putem standardizirane tablice (kalendara)(kalendara)

u tablicu se stavi obojena markica i simbol upie se kratak opis osjeta na stidnici i izgleda

sluzi

NaProNaPro tehnologijatehnologija

NaPro tehnologija - medicinski i kirurki pristup lijeenju enskog zdravlja i plodnosti na temelju Fertility care system

Abnormalnosti zabiljeene u tablici su samo vrh patofiziolokog ledenog brijega!

su povezane s: hipotalamiko hipofiznom disfunkcijom

slabom funkcijom folikula

poremeanim nivoima estrogena i

Abnormalnosti u tabliciAbnormalnosti u tablici

poremeanim nivoima estrogena i progesterona

PCO

endometriozom

Infertility & Miscarriage

Low Endorphins

Diet &Nutrition

Surgical

Male Factor

Low Hormones

Limited Mucus

Infection

Nutrition

Immunological

AdrenalFatigue

OthersTo be discovered

NaProNaPro tehnologijatehnologija

u skladu s opeprihvaenim medicinskim principima

anamneza

simptomi

kliniki status kliniki status

pretrage

dijagnoza

konzervativna i/ili kirurka terapija

FertilityFertilityCareCare tablica =tablica =kliniklinikiki statusstatus

suhi ciklusi

smanjena koliina sluzi

premenstrual spotting

intermenstrual spotting intermenstrual spotting

smee krvarenje na kraju menstruacije

kratka lutealna faza

duga lutelna faza

dugi ciklusi

PretragePretrageCiljano ispitivanje hormonaCiljano ispitivanje hormona

Peak Plus 7Progesteron (18.5 - 31.0 ng/dl) (60 - 100 nmol/L) Estrogen (145 300 pg/l) (400 800 nmol/l)Estrogen (145 300 pg/l) (400 800 nmol/l)

Peak Plus 3,5,7,9,11

Pre Peak P-3, P-1, P+1 Estrogen - preko 370 pg/l (1000 nmol/l)

PretragePretrageUltraUltrazvukzvuk folikulometrija

mali folikuli

inkompletna ruptura inkompletna ruptura

Luteinised Unruptured Follicle

uredna ruptura

endometralni odgovor

DijagnozaFUNKCIONALNI poremeaj

deficit hormona - folikularni ili lutealni

poremeena ovulacija

anovulacija

sindrom luteiniziranog nerupturiranog folikula sindrom luteiniziranog nerupturiranog folikula

parcijalna ruptura folikula

limitirani protok cervikalne sluzi upale

muki faktor

STRUKTURNI poremeaj

endometrioza, miomi, polipi, septum

Possible Diagnoses from NaProTechnology Evaluation

Hormonal Ultrasound Surgical Other

Low Progesterone Immature follicle Endometriosis Limited (hostile)

Mucus

Low Oestradiol Partial rupture Pelvic Adhesions Adrenal Fatigue

Poor Follicular

Function

Luteinised unruptured

follicle

Blocked Fallopian

Tubes

Chronic Endometritis

Corpus Luteum Delayed Rupture Hydrosalpinx*

Corpus Luteum

Insufficiency

Delayed Rupture HydrosalpinxEndorphin Deficiency *

Polycystic Ovaries Afollicularism Fibroid Food Intolerance

Reduced ovarian

reserve

Absent Cumulus

Oopherous

Polyp Nutritional Deficiency

Hypothyroidism Uterine Septum Immune dysfunction

*Although these diagnoses are hormonally mediated, at least in part, the diagnosis and management is not based on direct hormonal testing at this time.

Lijeenje

FUNKCIONALNO Podrka lutealnoj fazi - HCG, Progesteron Pojaanje sluzi -Vitamin B6, Mukolitici, Antibiotici Indukcija ovulacije Clomiphene, HCG, FSH, GnRH Imunoloki - food intolerance Imunoloki - food intolerance Adrenal fatigue - Kortikosteroidi Niski endorfini - Naltrexon Stres Management

STRUKTURALNO - kirurko

Bolest moe biti .Bolest moe biti .

