Nfp at fertility - interview with pd dr

How can NFP help with the desire to have children? To answer this question, we asked NFP expert and reproductive doctor Christian Gnoth.

According to my research, you are the absolute expert for NFP in the event of unfulfilled desire for children and have published numerous publications on this topic. How did you get to the NFP for the first time?

It was actually pure coincidence. I was already at the end of my studies at the university Dusseldorf (1989) for a way a little money looking to earn. The well-known NFP scientist Prof. Freundl asked me during my internship in his department whether I was not interested, together with Dr. Michael Bremme to program the first Atari version of the NFP cycle database. Before this project, I had no idea about NFP methods. But while working on what is now the world’s largest NFP cycle database, I learned more and more about the complex female cycle and the symptothermal method of NFP. I developed a strong interest in hormones and fertility, so I decided to go into gynecological endocrinology and reproductive medicine and join the NFP research group. To this day, my fascination with cycle research remains undiminished, so I keep researching new questions on this topic in order to a. To make the NFP knowledge known in the professional world and, of course, above all to pass it on to my patients in my practice in Greevenbroich.

Many readers know you as the author of the book * Desire for children – natural ways to the child of choice by introducing methods from Chinese medicine, natural family planning (NFP) and modern reproductive medicine (IVF, ICSI, etc.). How did this book come about??

I had previously worked on books about the desire to have children (with G&U, together with Freundl and Frank-Herrmann) and so asked the G&U-Verlag again asked me if I would not like to write a book together with a naturopath on the subject of wanting children. To begin with, I was frankly not enthusiastic about it, as it is for many serious conventional medicine doctors No go is to make common cause with a naturopath. The approaches of alternative practitioners are often not proven by scientific studies. But on the other hand, I knew from my experience with my own patients that the demand for a fertility book that represented both approaches was high. I therefore came up with a strategy for how we can comprehensively present classic reproductive medicine and homeopathy on the subject of wanting children in a book. There was actually nothing to be said against presenting homeopathy and the methods of reproductive medicine side by side, in separate chapters. Interested readers who are interested in homeopathic methods for the desire to have children thus learn something about the established possibilities of reproductive medicine. I have to emphasize that for me NFP is clearly one of the methods of conventional medicine, because in contrast to many complementary methods, NFP is based on numerous scientific studies, the results of which are reproducible at any time. All in all, I am very satisfied with the children’s wish book, because in my opinion it shows that conventional medicine and complementary medicine can complement each other. For this reason, in my fertility practice both approaches are used to treat patients.

An increasing number of couples remain childless. How and when can NFP help with the unfulfilled desire to have children? What possibilities are there to combine NFP methods sensibly with the modern methods of reproductive medicine?

First of all, NFP is diagnostics. In my opinion, every couple should deal with NFP well before they want to have children. Many women only appear in our practice in their mid / late 30s. Most of them have been taking birth control pills for many years. Her natural cycle could never develop undisturbed and was masked all year round, then of course it should work immediately after taking the pill with the desire to have children. However, many women do not know that it can take a long time for the natural cycle to settle, especially after years of pill use. This means that we as doctors can sometimes only diagnose cycle disorders after months. Many cycle disorders are masked by hormonal contraception with the pill and thus remain undetected for a long time. It may therefore be relatively late for a promising fertility treatment. If more women were to use NFP for contraception, cycle disorders and diseases would be recognized in good time and quickly before the child actually wanted and could be treated.

In addition, the fertility competence gained and knowledge of one’s own cycle can also be used very positively for the desire to have children. For example, using NFP methods, a woman can quickly find out when she is optimally fertile and whether she is ovulating in the respective cycle. The couples can now use this specifically and have traffic on the highly fertile days before ovulation in order to get pregnant. As already mentioned, disorders in the follicular maturation or luteal phase can be quickly diagnosed using the basal temperature curve. This means that any hormone therapy for luteal weakness can be carried out much earlier, more effectively and more gently on suitable days in the cycle using the cycle recordings.

Can NFP possibly predict faster whether the use of modern methods of reproductive medicine (e.g. IVF, ICSI, IUI) is necessary?

Yes, this question can actually be answered best and fastest with NFP. If a woman does not become pregnant in six documented NFP cycles with sex on the most fertile days, there may be a greater problem with fertility. In such a case, if you want to have children, you should urgently consult a specialist, who can then discuss further diagnostic steps and possible treatments.

Without NFP, the indication for a differentiated diagnosis and initiation of therapeutic steps is difficult. Misdiagnoses often arise because hormone levels are measured, for example, on the wrong cycle days. In some cases, the modern methods of reproductive medicine (IVF, ICSI, IUI) are therefore used too early and without a scientific indication, which Dutch studies have recently shown clearly. As a rule of thumb, it is stated that if the desire to have children does not occur naturally after 12 months, you should see a doctor. But who looked if the couple really had traffic on the fertile days in the 12 months? From my point of view, NFP is the most important preventive measure to prevent a desire to have children from becoming an unfulfilled desire to have children, because it gives the natural cycle space again and thus brings fertility competence back into people’s lives.

