Beruflich Dokumente
Kultur Dokumente
Women's Health
1
http://www.popepaulvi.com/ncfwh-evaltreat.htm
Prematurity Prevention
PMS
Ovarian Cysts
Repeated Miscarriage
Endometriosis
Postpartum Depression
Perimenopausal/Menopausal Care
Getting Help
NCWH Home
Contact us:
Pope Paul VI Institute
6901 Mercy Road
Omaha, Nebraska 68106
(402) 390-6600
Fax: (402) 390-9851
e-mail: ppvinurses@gmail.com
2
Evaluation and Treatment Programs
The National Center for Women's Health not only offers general obstetrics, gynecology and
gynecologic surgery, but also specializes in the provision of care for patients with the following
conditions:
---------------------------------------------------------------------
3
Infertility Program
The Pope Paul VI Institute Infertility Program, one of the few that exists in the United States, is a
disease-based approach which recognizes that "all infertility (or other reproductive problems) are
caused by some type of organic or functional disease process." Unlike the current medical approach
which typically involves limited evaluation, patients at the Pope Paul VI Institute will receive a
complete evaluation and a sound explanation as to why they are having problems achieving or
maintaining a pregnancy. The organic or functional causes of infertility can be relatively easily
diagnosed and treated.
• Endometriosis
• Pelvic adhesions
• Polycystic ovarian disease
• Obstructions of the fallopian tubes
• Hormonal dysfunctions
• Ovulation-related problems
• Previous chlamydia infections
• Hypothalamic amenorrhea
Infertility and related problems (such as repetitive miscarriage and tubal pregnancy) are best treated
with a comprehensive approach to diagnosis and treatment. A typical evaluation includes serial
hormone evaluation, a follicular ultrasound series, laparoscopy, hysteroscopy, and selective
hysterosalpingogram. A seminal fluid analysis is recommended for the man if this has not been done.
After evaluation, the physician conducts a comprehensive planning session with the couple during
which the couple is shown the videotape of their laparoscopy and the various causes of the
reproductive problem and the treatment plan for those difficulties are explained. Because it is a
disease-based approach, the disease that caused the reproductive problem for the woman (and/or her
husband) can be either eliminated or satisfactorily treated.
4
Effectiveness
By identifying and treating the underlying diseases that cause infertility, the Institute harnesses the
body's ability to work more effectively as opposed to "driving" the reproductive system, "pushing"
the system, or trying to "replace" the system. The effectiveness of the program varies depending
upon the type of disease that occurs. In some cases, the Institute's effectiveness is greater than 80
percent in assisting a couple to successfully achieve a pregnancy. In many common infertility
problems, the success rate will be 50 to 75 percent. In some more uncommon infertility problems, the
success rate will be lower than that but almost always higher than the rates expected from programs
driven by the artificial reproductive technologies (in vitro fertilization, artificial insemination, etc.).
While the infertility program of the Pope Paul VI Institute is one of the most successful in the United
States, a pregnancy can never be guaranteed.
NaProTechnology-Driven
The new medical science of NaProTechnology is geared toward the evaluation, study and treatment
of reproductive and gynecologic problems. It allows for evaluation and treatment that are
cooperative with the reproductive system (which in this case is working abnormally). Thus,
pregnancy can occur with a normal act of sexual intercourse. The system is natural and is acceptable
to everyone. The treatments carry a very low incidence of multiple births and a low incidence of
subsequent tubal pregnancy and miscarriage--both are common problems associated with the
programs of the artificial reproductive technologies.
Because the woman is charting her cycles, very accurate hormonal evaluations can be accomplished
and the various biological markers and their role in the infertility problem can be assessed. It is the
most effective means currently available (including comparisons to urine test kits for ovulation) for
determining the point in the menstrual cycle when a woman is fertile.
5
To learn how to NaProTRACK™ your cycles, enter Creighton Model FertilityCare™ System.
Affordable
Infertility treatment is often not covered by insurance programs. Artificial reproductive technology
programs run more than $10,000 per menstrual cycle and up to $150,000-$200,000 (or more) per
successful pregnancy.
At the Pope Paul VI Institute, evaluation likely includes NaProTRACKING™ the menstrual cycle, a
hormone profile, a follicular ultrasound evaluation, a selective hysterosalpingogram, and a diagnostic
laparoscopy. Test results might indicate the need for more treatment, including surgical intervention.
However, the overall cost of the program at the Pope Paul VI Institute is only a fraction of the cost of
a program that revolves around the artificial reproductive technologies.
