Use of the Creighton Model Fertility Care System and Prayer in a Successful Pregnancy after Recurrent Pregnancy Loss: A Case Report.

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Abstract

Introduction Through its comprehensive teaching system of charting, the Creighton Model FertilityCareTM System (CrMS) offers women and couples tools to identify the fertility potential and discover the multidimensional aspects of human reproduction. This case report describes how the CrMS helped a woman who experienced recurrent pregnancy loss identify the possible cause. The teaching of the system included a spiritual component. Praying the Most Precious Blood Chaplet was an important piece in the approach of grief management after pregnancy loss and, in our opinion, contributed to the outcome of a healthy pregnancy and a live birth. Case Presentation A 38-year-old Caucasian female enrolled in our CrMS teaching program in April 2023 with a previous diagnosis of polycystic ovary syndrome (PCOS) and recurrent pregnancy losses. She was gravida 12, para 5, miscarriage 7. Two miscarriages occurred after spontaneous conception at 8 weeks of gestation. She then conceived and carried 5 healthy pregnancies to full term. Afterward, she experienced 5 consecutive pregnancy losses. One pregnancy was lost at 5 weeks, another at 15 weeks, and three pregnancies were lost by 17 weeks of gestation. Unexplained pregnancy loss was her diagnosis. After the four second-trimester losses she attended the Introductory Session and two follow-up sessions at Santa Ana FertilityCareTM Center. Abnormal uterine bleeding, long cycles, and limited cervical mucus production were identified through the NaProTRAKINGTM of biomarkers. Metformin, progesterone, iron, and folate were used in preconception for PCOS management. She conceived without any assisted reproductive intervention. Lovenox was initiated and treatment with metformin during pregnancy was recommended. Spiritual accompaniment was then offered, and the Precious Blood Chaplet prayers were taught. A chorioangioma was diagnosed at week 24 of pregnancy and given expectant management. She had a full-term healthy pregnancy and live birth in March 2024.Conclusion The CrMS offers hope for women who experience pregnancy loss. Standardized charting of the fertility biomarkers helps professionals identify normal and abnormal reproductive function patterns. Identifying abnormalities on the charting alerts practitioners of the need for further evaluation and intervention in high-risk cases. Additionally, the spiritual component of the system allows users to discover the multidimensional aspects of human reproduction and the power of prayer. Limitations Charting the cycles using the CrMS is considered level one in the management of recurrent pregnancy loss. These cases require more complete assessment and treatment with doctors trained in Restorative Reproductive Medicine. Further evaluation of the CrMS is needed in more cases to determine the efficacy of the system in the evaluation and treatment of cases of recurrent pregnancy loss. Future Directions A multidisciplinary approach to evaluation and treatment is important for maintaining a healthy pregnancy after recurrent loss. Regardless of the underlying etiology, women and couples need support and accurate information about their chances of carrying a baby to term after pregnancy loss. The power of prayer should never be underestimated. Most Precious Blood of Jesus, save us!

This poster was presented at the Natural Family Planning (NFP) Forum September 4, 2024, and the 93rd Annual Educational Conference Catholic Medical Association in Orlando, Florida

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Background

The Creighton Model FertilityCareTM System (CrMS) is a standardized model to teach women to identify biomarkers of the fertile cycle and monitor their reproductive health.1 Women use the system to achieve or to avoid a pregnancy and to monitor fertility biomarkers. The model has been developed as a Natural Procreative (NaPro) education Technology® that uses a standardized and objective format to instruct women to identify and track the biomarkers.2 The biomarkers include the menstrual bleeding, cervical mucus produced in the woman’s cervix, and the length of the phases of the fertility cycle. By NaProTRAKINGTM these biomarkers women not only understand the naturally occurring phases of the fertility cycle, but trained professionals can recognize and evaluate the presence of abnormalities to monitor reproductive health.3 The CrMS recognizes fertility as an important vital sign to monitor and maintain health and has been used in the management of infertility and miscarriage with success.4,5