They fulfilled their wish to have children together with their wife and had a son. Which NFP method is used for your desire to have children?

When I was working with other colleagues on the first user study on the persona contraceptive computer (Bonnar J 1999), my wife and I had participated in this study. With a known outcome …

You recently published a new medical book “Periconceptional Gynecology”, which is pretty much the first book on this topic for medical professionals with a large NFP chapter. How do you see the chances of accommodating this book as a standard textbook in medical studies and thereby making NFP better known to medical professionals?

I very much hope that this book can stand out from other books and reach many medical professionals across disciplines. The chances are not that bad, after all, the book "Periconceptional Gynecology" has recently received good reviews in a review in the German Medical Journal. It is an interdisciplinary work that has brought together many experts from various disciplines. For example, it also contains chapters that are interesting for internists or neurologists or that have been written by internists and neurologists for gynecologists. Of course, gynecologists do not miss out on a book on the desire to have children, pregnancy and obstetrics, but other medical groups should also use this book, which could be another key to the spread of NFP among conventional doctors.

You are a specialist for women who suffer from PCO syndrome and therefore have very long irregular cycles. Can you naturally help a woman with PCOS to get pregnant or is it not possible without the modern methods of reproductive medicine (IVF, ICSI)? How good are the chances of fulfilling the desire to have children as a woman with PCOS?

The chances of fulfilling the desire to have children are actually relatively good for women with PCOS. According to a recent study (West S 2014), a 44-year-old woman with PCOS is about as rarely childless as a woman without PCOS. However, the number of children is reduced compared to women without this cycle disorder. The background is, of course, that a PCOS woman produces much less ovulation in her life due to the sometimes really long cycles. This means that these women simply have far fewer cycles to get pregnant. It is also more difficult to narrow down the time of ovulation during long cycles. Here the NFP application can be very helpful, after all, ovulation often announces itself through the cervical mucus symptom. Thus, a woman with PCOS and desire to have children should simply have traffic on days with the best quality cervical mucus to get pregnant. If the woman also observes the basal body temperature, she can very well narrow down when her fertile time in the cycle is over. In this way, a large number of women with PCOS naturally became pregnant before visiting a fertility center. However, if pregnancy does not occur after six cycles with optimal traffic in the highly fertile period, the use of modern methods of reproductive medicine (ovarian stimulation therapy) must be considered. Here too, the success rates are promising.

You are currently very active in the field of anti-Müllerian hormone (AMH) research. Can the measurement of the AMH level in the blood really predict the occurrence of menopause? What does an AMH blood test really do??

Reproductive health professionals agree that AMH is the most important reproductive hormone in women. However, the transition to menopause cannot be predicted exactly by AMH. Rather, the AMH provides information about the reserve of a woman’s egg cells, which usually declines dramatically during menopause.

A distinction is made between the monthly menstrual cycle and the ovarian cycle. The woman’s ovarian cycle lasts about a year and is the basis for a functioning egg maturation phase in the menstrual cycle. The AMH level is a direct indicator of a woman’s egg cell supply (ovarian reserve). So you can make two very important diagnoses for extreme values. For example, if a 19-year-old woman has an AMH level of less than 1, her egg cell supply is clearly too low. She probably has only a few optimal years left to get pregnant. One can imagine that the life planning of the 19 year old woman can be turned upside down with such a diagnosis. Conversely, one can infer the well-known PCOS from AMH values that are clearly too high. Measuring the AMH level will be one of the most important tools for early diagnosis of PCOS in the near future. This means that we will be able to diagnose women with PCOS much faster and more precisely in the future.

I recently read that the measurement of the AMH is subject to enormous fluctuations. That would mean that you can hardly rely on the measured values. Are diagnoses of fertility or PCOS not really unreliable?

Yes, there are still technical problems with measuring the AMH level. These will be resolved shortly with a new test system (assay). This means that the predictions and diagnoses will also be reliable. With extreme values, however, diagnoses are already reliably possible.

I found the study on the question “Does weight have an impact on fertility?” (Kubka MS 2011), which you recently participated in, particularly spectacular. Can you summarize the results briefly?

This study mainly examined how the success rate of modern methods of reproductive medicine (IVF, ICSI) is dependent on the weight of the man or woman. Here, IVF showed the highest success rate when the man is slightly overweight. ICSI had the highest success rate in couples where either the man or the woman were slightly overweight. The worst success rate for both methods was when the woman was clearly overweight. In general, the study shows that weight already has an impact on fertility. However, I would not advise a woman to gain or lose weight before IVF or ICSI treatment. For me, the study has more of an informative character when you treat a couple with a certain weight constellation.