Many couples come to Omaha for a 7-10 day stay to accomplish a complete infertility evaluation. The
nurses will help you through this process and are available for any questions.
6
Prematurity Prevention Program
Prematurity, one of the major complications of pregnancy, affects approximately 10 percent of all
pregnancies. Premature birth carries a significant risk of complications. In most circumstances, the
best incubator for the baby is the mother's womb. Modern medicine has not been able to duplicate
the womb's ability to care for the baby's growth and development needs.
Premature birth also necessitates prolonged hospital stays for the baby, thus affecting the baby's
early infancy environment. While neonatal intensive care units are capable and the baby's survival is
good (especially after the 28th week), having a baby in intensive care decreases the ability of the
parents to bond with the newborn and their ability to provide the newborn with the needed love and
affection. Moreover, intensive care nursery is expensive.
For these reasons, a pregnancy should be maintained as long as possible (so long as everything else is
normal). The Pope Paul VI Institute has introduced a Prematurity Prevention Program based on 20
years of research. While the national preterm birth rate is approximately 10 percent, the
prematurity birth rate at the Pope Paul VI Institute is less than 4 percent. This is the result of an
aggressive and pro-active management program.
• Previous prematurity
• Exposure to Diethylstilbestrol (DES)
• Cervical incompetence (congenital, acquired, or family history)
• Previous repetitive miscarriages
• Placenta previa
• Malformations of the uterus or large uterine fibroids
• Cervical cone biopsy
• Multiple pregnancy (twins, triplets, etc.)
• Persistent uterine irritability
• Excessive amniotic fluid (polyhydramnios)
• Severe kidney or urinary tract infections
• Age less than 18 years or greater than 35 years
• Smoker
• Infertility or other reproductive disorders
• Low grade uterine infection
Ultrasound Monitoring
Ultrasounds are performed at 6 to 8 weeks, 14 weeks, and 18 to 22 weeks to evaluate patients at high
risk of preterm birth. Changes in the cervix, which have been undetected by the obstetrician till now,
can be detected many weeks prior to the onset of preterm labor. Detection of dramatic changes
allows for implementation of treatment options.
7
Treatment Approaches for the Prevention of Preterm Birth
For patients that exhibit increased uterine contractions during the course of their pregnancy and
exhibit those signs that are suggestive of an increased risk for preterm labor, the physician will
implement a number of treatment options. These treatment options may include the following:
• Bed rest
• Hydration
• Urinalysis
• Progesterone therapy
• Tocolytic agents
• Cervical cerclage
• Pulsed antibiotic therapy
A Team Approach
Preterm birth can be prevented in the majority of circumstances. At the same time, accomplishing
such a goal is a team effort. It is extremely important that you, the patient, recognize the part you
play on this team. Your self monitoring of uterine contractions in pregnancy is critical to pregnancy
health maintenance and should be a part of your obstetrical management. It has been the physician's
experience that this is more effective than electronic monitoring of uterine contractions. The
physicians and nurses are also part of the team. Good communication is the key.
Finding Help
If you are at high risk for preterm labor or have previously had a preterm delivery, you can obtain
help at the Pope Paul VI Institute. An appointment with the physicians at the Pope Paul VI Institute
can be made by calling (402) 390-6600. You may also call for a long-distance telephone consultation
with a registered nurse. Indicate that you are at risk for pre-term labor.
8
Premenstrual Syndrome
Premenstrual syndrome (PMS) is a medical condition with a combination of emotional and physical
symptoms that can disrupt your health, work, and personal life. The symptoms can occur on a
regular basis during the premenstrual phase of the menstrual cycle (7 to 10 days prior to the onset of
menstruation). It can be a very debilitating condition.
PMS symptoms are very real. There are 150-200 different symptoms associated with PMS. Common
symptoms are bloating, fatigue, irritability, depression, teariness, breast tenderness, carbohydrate
craving, weight gain, headache, and insomnia. These begin to occur at least four days prior to
menstruation.
It is important to distinguish symptoms which are present premenstrually and those that are present
all of the time, e.g. symptoms associated with depression.
Evaluation
Your physician will ask you to begin charting your cycles using CREIGHTON MODEL
FertilityCare™ System. After you have two months of charting, the doctor will recommend a
hormone evaluation which will be timed in cooperation with your charting. By timing the hormone
evaluation based on the information provided by your chart, your physician will be able to determine
the extent to which progesterone and estrogen levels are deficient. Premenstrual syndrome has
generally been considered to be a progesterone deficiency condition. Studies have also shown that
decreased levels of beta-endorphins may be present. In many patients with PMS, a relative degree of
hypothyroidism is also present.