Akutna

nagli poetak

kratko trajanje

Kronina

postupan poetak

due trajanje kratko trajanje

moe proi spontano

najee jedan uzrok

moe se izlijeiti s jednim zahvatom i/ili lijekom

due trajanje

rijetko prolazi spontano

najee vie uzroka

ishod lijeenja se poboljava dugotrajnom primjenom vie lijekova i/ili zahvata

KronianKronian vs Avs Akutni pristupkutni pristup

NaPro Tehnologija trai dugotrajne

zdravstvene tegobe i pokuava ih poboljati

MPO dugotrajne zdravstvene

tegobe smatra manje vanim od kratkotrajnog pokuava ih poboljati

kroz cijeli reproduktivni ivot

kronina perspektiva

vanim od kratkotrajnog lijeenja

akutna perspektiva

Kronian Kronian vsvs AAkutni pristupkutni pristup

NaPro Tehnologija

neplodnost predstavlja prisustvo bolesti, koju

MPO

neplodnost predstavlja tehniki izazov da se prisustvo bolesti, koju

treba otkriti i lijeititehniki izazov da se premosti nefunkcionalni proces

Neplodnost je kronino stanjeNeplodnost je kronino stanje

Neplodnost je najee posljedica vie kroninih stanja (rijetko akutne bolesti)

(Ne)logino je kronino stanje lijeiti akutnim (Ne)logino je kronino stanje lijeiti akutnim zahvatom

3 Case Presentations3 Case Presentations

1.1. Case ACase A

2.2. Case BCase B

3.3. Case CCase C

Case ACase A

GravidaGravida 0 Para 0, 0 Para 0, Female aged 41, Male aged 40, Female aged 41, Male aged 40, Trying to conceive for 2 yearsTrying to conceive for 2 years

Case ACase A

Unexplained InfertilityUnexplained Infertility Lap and Dye Lap and Dye normal 2007normal 2007

Semen analysis Semen analysis normal 2007normal 2007

IUI x 3 IUI x 3 FSH/LH and HCG FSH/LH and HCG -- June 2008June 2008 IUI x 3 IUI x 3 FSH/LH and HCG FSH/LH and HCG -- June 2008June 2008 IVF x 2 IVF x 2 3 Embryos transferred 3 Embryos transferred Aug 2008 & March 2009Aug 2008 & March 2009

Presented for Presented for NaPro NaPro treatment treatment March 2009March 2009

Case A Case A NPT DiagnosesNPT Diagnoses

Chronic EndometritisChronic Endometritis Progesterone deficiency Progesterone deficiency poor follicular function poor follicular function

& corpus luteum insufficiency& corpus luteum insufficiency & corpus luteum insufficiency& corpus luteum insufficiency

Hostile Cervical MucusHostile Cervical Mucus Clinical endorphin deficiencyClinical endorphin deficiency Mild food intoleranceMild food intolerance

Case A Case A NPT TreatmentsNPT Treatments

Clinical endorphin deficiencyClinical endorphin deficiency Naltrexone 2mg Naltrexone 2mg noctenocte

Mild food intolerance (Mild food intolerance (IgGIgG) ) Egg yolk and soyaEgg yolk and soya Egg yolk and soyaEgg yolk and soya

Case A Case A NPT treatmentNPT treatment

Progesterone deficiency Progesterone deficiency poor follicular function poor follicular function

& corpus luteum insufficiency& corpus luteum insufficiency

Letrozole 2.5mg 10 tabs on day 3Letrozole 2.5mg 10 tabs on day 3 Letrozole 2.5mg 10 tabs on day 3Letrozole 2.5mg 10 tabs on day 3 HCG 10,000 iu mid cycle HCG 10,000 iu mid cycle HCG 2,500 iu Peak +3,5,7HCG 2,500 iu Peak +3,5,7

Case A Case A NPT TreatmentsNPT Treatments

Hostile Cervical MucusHostile Cervical Mucus CaCarbrbocistocisteeine 375mg tid x 7 days, day 11ine 375mg tid x 7 days, day 11

Amoxycillin 500mg tid x 5 days, day 11Amoxycillin 500mg tid x 5 days, day 11

PreSeed Vaginal LubricantPreSeed Vaginal Lubricant PreSeed Vaginal LubricantPreSeed Vaginal Lubricant

Case A Case A NPT TreatmentsNPT Treatments

Chronic Chronic EndometritisEndometritis Metronidazole 400mg BD x 3 weeksMetronidazole 400mg BD x 3 weeks