Learning the CrMS includes an introductory session and a series of follow-up sessions where women and couples learn to pay attention to the language of the body. The learning process includes instruction on biological aspects such as reproductive anatomy and physiology, establishing an observational routine, and charting the biomarkers using a standardized vaginal discharge recording system. Biomarkers of NaProTECHNOLOGY® are identified and reviewed. Cycle length, phases of the cycle duration, bleeding characteristics, and symptoms are evaluated. The cervical mucus is analyzed with a scoring system. The analysis of biomarkers allows the interpretation of normal and abnormal patterns in the procreative system. The NaPro Education Technology® involves a multidimensional approach including Spiritual, Physical, Intellectual, Creative, and Emotional (SPICE) aspects of human sexuality. Learning SPICE helps women and couples to recognize the multidimensional element involved in using the system for family planning and to understand God’s gift of fertility.6 The system use a SPICE index tool designed to be a confidential assessment of the needs and growth in emotional, psychological, spiritual, communicative, and physical interaction and decision-making. Pregnancy evaluation is another component of the system. All clients who become pregnant within the program complete the pregnancy evaluation. The pregnancy evaluation records how the pregnancy was confirmed, symptoms of the pregnancy, observations during the conception cycle, charting, intentions of using the method, use of medications during the conception cycle, and classification of the pregnancy according to intentions to achieve or avoid pregnancy. 

Case Presentation

38-year-old caucasian woman gravida 12 times with 5 healthy pregnancies and 5 children living. She had two miscarriages at age 20 before her first healthy delivery to term. She had a personal history of UTIs, Migraine headaches, PCOS, and vaginal infections. After her 5th healthy pregnancy, she experienced a miscarriage at 5 weeks of gestation and four consecutive second-trimester pregnancy losses. The first loss was a male delivered in August 2021 at 17 weeks. The second loss was a male delivered in February 2022 at 15 weeks of gestation. The third loss was a male delivered in August 2022 at 17 weeks of gestation. The fourth loss was a girl delivered in March 2023 at 17 weeks. All pregnancy losses were natural conceptions and genetic testing was reported normal. Hormonal, immunological, autoimmune, and other causes of pregnancy loss were ruled out. The medical interventions implemented included progesterone, folate, and Lovenox. Although metformin was used during the preconception period the treatment was discontinued during pregnancy.  The treating professionals were unable to offer any reason why she was not carrying her otherwise healthy babies to term. She felt nothing else could be done going forward to save future babies. This made her losses and grief even more difficult to bear. 

She visited Santa Ana FertilityCareTM Center after the 4th second-trimester pregnancy loss to learn how to chart her cycles using the CrMS to uncover “why [she] kept losing babies”. In April 2023 the client attended a personalized introductory session to the model where she learned basic reproductive anatomy and physiology and also received instruction on how to make good observations of the fertility biomarkers. NaproTRAKINGTM correctly the signs of fertility and correct use of the FertilityCareTM chart were discussed. Learning SPICE and exploring the spiritual, emotional, and psychological needs of dealing with consecutive pregnancy loss was also discussed. In the spiritual component of SPICE, the client was recommended to pray the Chaplet of the Most Precious Blood.

The client returned to the center on May 23, 2023, for follow-up. Assessment of the observations and teaching of terminology was provided. Upon reviewing NaProTECHNOLOGY® biomarkers in the FertilityCareTM chart, intermenstrual bleeding was identified. Referral to a medical consultant was recommended to evaluate the abnormal bleeding. A SPICE index tool was provided to be completed. Prayers with the Chaplet of the Precious Blood were encouraged and shared during the follow-up session. The client expressed gratitude for the understanding of her fertility with the Creighton Model System charting and for including a spiritual component in going through the difficult grieving process after so many pregnancy losses. 

Evaluation of the NaProTECHNOLOGY® biomarkers revealed a long cycle (36 days) with limited mucus production. A mucus cycle score was calculated at 7.6 classification intermediate regular. A medical referral was recommended to evaluate a possible ovulatory dysfunction related to PCOS.