Medical Treatment
In some cases your doctor may prescribe medication to reduce your symptoms. These include:
If thyroid levels are high or low, a small amount of thyroid medication may be recommended.
A drug used by the Pope Paul VI Institute Physicians in treating PMS is naltrexone. In patients with
low beta-endorphin levels, naltrexone acts to lower the tissue levels of beta-endorphin and allows for
more normal ovarian function. This is especially helpful if anxiety is a major PMS component.
Effectiveness of Treatment
Based on research at the Pope Paul VI Institute for the Study of Human Reproduction, the
overwhelming majority of patients treated according to our protocols feel significant improvement.
9
Abnormal Uterine Bleeding
Each month, the endometrium--the lining of the uterus--builds up and sheds. An average menstrual
cycle lasts about 28 days, counting from the first day (day 1) of one period through the last day
before the beginning of the next. However, a normal cycle may be shorter or longer than this ranging
from 21 to 35 days. The menstrual period is the time during the cycle when bleeding occurs and may
last from 3 to 7 days.
Abnormal bleeding is bleeding that is not regular, lasts longer, or is heavier than usual. This
information describes abnormal uterine bleeding and explains its causes and treatments.
Abnormal bleeding may be the result of a hormonal imbalance. This imbalance can make bleeding
longer or shorter than usual, or periods may be more or less frequent.
Besides lack of ovulation and other hormone imbalances, irregular cycles may occur because of
weight loss or gain, heavy exercise, stress, illness, or use of drugs. Pregnancy can also cause missed
periods or abnormal bleeding. If you think you might be pregnant, you should see your doctor.
Some vaginal bleeding is not from the uterus and may come from other areas.
Diagnosis
To diagnose abnormal uterine bleeding, your doctor will ask you about your medical history and will
give you a physical exam. It is helpful for you to chart the dates and length of your periods by using
the CREIGHTON MODEL FertilityCareTM System. This is an excellent and accurate means of
monitoring the abnormal bleeding. The tests used to diagnose abnormal uterine bleeding may be
based on that charting and the symptoms you are having.
10
Your doctor may perform a biopsy, in which a small amount of the tissue lining the uterus is
removed and looked at under microscope. Cultures of the cervix and vagina may be performed to
check for infection.
• Ultrasound
• Laparoscopy
• Dilation and curettage (D&C)
• Hysterosalpingography
Some of these procedures can be performed in a doctor's office, while others may be done in a
hospital with anesthesia.
Treatment
Treatment for abnormal uterine bleeding will be based on the diagnosis. It may involve surgery or
taking hormones, iron, or other drugs. When hormones are indicated, they are given cooperatively
with the woman's cycle, based on her NaProTRACKING.
11
Ovarian Cysts (Recurrent or Otherwise)
Many women suffer from the recurrence of ovarian cysts. These can become quite painful and when
they present themselves, it is common for the physician to recommend either birth control pills for
their treatment or surgical intervention sometimes leading to removal of the ovary. In both cases,
these treatments are generally unnecessary.
It is helpful to understand the basic workings of the development of the two major types of ovarian
cysts:
With the beginning of the menstrual cycle, the ovary generally does not have any cysts on it or they
are very small or left over from the previous cycle. However, as ovulation approaches, there is a cyst
that develops on the ovary called the follicle. The egg is located inside the follicle. At the time of
ovulation, the follicle ruptures and the egg is released. The follicle then becomes a corpus luteum,
which produces progesterone and estrogen. These two hormones prevent the further cystic
development on the ovary. When these two hormones are no longer produced (approximately 13
days following ovulation), then menstruation occurs and the process starts all over again.
Treatments
Because both of these types of ovarian cysts are related to abnormal hormone function as the
primary cause, one can realize that surgical intervention or treatment of these is generally not
helpful. In particular, it does not help in the recurrence of these cysts. It may help, of course, in the
management of the initial situation but it does not help recurrence of these because surgery does not
get to the basic problem that causes these ovarian cysts. Nonetheless, surgical management is often
recommended.
12
The management of these problems is primarily hormonal. Many physicians will recommend the use
of birth control pills for this hormonal management, however, that also does not get to the
underlying problems.
At the Pope Paul VI Institute, we recommend that the patient learn how to NaProTRACK her
menstrual cycles. This allows her to record the various biological markers that key the events of the
menstrual cycle. She can do this by learning the CREIGHTON MODEL FertilityCare™ System.
