SAT-LB3 Developing an Integrative Medicine Patient Care Protocol for Natural Fertility in Primary Infertile Couples: A Case Series

Background:Although advances in the field of Assisted Reproduction have improved significantly the reproductive outcome for infertile couples, success rates nonetheless remain low. Furthermore, several infertile couples are skeptical of using experimental or even established ART treatments, resulting in the need for reproductive health professionals to discuss other models which might best benefit patients who need fertility care.Clinical case series:All patients that were referred to our clinic for primary infertility (no positive pregnancy test after at least 2 years of unprotected intercourse) and had been either offered to proceed with IVF or had already a history of at least 1 failed IVF cycle, in the course of 1 year (March 2018-February 2019) were included in this study. All patients were younger than 42 years of age, AMH less than 1 ng/mL, FSH less than 12 IU/L (follicular phase FSH normal range 2.8-9.3 IU/L) and normal ovulation was present. Couples were counseled regarding a novel integrative model of achieving spontaneous pregnancy through expectant management while modifying key parameters affecting female fertility, developed after evidence-based appraisal of all relative literature. All 14 patients were examined for insulin resistance, subclinical thyroid disease, thrombophilia, and chronic endometritis and were offered the appropriate treatment, aiming for optimal (as opposed to within normal range) figures. For chronic endometritis both spouses received a one-month long triple antibiotic treatment. All patients were given careful personalized nutritional and vitamin supplementation guidelines. Regarding the psychological component of fertility all patients underwent monthly homeopathy and/or weekly acupuncture courses. All patients were designed to be followed-up for 6 months after completion of treatment (9 months after antibiotic treatment). 3 patients dropped out before receiving full treatment (rate 21%). 2 patients did not have a positive pregnancy test. All 9 remaining patients came back with a positive pregnancy test (rate 81% of those who completed treatment) on the first month of follow-up that resulted in an uncomplicated pregnancy and delivery of healthy singleton babies. Conclusion:This is the first case series indicating that expectant management could be the answer to some cases of infertility. Poor responders are sometimes reluctant to be involved in the global trend of IVF and ART, therefore a more holistic integrative approach might balance the imbalances and increase their fecundity. However, no causal inferences should be made from this consecutive case series regarding the efficacy of the investigated treatment.