Clarithromycin 500mg BD x 3 weeksClarithromycin 500mg BD x 3 weeks

Pro biotic for 6 weeksPro biotic for 6 weeks Pro biotic for 6 weeksPro biotic for 6 weeks

Start day 14 of cycleStart day 14 of cycle

Case ACase A

42 years old at conception 42 years old at conception Hormone support with Hormone support with cyclogestcyclogest 400mg 400mg pvpv. .

twice daily until 8 weeks twice daily until 8 weeks CyclogestCyclogest 400mg 400mg pvpv noctenocte until until 116 weeks 6 weeks CyclogestCyclogest 400mg 400mg pvpv noctenocte until until 116 weeks 6 weeks

gestationgestation

Case ACase A

She delivered a healthy baby boy by Caesarean She delivered a healthy baby boy by Caesarean section in November 2010, weighing 3180g.section in November 2010, weighing 3180g.

Case ACase A

Chart was critically important to the processChart was critically important to the process Timing of blood testsTiming of blood tests

Timing of HCG injectionsTiming of HCG injections

Identify hostile mucusIdentify hostile mucus Identify hostile mucusIdentify hostile mucus

Identify Brown Bleed Identify Brown Bleed Chronic Chronic EndometritisEndometritis

Case ACase A

IVF which attempted to solve the symptom of IVF which attempted to solve the symptom of infertility through bypassing the natural process infertility through bypassing the natural process of conception was inappropriate and ineffective of conception was inappropriate and ineffective as she had several chronic conditions that as she had several chronic conditions that as she had several chronic conditions that as she had several chronic conditions that needed to be treated in a targeted fashion to needed to be treated in a targeted fashion to restore normal reproductive functionrestore normal reproductive function

Case BCase B

GravidaGravida 1 Para 0 1 Para 0 Female aged 37 Male aged 39 Female aged 37 Male aged 39 7 years trying to conceive 7 years trying to conceive

Case BCase B

Trying to conceive since Jan 2002Trying to conceive since Jan 2002 Cycle 32 to 25 daysCycle 32 to 25 days Unplanned miscarriage at 11 weeks Unplanned miscarriage at 11 weeks 19991999 Diagnosis Diagnosis Mild PCOD by ultrasoundMild PCOD by ultrasound Diagnosis Diagnosis Mild PCOD by ultrasoundMild PCOD by ultrasound

Case B Case B UsualUsual investigationsinvestigations

Laparoscopy 01 &08, Laparoscopy 01 &08, Hysteroscopy 09Hysteroscopy 09 Semen analysis several tests Semen analysis several tests 0101-- 0808 Day 3 bloodsDay 3 bloods Day 3 bloodsDay 3 bloods ThrombophilliaThrombophillia ScreenScreen Immunological testing Chicago BloodsImmunological testing Chicago Bloods

Case B Case B TreatmentsTreatments

Clomiphene Clomiphene 50mg daily for 5 days, from day 3 of cycle x 450mg daily for 5 days, from day 3 of cycle x 4

100mg daily for 5 days, from day 3 of cycle x 4100mg daily for 5 days, from day 3 of cycle x 4

150mg daily for 5 days, from day 3 of cycle x 4150mg daily for 5 days, from day 3 of cycle x 4 150mg daily for 5 days, from day 3 of cycle x 4150mg daily for 5 days, from day 3 of cycle x 4

12 cycles in total previously12 cycles in total previously

Case B Case B TreatmentsTreatments

IVF x 3 stimulated cycles IVF x 3 stimulated cycles Feb 2006 Feb 2006 March 2009March 2009

Embryo transfer Embryo transfer 3 fresh and 1 frozen3 fresh and 1 frozen 2 2 3 embryos each time3 embryos each time2 2 3 embryos each time3 embryos each time

Additional Aspirin, Enoxaparin, Prednisolone 25mg with last Additional Aspirin, Enoxaparin, Prednisolone 25mg with last IVF cycle despite normal testingIVF cycle despite normal testing

Case B Case B NPT DiagnosesNPT Diagnoses

Presented Presented for NaPro treatment for NaPro treatment on April 2009on April 2009 Progesterone deficiency Progesterone deficiency with corpus luteum with corpus luteum

insufficiencyinsufficiency Polycystic Ovaries Polycystic Ovaries with poor follicular with poor follicular Polycystic Ovaries Polycystic Ovaries with poor follicular with poor follicular

functionfunction Clinical endorphin deficiencyClinical endorphin deficiency Clinical Adrenal fatigueClinical Adrenal fatigue

