For myself and my friends and colleagues who embrace authentic reproductive healthcare, the evidence for fertility awareness и restorative reproductive technology (RRM) is often very personal. It’s the belief that comes from experiencing, or seeing someone else experience, symptom relief when nothing else worked, a diagnosis of a mystery condition, a pregnancy when hope was all but lost, or developing a better relationship with one’s body. It’s getting off the pill and becoming the healthiest you’ve ever been. It’s having healthy babies after многочисленные выкидыши. It’s finally having a game plan for the endometriosis that caused years of debilitating pain. It’s about feeling like there’s hope and clarity during perimenopause at the other end of the reproductive continuum.
While this evidence is real and speaks to the heart better than numbers and statistics ever could, it’s not the hard-hitting evidence that can stand up against the rampant biases and misinformation that fertility awareness и RRM face. But in November 2025, the largest NaProTechnology study to date was published, providing valuable information and insight into the effectiveness of NaPro (and, by extension, perhaps other forms of RRM) in a clinical setting.
Что такое NaProTechnology?
Технология естественного оплодотворения, or simply “NaPro,” is a women’s health science that utilizes treatments and approaches that cooperate с a woman’s body rather than trying to control or work against her natural biological processes. NaProTechnology was developed by Dr. Thomas Hilgers, MD, at the St. Paul VI Institute for the Study of Human Reproduction in Omaha, Nebraska. As the November 2025 исследование puts it, NaPro is “grounded in detailed evaluation of physical, biochemical, and ultrasound (US) biomarkers of the menstrual cycle” and “the primary objective [is] restoring physiological function to facilitate natural conception [1].”
This is the main difference between NaPro and other RRM approaches vs. artificial reproductive technologies (ART). ART seeks to get an egg and sperm together by any means possible, using intrauterine insemination (IUI) and/or in vitro fertilization (IVF), even if it’s not the couple’s own genetic material. Experiences vary widely, but couples on an ART track have to navigate a миллиардная индустрия с little oversight, and an increased risk of осложнения беременности should successful conception ever take place. Conversely, couples who pursue NaProTechnology typically walk away from their treatment healthier than when they started, with underlying issues addressed, hormones balanced, and a new lifestyle to manage any continuing symptoms—and, often, they also take home a healthy baby with them.
The importance of large-scale NaPro and RRM studies
While I hope that NaProTechnology will continue to expand and become more accessible (and that awareness of it will continue to grow), it will never be a billion-dollar industry like IVF. No one is charging couples thousands of dollars to learn to chart cycles—the first step towards utilizing restorative care. And I can’t imagine a doctor or nurse meeting with a couple in an IVF clinic and saying, “You know what? I know you’ve been trying to conceive for a couple of years, but jumping straight into IVF still feels drastic. What if all you need is some supplemental progesterone? Just hang on to that 15K for right now and we’ll get a good understanding of how your body is functioning first.” (And if you think that’s a cynical take, consider that a recent paper published in JAMA found that, in 2023, over half of IVF cycles in the country were done at clinics affiliated with private equity firms—a number that has almost assuredly increased in 2026.)
All that to say, it’s difficult to win support for RRM without the vast money and resources available to proponents of ART—but that’s where good data comes in. Data can show that the anecdotal evidence of everyday miracles accomplished by NaPro are common experiences rather than outlying cases, offer an argument to skeptics, and ultimately help women to make better informed decisions about their healthcare options.
Data can show that the anecdotal evidence of everyday miracles accomplished by NaPro are common experiences rather than outlying cases, offer an argument to skeptics, and ultimately help women to make better informed decisions about their healthcare options.
The aforementioned November 2025 NaPro studyОпубликовано в Рубежи в области репродуктивного здоровья by Sánchez-Méndez et al., involved collecting and analyzing data from 1,310 couples receiving care from the Fertilitas Center in Madrid, Spain (hereafter referred to as “the Fertilitas study”). The Fertilitas study was a retrospective analysis looking back over a 5-year period, ending December 2023, and identified factors that seemed to influence a couple’s take-home baby rate (THB) (excluding pregnancies that ended in miscarriage, stillbirth, or neonatal death before hospital discharge). Overall, the take-home baby rate was considered “notably high,” with a crude rate of 35.5% for all the couples included in the study, and the much-higher THB rate of 62.1% when adjusted for couples who discontinued treatment sooner than recommended [1].
