The RRM Approach to Infertility
Author: Maria Porcellato
It’s not uncommon to see on the news that infertility rates are soaring year after year. I could talk about the numbers, but it is more important to focus on why is this occurring rather than creating fear mongering in a vulnerable group of women and couples. The focus on this session is to provide positive options and solutions and to empower you to learn more about your fertility health.
Infertility is a symptom of underlying disease. A better definition would be to call it “subfertility” because infertility indicates a total inability to conceive, while subfertility indicates there is something interfering with the ability to conceive or carry a pregnancy to term. The vast majority of women who have trouble conceiving are not infertile at all. What the news is actually reporting is that more and more women are not healthy overall and it’s impacting their ability to build their family. This is actually an encouraging thought because it means that we can overcome health obstacles and achieve pregnancy with the right guidance.
There are diseases that cause infertility and have a “two-pronged” effect. They not only hinder the functioning of fertility, but they also cause both short and long-term health problems. The persistent unwillingness to address infertility problems from this point of view or perspective is one of the major flaws in the current approach to the treatment of infertility, which largely involves artificial techniques. 12 effective cycles is a normal length of time to achieve pregnancy. Effective cycles being key, and most women have underlying issues that have an impact on this. Apart from two major gynaecological diseases that are under diagnosed such as PCOS and endometriosis, hormonal balance, nutrition, weight, immune system dysfunction, metabolic exercise, sleep and insulin resistance have a major impact on fertility.
We are taught as health professionals that the focus should be healing people with the least invasive, most effective and most cost effective approach. Sadly, when it comes to fertility treatment, our medical educational institutions have let women and couples down with outdated training programs and are shuffling patients into an approach that is easy for the medical profession but physically, psychologically and financially a burden for patients who just want to know why they are having fertility issues. If patients know why they can’t conceive, it helps them cope, reduces stress, and creates closure so they can move forward. It is important for everyone to identify their needs and options. Fertility treatment is not a one size fits all model.
Fertility problems also carry with them significant emotional sequelae. This is fairly well recognized by those who work in this field and psychosocial distress can contribute significantly to the cause of some forms of infertility. We must be sensitive to women and couples who do not have children. Let them lead the conversation if it comes up and avoid asking personal questions that could put them in a difficult spot or bringing it up in front of others. If you think someone you know is struggling with fertility, reach out privately or share your own experiences at the appropriate time. Be respectful and compassionate. Sharing is part of the human experience and can provide much needed support to someone who is struggling.
How did we get here?
Until 1978, most of the effort in medicine in evaluating and treating women with infertility was placed in trying to identify and treat the underlying causes. In 1978, in vitro fertilization produced a paradigm shift. It led to a “skipping over” the causes and this continues up to the present time to be the foundational management approach with artificial technology In essence, this is a symptomatic or Band-Aid approach to treatment, not one that gets to the root causes. Unfortunately, the training in medical and other health care professions followed suit to become less diagnostic when it comes to women’s health and fertility.
Male factor fertility certainly plays a role as well. However, even with suboptimal male factor fertility, conception is still possible. Women’s cervical mucus was designed to optimize and transport the sperm that interacts at the time of conception.
In my experience with over 900 women and couples what have I learned?
1. Everyone wants to know why they are struggling with fertility.
When being referred they expect that they will get clarity on the situation but this is not what happens in reality and leads to frustration. Women and couples want to be listened to and heard with personalized service, not treated like a number.
2. ART is not a desirable option from a physical, emotional or financial perspective. It leads to failure when the underlying causes have not been addressed first and should be a last resort, not a first resort. Clinicians need to accept that this route is not for everyone.
3. Fertility charting and appreciation is very empowering for the women and strengthens the bond of the couple
4. Second opinions are very valuable for information gathering and decision making.
What can be done?
From least expensive and invasive to most expensive and invasive
suggestions:
1. See your family doctor for general health: thyroid, insulin resistance, exercise, stress management, sleep. For men, rule out a varicocele, silent urinary tract infections, heat to pelvic area.
2. Consult other health care professionals on your team: pharmacist, pelvic physiotherapy, dieticians, ND
3. Learn fertility appreciation and chart your fertility cycles to see patterns or trends. After all, you know your own body, and you’re your best advocate. Cohen identified importance of cervical mucus with ability to conceive back in 1952. There are various programs and apps, some are medical based models that utilize biomarkers.
4. Seek those with RRM specialty training: various resources, models and programs ex. Neo Fertility, Creighton, IIRRM, FACTS, FEMM
5. Adoption
6. ART
Accessing RRM Care
Endodiagnosis.com/providers has links where you can learn more about RRM training programs for healthcare professionals. This may be helpful in finding an RRM trained professisonal for care.
You can visit the professional associations of the International Institute of Restorative Reproductive Medicine. The Institute of Restorative Reproductive Medicine of America, Facts about Fertility, FCCA or Fertility Care Centers of America or the American Academy for for Fertility Care Professionals, the current individual models you can train in are Creighton Model Fertility Care, and NAPROtechnology, Neo Fertility, Billings Ovulation Method, Marquette, and FEMM, to name a few.