Figure 1

On June 2023, the client continued charting and was able to identify peak fertility. On July 11, 2023, the client reported a positive pregnancy test. A pregnancy evaluation was done. Pregnancy was confirmed by a blood pregnancy test and ultrasound. The client reported that during the conception cycle, she was using metformin, progesterone, iron, and folate. Lovenox was initiated during pregnancy. The abnormal ovulation documented on the FertilityCareTM chart by the limited mucus cycle and long cycles alerted of the need to treat the metabolic component of her PCOS. A recommendation to continue using metformin therapy during pregnancy was made. The client reported that the spiritual aspect was helping in her healing process and she was encouraged to keep praying the Precious Blood Chaplet.

The client was closely monitored by Maternal Fetal Medicine Specialists, who found a Chorioangioma in week 24 of pregnancy. Close monitoring continued during the pregnancy. On March 5, 2024, the client reported normal-term labor. Baby Eden was delivered alive and well with a weight of 8 lbs 6 oz, and a height of 20 and 1/4 inches long. Our FertilityCareTM Center believed in the power of prayer and in the Precious Blood intervention.

Discussion

Recurrent pregnancy loss is defined as the loss of two or more pregnancies occurring before 24 weeks of gestation. The incidence of recurrent pregnancy loss is 1-5% in women trying to conceive.7 Chromosomal errors, anatomical defects, autoimmune disorders, nutrient deficiencies, endocrine disorders, and endometrial dysfunction are common causes of pregnancy loss. The ACOG recommends a full evaluation after two losses. The etiology of the pregnancy loss could be multifactorial with 75% of the cases remaining unexplained.8 In the present case, a miscarriage and four second-trimester pregnancy losses were consecutive. After the fourth loss, the professionals taking care of the patient were unable to find the causes of the second-trimester miscarriages. 

Charting the fertility cycles with a standardized method has been used to identify the root causes of infertility and increase the chances of live birth after recurrent pregnancy loss.9 In this case the CrMS charting helped to identify abnormalities in the fertility cycle. The biomarkers recorded in the FertilityCareTM chart revealed abnormal bleeding, a long cycle, and limited mucus production. Cycles that are 32 -38 days in duration are associated with PCOS.10 Recent research has determined that women with PCOS present changes in the characteristics of the cervical mucus and poorly defined and atypical crystallization.11 The abnormal NaProTECHNOLOGY® biomarkers reported in this case were indicators that the ovulatory event was no healthy, and the underlying cause of the recurrent pregnancy loss was probably attributed to a poor management of the metabolic component of PCOS. 

The use of Metformin therapy during pregnancy has shown to be an effective treatment to prevent pregnancy loss.12,13 In the case presented, the use of metformin after and during pregnancy was an important measure in the treatment of her PCOS and may have contributed to the successful pregnancy outcome.

Recurrent pregnancy loss is a traumatic event with psychological, emotional, and spiritual wounds for the woman, the couple, and the family.14 The effect of prayer on patients’ health has been studied before. A meta-analysis concluded that prayer positively impacted healthcare outcomes. 15 Health professionals should consider patients’ spiritual and religious needs and appropriate support should be offered to women suffering from recurrent pregnancy loss. In this case the SPICE component of the CrMS offered a space to talk about the emotional, psychological, and spiritual burden of pregnancy loss and incorporated prayer as an important component in taking care of spiritual needs after a traumatic event. 

Conclusion

The CrMS was a useful tool for evaluating a case of recurrent pregnancy loss. The analysis of the biomarkers allowed the interpretation and finding of abnormal patterns that could be corrected to achieve a full-term healthy pregnancy. The SPICE instruction facilitated to get a deeper understanding of the spiritual, physical, intellectual, creative, and emotional needs and allowed going beyond the biological and medical aspects of the system. SPICE helped to incorporate prayer to meet the spiritual needs of the client in the process of physical healing and her pain and grief after recurrent losses. Depending on the history of a client’s practice of religion, a client can be encouraged to pray for a good outcome. In this case, the client welcomed this suggestion.