Four key takeaways from the 2025 Fertilitas Center NaPro study
#1 Early intervention is key
While it’s not a new discovery that age impacts fertility, the Fertilitas study reinforces the importance of age as a factor. The pregnancy rate was “87.3% in women under 30 years, 63.2% for ages 30–35, 53.3% for 36–40, and 24.4% for those over 40.” The average age of participants was 35.0 for women and 36.9 for men, and these couples had been trying to conceive for an average of 24 months prior to becoming patients at the Fertilitas Center.
A general recommendation is that couples seek infertility treatment after 12 months of trying to conceive. This is significant as the average duration of infertility for couples who took home a baby at the end of treatment was only 18 months rather than 24. For patients who required surgical treatment, the average wait time for surgery was 4.1 months for patients who ended up with a baby, versus 7.2 months for the couples who unfortunately did not [1]. Fertility decreases with age, while the severity of symptoms and functional problems can increase as time goes on. The statistics presented by this study highlight that treating root problems early on offers the best chance at healing and successful natural conception.
#2 “Infertility” (especially “unexplained infertility”) is not a complete diagnosis
The 2025 Fertilitas study references this 2014 review on infertility, which found that a “standard fertility evaluation” would fail to identify a cause of infertility 15–30% of the time, and suggests that approximately one-third of ART patients have unexplained infertility [2]. This Обзор 2024 года on unexplained infertility found that in studies that looked at unexplained infertility, of the 258 studies analyzed, only 56.1% checked progesterone levels in the luteal phase, 42.2% assessed ovulation by the patient reporting whether or not she had a history of regular cycles, and a hormone profile was created in less than 50% of cases [3]. This is wildly different from the NaPro approach, which prioritizes discovering and treating the root cause of infertility first and foremost.
Case in point: the Fertilitas study separated couples by infertility type (primary, secondary, or recurrent loss) and by the specific diagnosis of infertility. Not only were couples не stuck with an “unexplained” label, but the average couple received 2.5 diagnoses in the diagnosis stage of NaPro treatment, and started an individualized treatment plan accordingly. The Fertilitas study also identified factors that responded well to NaPro intervention and resulted in higher take-home baby rates. This included infertility due to recurrent pregnancy loss (2.7x higher THB than primary or secondary infertility), diagnosis of functional disorder/hormonal abnormalities (1.5x higher THB than no diagnosis), diagnosis of endometriosis (1.6x higher THB than no diagnosis), male factor infertility (1.5x higher THB than no diagnosis), and a lower average number of diagnoses [1].
The Fertilitas study separated couples by infertility type (primary, secondary, or recurrent loss) and by the specific diagnosis of infertility. Not only were couples не stuck with an “unexplained” label, but the average couple received 2.5 diagnoses in the diagnosis stage of NaPro treatment, and started an individualized treatment plan accordingly.
While it might sound odd that having hormonal abnormalities or endometriosis was considered a “favorable condition” for a later successful pregnancy, this is in comparison to other conditions that contribute to infertility. NaProTechnology is well suited to identifying and correcting hormonal imbalance while structural factors like damaged fallopian tubes are harder (although by no means impossible) to treat.
#3 NaPro requires time and commitment
One of the limitations highlighted by the authors of the Fertilitas study was the high dropout rate seen in this study and in similar studies. The clinic advised patients to remain in the program for 18–24 months, but 21.4% of couples discontinued treatment during the first year, and 37.5% discontinued treatment by the end of the second year.
Amongst those who dropped out in the first year, not all couples gave a reason for leaving, but the top reason cited was discouragement (31.5% of couples) followed by transition to ART (17%) [1]. As this Исследование 2021 года on ART in Spain noted, it can take about a year for couples to get an ART appointment through the Spanish public healthcare system [4]. The authors of the Fertilitas study noted that it was very likely that some couples joined the NaPro program at Fertilitas in order to start some form of infertility treatment while waiting for an ART appointment to become available, and left Fertilitas once their “plan A” became available.
