In a culture that promotes alternative medicine, natural childbirth, and sometimes-bizarre dietary supplements, it seems strange that natural infertility treatments are not well-known. A natural infertility treatment is not necessarily alternative medicine, but rather a conventional-medicine approach that seeks to cure the underlying cause of infertility, allowing natural conception. It stands in contrast to assisted reproductive technology such as in vitro fertilization (IVF), which is stick a "band-aid" solution that does nothing about the underlying causes of fertility problems.

Why is assisted reproductive technology the current standard of care for infertility? If you type "fertility treatment" into Wikipedia, you are redirected to "assisted reproductive technology." Wikipedia, being written collaboratively by people around the world, reflects the biases and attitudes of those people. Fertility drugs and IVF are what people think of when they think about infertility treatments.

I think the reason IVF is so popular — despite its astronomical cost and mediocre success rate (only 1 in 3 attempts results in a live birth) — is because it is a "magic pill" approach. It is a silver bullet, a straightforward process left in the hands of doctors. Natural fertility treatments are more complicated because they start with diagnostics, rather than jumping immediately into treatment.

Among the diagnostic steps used in natural fertility treatments for women are ultrasound, laparoscopy, and sonohysterosalpingography (SHSG) to look for structural problems in the reproductive organs, as well as hormone level checks. During her menstrual cycle, a woman's estrogen and progesterone levels can change significantly in as little as 24 hours, so daily or every-other-day tests are best. Any underlying disease or structural abnormality that is uncovered is treated to increase the odds of a naturally conceived pregnancy.

How successful is natural infertility treatment compared to assisted reproductive technology? IVF has a maximum success (pregnancy) rate well under 50% (for 27-year-old women), with an average success rate closer to 35%. Statistics for live birth are even worse, with an average of only about 27% of attempts resulting in live births. That means that an average of 8% of attempts result in a miscarriage or stillbirth (or, if the fetus is imperfect, abortion). The poor success rates reflect, in part, the fact that over 50% of embryos conceived in vitro have chromosomal abnormalities, as reported by Rebecca Taylor of Mary Meets Dolly. Natural fertility technology also has treatments for male infertility.

According to the Pope Paul VI institute, a major proponent of natural infertility treatment, so-called "natural reproductive technology" has higher success rates than IVF for various infertility diagnoses. These results are both statistically significant (i.e. not due to chance) and personally significant (i.e. they're a lot higher). For example, for a diagnosis of endometriosis, IVF has a success (pregnancy) rate of about 21%, while natural reproductive treatment has a success rate of about 57%. It reports a 37% success rate for tubal occlusion compared to IVF's 27%. The whopping 82% success rate reported for natural fertility treatment of anovulation (not producing mature eggs) may be due to straightforward treatment of the most obvious cause of anovulation, hormonal insufficiency (although I am speculating here).

I find it amazing that natural treatments for infertility are not better-known, even though they are more effective than current approaches. That's right: for infertile couples, it is more effective to try to conceive a baby the way nature always has than to inject a sperm into an egg under a microscope, with less chance of complications like chromosomal abnormalities and multiple gestation. Who wouldn't choose that first, if they knew it was available?

Image credit: "Test tube baby" by Brendan Dolan-Gavitt. (CC) Some rights reserved.