You recently published a very interesting study (Gnoth 2011) from your practice, which says that around 85% of her patients have a child within 12 cycles using methods of assisted reproductive technology (IVF, ICSI, cryo). This is a similarly good birth rate to that of healthy women in their prime. Isn’t that the wrong message for couples who are delaying their desire to have children in favor of their careers??

The high birth rate applies to all of our patients of all ages. In patients over 40 years of age, the birth rate is only around 25 percent. I also can’t turn the woman’s biological clock back. Likewise, 12 cycles can be a very long, exhausting time. The procedures and methods are both psychologically and physically stressful for the patients. I still admire the patience and strength of many couples in my practice. Even if my desire to have children is my daily routine, I would advise all women to get pregnant naturally at the best biological age. I also interpret the results of the study somewhat differently than you do. The study shows that reproductive medicine can try so hard, it can bring the reduced fertility of a couple back to the natural level, but not exceed it. In principle, we can only use the methods of assisted reproduction technology to reproduce what is in the body of the women and men is stuck to return to natural normal levels.

For me it is fascinating that the symptothermal method can limit ovulation to a few days (Frank-Herrmann 2005). Do you also use NFP for cycle diagnostics in the case of an unfulfilled desire for children in your practice? How ready are your patients to learn the NFP method??

Of course, it is impressive what possibilities the NFP method can offer in diagnostics and in the limitation of ovulation. For the desire to have children, the most important fertility indicator by far is the cervical mucus, well before the basal temperature or any hormones, which I was able to show together with other scientists (Bigelow 2004). For this reason, I explain to my patients very precisely what the cervical mucus is, how it is observed and when it is best to have traffic to get pregnant. However, NFP also includes basal body temperature measurement, but this is a little too expensive for some patients. However, if I can encourage them to document their cycles symptothermally, I would of course like to use this recording for diagnostics.

Many couples think that having sex every 24 hours is optimal for having children. Such information does not put the couples under too much pressure?

It’s nice that you mentioned that. Yes, many couples can feel enormous pressure from such statements. For this reason, I talk about this topic very differently at the fertility clinic. The fact is that if you had traffic at least once during the two to three days with the best mucus quality, you used about 80 percent of the individual conceptual opportunity in this cycle. So it is not the quantity that matters, but the right timing. As is well known, sperm can remain fertile in the woman’s body for up to 5 days, which also gives a certain amount of leeway in terms of timing.

Despite your work in the field and your really extensive research, you take the time to fly to Eritrea and help people there almost every year. What exactly do you do there and how did your annual assignment in Eritrea come about??

The desire to have children is a very central issue in Eritrea. For women, having a child is worse than not having a husband. Women without children are marginalized in society. For this reason, the desire to have children is very large. If this is not the case, a lot is at stake for women, their whole social existence. Now in Eritrea there are no technical possibilities for reproductive medicine. Likewise, ultrasound examinations or hormone measurements are rarely possible. The only tool that people in Eritrea have to learn about and optimize their fertility is fertility awareness. Natural methods also play a very important role in contraception, since the pill is often rejected for various reasons or is not available. That’s why I help train new gynecologists for about 10 days a year to help them a. to convey the necessary NFP knowledge.

There is probably no one more suitable to look a few years into the future with their specialist knowledge of the desire to have children. Where do you think the NFP will be when it comes to having children in the next 5 to 10 years?

First of all, the absolute priority is to bring the natural cycle back into the consciousness and "life" of women in the next 5 years. The natural cycle is currently “abolished,” often before the cycle can develop it is masked by hormonal contraception. When the desire to have children comes in the mid-thirties, the cycle is often stimulated by hormones to stimulate it again. This development has to be stopped, because women have a scientifically sound alternative both with the desire to have children and with contraception with NFP.

For this to succeed, however, the NFP must evolve and become more modern and practical. In my opinion, it is not enough that the cycles are no longer recorded on paper, but on the smartphone. In my view, the temperature measurement must also change significantly, and companies like duofertilty provide interesting approaches. If you want to spread the NFP widely and "make it socially acceptable", the temperature must be comfortable, e.g. B. can be measured without problems on the skin using a watch. Measuring sites like the vagina, mouth or anus are not suitable for the masses. I also experience this in daily practice with my patients. In addition, it would be much better if the evaluation did not require the cervical mucus. Maybe in the next 5 years a completely new NFP method can be developed, which uses only a continuous temperature measurement over the skin.

In addition, the way we learn NFP methods has to change. In my opinion, classic NFP advice has no future. Nowadays, people learn conveniently online on a PC. For this reason, the online advisory service must be improved and expanded.

In addition, the hormone computers that combine hormone measurements in the urine with the NFP regulations will gain in importance because they will develop enormously and deliver precise results. This will primarily affect the area of conception optimization.

The chances for a nationwide distribution of NFP methods are better than ever in the next 5 years, because more and more people are developing health and sustainability awareness in all areas of life. If we can jump on this train, everything is possible.

Nfp at fertility – interview with pd dr