While the overall THB rate for the Fertilitas study was 35.3%, the rate jumped up to 62.1% for patients who stuck with the program. This accounts for the fact that patients in each treatment time group were bringing home babies after up to 33 months total treatment time. Granted, the majority of successful pregnancies (72.4%) occurred during the first year of treatment, and it’s understandable that couples would feel discouraged after a year of treatment and want time for emotional recovery or to seek out other options. However, the adjusted cumulative take-home baby rate at one year was only 28.9% compared to 62.1% at 33 months [1].
This calls for further study to better understand why couples withdraw from treatment, and how infertility care professionals can better support patients through long-term treatment since the evidence seems to support giving NaPro a chance for two years—and potentially longer.
#4 The ART question
Another interesting correlation in this study is that couples with prior ART had a THB of 25.3% compared to the THB of 39.2% for couples with no prior ART. This study does not offer details into what “prior ART” might mean from couple to couple, whether it was a one-time IUI treatment or multiple failed IVF treatments, which makes it difficult to speculate on what specific factors may be in play. Nor does the study describe what factors tended to be associated with one another.
It may be that couples with failed ART had more complicated infertility cases to begin with, and thus a lower chance of successful pregnancy in a NaPro program as well. However, as was recently described in our article on замораживание яйцеклеток, egg harvesting (an integral part of the IVF process) poses risks to future fertility, including abdominal adhesions and the formation of anti-ovarian antibodies. It may be that the 13.9% lower take-home baby rate for couples with prior ART is a sign that the way IVF overrides the reproductive system can cause lasting harm, and women should be informed of this risk prior to receiving IVF treatments.
It may be that the 13.9% lower take-home baby rate for couples with prior ART is a sign that the way IVF overrides the reproductive system can cause lasting harm, and women should be informed of this risk prior to receiving IVF treatments.
Ограничения исследования
The authors of the Fertilitas study were transparent about the fact that this study set out to collect observational evidence—and that’s exactly what it did. It was a retrospective study, so participants were not recruited based on specific criteria (and indeed, some of the couples in this study were simply waiting for their ART appointment!), and patients had experienced infertility for longer than NaPro programs recommend prior to starting treatment.
On the one hand, the Fertilitas study painted an accurate picture of the real-world situations in which NaPro is frequently employed. On the other hand, this contributes to factors like high drop-out rate, which make it more difficult to accurately understand the successful pregnancy rates one might expect to see in an ideal NaProTechnology clinical setting. Furthermore, this type of study has no control group, and no comparisons made between other infertility treatment strategies. And while having a randomized control trial would be ideal for data, randomly assigning infertile couples to NaPro, IVF, or no-treatment groups would hardly be ethical.
And while this 12 page study was interesting, I honestly wish there was a 120 page version of the study available. I understand why they used categories like “functional disorder” to be able to run a statistical analysis with a manageable number of factors, but I had more questions the more I read. What were the most common hormonal abnormalities they ran into? Which were the easiest to treat? How was treatment different for recurrent pregnancy loss patients versus those with primary or secondary infertility? How did diagnoses between the primary and secondary infertility groups differ? How did symptoms like pain improve, even for patients who did not achieve pregnancy? The study mentioned that patients received a multidisciplinary approach that included “gastroenterologists, immunologists, endocrinologists, psychiatrists, nutritionists, and psychologists [1];” how many patients met with these different specialists, and how did that impact their treatment experience?
While a retrospective analysis probably didn’t have access to much of this information, future case-studies and clinical studies could be designed to provide more information and look for further trends.
Our hopes for future studies on NaPro and RRM
The Fertilitas study provided encouraging evidence for the successful pregnancy rates observed in a large NaPro clinic, and we hope it is the start of more and bigger research into fertility awareness and RRM. It would be wonderful to investigate outcomes besides pregnancy rate, such as success of endometriosis, PCOS, or fibroid treatment on pain and other quality of life factors.
Speaking of endometriosis treatment, future studies should aim to collect information on RRM surgical procedures with the hope of optimizing and standardizing surgical protocols and making these procedures more accessible to patients, especially since this study noted that having to wait longer for surgical treatment lowered the chance of success, and a full third of the patients in the study required some sort of surgical intervention [1]. And lastly, how can couples receiving infertility treatment that may take more than one year receive adequate support to avoid as much stress and discouragement as possible? With more long-term and multi-center studies, more answers can be found for the excellent questions raised by this study.