Limitations

Charting the cycles using the CrMS is considered level one in the management of recurrent pregnancy loss. These cases require more complete assessment and treatment with doctors trained in Restorative Reproductive Medicine. More case studies are necessary to extrapolate the usefulness of the CrMS in the management of bigger populations. Further evaluation of the Creighton Model FertilityCareTM System is needed in more cases to determine the efficacy of the system in the evaluation and treatment of cases of recurrent pregnancy loss. 

Future Directions

A multidisciplinary approach to evaluation and treatment is important for maintaining a healthy pregnancy after recurrent loss. Regardless of the underlying etiology, women and couples need support and accurate information about their chances of carrying a baby to term after pregnancy loss. The CrMS is one of the steps for understanding the reproductive system function and charting of the cycles can be used to identify underlying conditions that can be managed in the prevention of pregnancy loss. The spiritual component of the system can offer support and women with pregnancy loss can find healing and restoration. The power of prayer never should be underestimated.

Most Precious Blood of Jesus Save us!

References

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  2. Hilgers TW. Introduction to the Creighton Model System. In: Hilgers TW, editor. The medical and surgical practice of NaProTechnology. Omaha: Pope Paul VI Institute Press; 2004. pp. 43–56. 
  3. Brown JB. Types of ovarian activity in women and their significance: the continuum (a reinterpretation of early findings). Hum Reprod Update. 2011 Mar-Apr;17(2):141-58. doi: 10.1093/humupd/dmq040. Epub 2010 Oct 5. PMID: 20923873; PMCID: PMC3039221.
  4. Stanford JB, Parnell TA, Boyle PC. Outcomes from treatment of infertility with natural procreative technology in an Irish general practice. J Am Board Fam Med. 2008 Sep-Oct;21(5):375-84. doi: 10.3122/jabfm.2008.05.070239. Erratum in: J Am Board Fam Med. 2008 Nov-Dec;21(6):583. PMID: 18772291.
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  7. Dimitriadis E, Menkhorst E, Saito S, Kutteh WH, Brosens JJ. Recurrent pregnancy loss. Nat Rev Dis Primers. 2020 Dec 10;6(1):98. doi: 10.1038/s41572-020-00228-z. PMID: 33303732.
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  10. Hilgers TW. Introduction to the Creighton Model System. In: Hilgers TW, editor. The medical and surgical practice of NaProTechnology. Omaha: Pope Paul VI Institute Press; 2004. pp. 583. 
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  12. Kumar P, Khan K. Effects of metformin use in pregnant patients with polycystic ovary syndrome. J Hum Reprod Sci. 2012 May;5(2):166-9. doi: 10.4103/0974-1208.101012. PMID: 23162354; PMCID: PMC3493830.
  13. Zeng, Xian-Ling MDa; Zhang, Ya-Fei MDb; Tian, Quan PhDa; Xue, Yan PhDa; An, Rui-Fang PhDa,*. Effects of metformin on pregnancy outcomes in women with polycystic ovary syndrome: A meta-analysis. Medicine 95(36):p e4526, September 2016. | DOI: 10.1097/MD.0000000000004526 
  14. Quenby S, Gallos ID, Dhillon-Smith RK, Podesek M, Stephenson MD, Fisher J, Brosens JJ, Brewin J, Ramhorst R, Lucas ES, McCoy RC, Anderson R, Daher S, Regan L, Al-Memar M, Bourne T, MacIntyre DA, Rai R, Christiansen OB, Sugiura-Ogasawara M, Odendaal J, Devall AJ, Bennett PR, Petrou S, Coomarasamy A. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. Lancet. 2021 May 1;397(10285):1658-1667. doi: 10.1016/S0140-6736(21)00682-6. Epub 2021 Apr 27. PMID: 33915094.
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