Case B Case B NPT TreatmentsNPT Treatments

Progesterone deficiency Progesterone deficiency with corpus luteum with corpus luteum insufficiencyinsufficiency

Polycystic Ovaries Polycystic Ovaries with poor follicular with poor follicular functionfunctionfunctionfunction HCG 2,500iu P+3,5,7,9HCG 2,500iu P+3,5,7,9

Letrozole 2.5mg Letrozole 2.5mg 16 tabs 16 tabs day 3day 3

HCG 10,000 iu mid cycleHCG 10,000 iu mid cycle

Case B Case B NPT TreatmentsNPT Treatments

Clinical endorphin deficiencyClinical endorphin deficiency Naltrexone 3mg nocteNaltrexone 3mg nocte

Clinical Adrenal fatigueClinical Adrenal fatigue Hydrocortisone 5mg Hydrocortisone 5mg 7am & 12 noon7am & 12 noon Hydrocortisone 5mg Hydrocortisone 5mg 7am & 12 noon7am & 12 noon

SupplementsSupplements Vitamin D3 Vitamin D3 2,400iu daily2,400iu daily

Omega 3 2000mg daily plus Folic acidOmega 3 2000mg daily plus Folic acid

Case B Case B NPT OutcomeNPT Outcome

With treatment we achieved a normal With treatment we achieved a normal appearing chart, with proven follicle rupture appearing chart, with proven follicle rupture by ultrasound, and a healthy happy patient. by ultrasound, and a healthy happy patient.

She conceived on her 5th cycle of treatment She conceived on her 5th cycle of treatment She conceived on her 5th cycle of treatment She conceived on her 5th cycle of treatment (second effective cycle) in April 2010(second effective cycle) in April 2010

Case B Case B NPT Pregnancy treatmentNPT Pregnancy treatment

Cyclogest 400mg pv twice daily until 36 Cyclogest 400mg pv twice daily until 36 weeks gestationweeks gestation

Aspirin 75mg daily until 30 weeks Aspirin 75mg daily until 30 weeks Aspirin 75mg daily until 30 weeks Aspirin 75mg daily until 30 weeks Prednisolone 25mg daily until 12 weeks Prednisolone 25mg daily until 12 weeks

Case B Case B NPT Pregnancy OutcomeNPT Pregnancy Outcome

She had a normal vaginal delivery of a healthy She had a normal vaginal delivery of a healthy baby boy, 3.130 Kg in January 2011baby boy, 3.130 Kg in January 2011

Mother was 38 years old at deliveryMother was 38 years old at delivery Mother was 38 years old at deliveryMother was 38 years old at delivery

Case B Case B CommentsComments

Immediately identified Corpus luteum Immediately identified Corpus luteum insufficiency & confirmed restoration of insufficiency & confirmed restoration of normal function with treatment.normal function with treatment.

Patients well being improved with naltrexone Patients well being improved with naltrexone Patients well being improved with naltrexone Patients well being improved with naltrexone and cortisol treatment. When this happens, we and cortisol treatment. When this happens, we often find our treatment is more successful. often find our treatment is more successful.

Case CCase C

GravidaGravida 1 (with IVF), Para 01 (with IVF), Para 0 Female age 38, Male age 38Female age 38, Male age 38 Never conceived naturally since trying in Never conceived naturally since trying in

February February 20032003February February 20032003 OligoasthenozoospermiaOligoasthenozoospermia and endometriosis and endometriosis

Case C Case C Previous TreatmentsPrevious Treatments

12 cycles of ovulation induction with 12 cycles of ovulation induction with clomipheneclomiphene

3 attempts at IUI 3 attempts at IUI 3 failed IVF attempts between Dec 2005 and 3 failed IVF attempts between Dec 2005 and 3 failed IVF attempts between Dec 2005 and 3 failed IVF attempts between Dec 2005 and

April 2007April 2007 2 embryos replaced x 3 IVF cycles2 embryos replaced x 3 IVF cycles

Miscarriage at 9 weeks after first attemptMiscarriage at 9 weeks after first attempt

Case C Case C NPT DiagnosesNPT Diagnoses

Presented Presented for for NaProNaPro tretmenttretment in January in January 20082008

EndometriosisEndometriosis OligoasthenozoospermiaOligoasthenozoospermia OligoasthenozoospermiaOligoasthenozoospermia Clinical endorphin deficiencyClinical endorphin deficiency Low progesterone and Low progesterone and oestradioloestradiol combined combined

poor follicle function and corpus poor follicle function and corpus luteumluteuminsufficiency insufficiency Obvious from ChartObvious from Chart

Food Intolerance to eggsFood Intolerance to eggs

Case C Case C NPT TreatmentsNPT Treatments

Clinical endorphin deficiencyClinical endorphin deficiency Naltrexone 4.5mg nightlyNaltrexone 4.5mg nightly

Food Intolerance to eggsFood Intolerance to eggs Food Intolerance to eggsFood Intolerance to eggs Change in dietChange in diet

Case C Case C NPT TreatmentsNPT Treatments

EndometriosisEndometriosis Laparoscopy and diathermy June 2008Laparoscopy and diathermy June 2008

OligoasthenozoospermiaOligoasthenozoospermia CoEnzyme Q10 200CoEnzyme Q10 200 mg dailymg daily CoEnzyme Q10 200CoEnzyme Q10 200 mg dailymg daily

Tamoxifen 20Tamoxifen 20 mg dailymg daily

FertilityPlus for menFertilityPlus for men

Lifestyle Lifestyle (cigarettes, alcohol, caffeine, stress)(cigarettes, alcohol, caffeine, stress)

Case C Case C NPT TreatmentsNPT Treatments

Low progesterone and Low progesterone and oestradioloestradiol combined combined poor follicle function and corpus poor follicle function and corpus luteumluteuminsufficiencyinsufficiency Clomiphene 150mg daily x 3 days, starting on day Clomiphene 150mg daily x 3 days, starting on day Clomiphene 150mg daily x 3 days, starting on day Clomiphene 150mg daily x 3 days, starting on day

3 of the cycle with HCG 5000 3 of the cycle with HCG 5000 iuiu mid cycle to mid cycle to facilitate follicle rupture and HCG 2,500 facilitate follicle rupture and HCG 2,500 iuiu on on days 3, 5 and 7 after ovulation days 3, 5 and 7 after ovulation

Case C Case C NPT Pregnancy TreatmentsNPT Pregnancy Treatments

Positive pregnancy test in September 2008 Positive pregnancy test in September 2008 Cyclogest 400mg pv nocte until 14 weeks Cyclogest 400mg pv nocte until 14 weeks Naltrexone 4.5mg nocte until 38 weeksNaltrexone 4.5mg nocte until 38 weeks

Case C Case C NPT Pregnancy outcomeNPT Pregnancy outcome

They had a healthy baby boy by normal vaginal They had a healthy baby boy by normal vaginal delivery weighing 3.400kg in June 2009, when delivery weighing 3.400kg in June 2009, when mum was 40 years old.mum was 40 years old.

Case C Case C repeat attemptrepeat attempt

Second attempt in February 2010 Second attempt in February 2010 Same treatment approach successfully Same treatment approach successfully

conceived by September 2010. conceived by September 2010.

Healthy baby boy delivered 19th May 2011 Healthy baby boy delivered 19th May 2011 when mum was 42 years old.when mum was 42 years old.

Case C Case C CommentsComments

CChart demonstrated premenstrual spotting hart demonstrated premenstrual spotting indicating a problem with endometrial indicating a problem with endometrial integrity in the luteal phase of the cycleintegrity in the luteal phase of the cycle

It is important to adequately treat mild It is important to adequately treat mild It is important to adequately treat mild It is important to adequately treat mild endometriosis as this has been shown to endometriosis as this has been shown to improve pregnancy and live birth ratesimprove pregnancy and live birth rates

Primjer 1

G0, P 0 Dob : 28 Dob M: 33 Trudnou pokuavaju 4 godine Trudnou pokuavaju 4 godine U program se ukljuili: 06/2009

Primjer 1

Astenoteratozoospermia, + Prouteus Mirabilis (2 godine, terapija antibioticima bezuspjena)

eljeli inseminaciju no - dvije hrvatske vodee klinike iskljuivo ICSIklinike iskljuivo ICSI

Primjer 1

NaPro terapija: Prestati puiti, smanjiti koliine alkohola i kave,

smanjiti stres, vjebati Multivitamini (FertilityPlus for men) Multivitamini (FertilityPlus for men) Coenzim Q 10 Ciprofloxacin 250 mg bid -2 x dnevno, 6 tjedana

- uspjeno eliminirali bakteriju Proteus Mirabilis LDN

Primjer 1

M: 9 mjeseci terapije trudnoa Bligted ovum u 8 tj. trudnoe kiretirana

(10/2009) : nije imala terapiju jer jo nije poela voditi : nije imala terapiju jer jo nije poela voditi

kalendar

Primjer 1

: Poor Follicular Function Clomid 50mg daily for 3 days, start day 3 of

cycle. Utrogestan 200mg pv nocte x 10 nights, start

Peak +3 of cycle. Supplements -Vitamin D3 2,400 daily, Omega 3

2000mg daily, folic acid Avoid milk and eggs

Primjer 1

Trudna 35 tj

Primjer 2

G0, P0 Dob : 34g Dob M: 38g Trudnou pokuavaju 4g Trudnou pokuavaju 4g U program se ukljuili: 06/2009

Primjer 2

Dijagnoza: oligoasthenoteratozoospermia Terapija: 2 x AIH, bez trudnoe

Primjer 2

NaPro insuficijencija utog tijela sumnja na polip i endometriozu muki faktor muki faktor

Primjer 2

HYS - odstranjen polip LPSC - endometrioza pelvinog peritoneuma LPSC - obostrana neprohodnost jajovoda

Primjer 2

Terapija: M: ciprofloksacin 2x250mg, 3 tjedna : Klomifen 50mg 3 dana od 3.d.c. Klomifen 50mg 3 dana od 3.d.c. HCG 10000 i.j. P-1, 2500i.j. P+3,5,7 LDN 3mg prehrana: izbjegavati mlijeko i mlijene

proizvode, jaja

Primjer 2

rodila 8/2011 40+3 tj. trudnoe 3580/50

Primjer 3Primjer 3

Vesna Vulovi je pala iz aviona s 10 000 metara i preivjela

Veina koja padne s 10 000 metara e preivjeti?preivjeti?

Usporedba Usporedba NaProNaPro i i MPOMPOIrska NaPro Nizozemska MPO

Hum Reprod 2007JABFM 2008

Usporedba Usporedba NaProNaPro i i MPOMPO

Nizozemska MPO

N=1351

Starost ene=32.8g

Irska NaPro

N=1072

Starost ene =35.8g

Trajanje neplodnosti=3.6g

Prethodni MPO=0%

1 godina 64.7% trudnoa

Trajanje neplodnosti=5.6g

Prethodni MPO=33%

2 godine 52.8% poroda

Hum Reprod 2007JABFM 2008

ZakljuakZakljuak

Neplodnost je kronino stanje i kao takvo treba biti lijeeno.

Dijagnostiki postupci moraju tragati za Dijagnostiki postupci moraju tragati za SVIM uzrocima i doprinosnim imbenicima.

Lijeiti treba SVE uzroke i doprinosne imbenike.

elja je imati zdravo dijete, majku i oca.

Za koga nije NaPro

Azoospermija Neprohodni jajovodi (nakon kirurke

rekonstrukcije) Postmenopauza Postmenopauza

NaPro zamjena za IVF?

Za sve one parove koji iz bilo kojeg Za sve one parove koji iz bilo kojeg razloga ne ele MPO

Dokazi Dokazi -- Cochrane Cochrane bazabaza

Outcomes should be reported as pregnancy rates per woman or couple, because repeat cycle data are not because repeat cycle data are not statistically independent and are less relevant to the patient

Pandian et al. Cochrane Database Sys Rev 2005

Cochrane evaluation of IVFCochrane evaluation of IVF

The effectiveness of IVF relative to other treatment options for unexplained infertility remains unproven. Adverse events and the costs associated with the Adverse events and the costs associated with the interventions compared have not been adequately assessed.

Pandian et al. Cochrane Database Sys Rev 2005

Cumulative pregnancy ratesCumulative pregnancy rates

In couples without clear indications for IVF, the main

benefit of early IVF may be to shorten time to

pregnancy, a benefit that must be weighed against

Stanford JB, et al. Fertil Steril 2010

pregnancy, a benefit that must be weighed against

costs and potential adverse outcomes.