With a persistent follicular cyst she will have a prolonged preovulatory phase; with a luteal cyst she
may have a prolonged postovulatory phase. In either case, when the patient presents with pelvic pain
and an ovarian cyst, an evaluation of the recordings of the biomarkers can be connected with the
symptoms that the patient has an ovarian cyst, a reasonably exacting diagnosis can be made.
In both cases, treatment with natural progesterone is the answer! The progesterone can be given
cooperatively with the woman's cycle.
13
Repeated Miscarriage
Miscarriage, often called spontaneous abortion by doctors, is the loss of a pregnancy before 20 weeks.
It occurs in about 15-20% of all pregnancies. Most happen in the first three months. Three of more
miscarriages in a row may be called repeated miscarriage (or habitual abortion). Women who have
repeated miscarriages need special tests to try to find the reason for them.
After several miscarriages, you may wonder whether you will ever be able to have a healthy baby. Be
hopeful. The chances of having a successful pregnancy are good even after more than one
miscarriage. The approach of the doctors at the Pope Paul VI Institute is to diagnose what is wrong,
to correct it, and then to support any future pregnancies with hormonal support as soon as the
pregnancy is diagnosed.
Causes
Often, the reasons for repeated miscarriage is not known. Sometimes, however, it has a definite
cause. Examples of known causes include:
• Hormone imbalance
• Illnesses in the mother
• Disorders of the immune system
• Abnormalities of the uterus
• Environmental and lifestyle factors
• Chromosomal problems
If you have had more than one miscarriage, each may have had a different cause.
Diagnosis
Because repeated miscarriage has many possible causes, your doctor will need a great deal or
information to diagnose the problem. You will be asked about your medical history and past
pregnancies, as well as your lifestyle. A complete physical exam, including a pelvic exam, is also
important.
The doctors at the Pope Paul VI Institute will ask you to begin charting your cycles using the
Creighton Model FertilityCareTM System. By using your chart as a tool, our diagnostic procedures
and treatment can be performed and administered more effectively. It allows you and your physician
to work in cooperation with your natural cycle. At times cycle abnormalities will become evident in
your charting. This information is invaluable to your physician.
14
treatment may be very helpful both before the baby is conceived and during the pregnancy. The
physicians at the Pope Paul VI Institute believe in immediate support with progesterone and possibly
human chorionic gonadotropin depending on the woman's history.
1. Have a complete medical workup before you try to get pregnant again. It may be that the
cause of the miscarriages can be found and treated by your doctor.
2. If you think that you might be pregnant, see your doctor right away. The sooner you seek
prenatal care, the sooner you can receive any special care that you may need.
3. Follow your doctor's instructions. He or she will tell you what you need to do to keep
yourself and your baby as healthy as possible.
Finally...
Even if you have had repeated miscarriages, you still have a good chance to have a successful
pregnancy. Future pregnancies will need prompt, early evaluation. Your doctor will check your
pregnancy closely and provide any special care you may need as your baby grows.
15
Dysmenorrhea and Pelvic Pain
Dysmenorrhea refers to cramps which may occur beginning a few days prior to menstruation and
continue for several days during the menstrual flow. These cramps are due to the actual contraction
of the muscle of the uterus as it expulses the lining of the uterus at the time of menstruation.
Menstrual cramps can be very severe and immobilizing. They can cause one to miss work, school,
etc. It can be associated with nausea, vomiting and rectal pain.
Almost always, this pain is due to some type of underlying organic disease which does lend itself to
specific treatment strategies which are very often successful.
Causes
• Infection
• Endometriosis
• Pelvic adhesions
• Cervical stenosis
Evaluation
Evaluation may include:
It is helpful in evaluating your pain to NaProTRACK your menstrual cycles. By learning a system
for recording the events of your menstrual cycle, you can keep a careful record of your pain.
Treatment
• Oral medications called prostaglandin inhibitors (such as Advil, Aleve, Motrin, Naprosyn,
Anaprox, Cataflam) are often the beginning treatment
• If these are not helpful, then a diagnostic laparoscopy with laser vaporization of the
endometrial implants.
Very often, the birth control pill (BCP) is prescribed for dysmenorrhea. The disadvantage to using
the pill to treat this is that it is not diagnosing or correcting the problem. It is masking or suppressing
the symptoms. You also have to deal with the annoying and harmful side effects that the BCP causes.
More importantly, so many of these changes in the menstrual cycle from the pill have the ability to
affect fertility long term. Therefore, in order to have the best chance at preserving fertility and
avoiding infertility, it would be best to avoid the birth control pill as a solution to cyclic pain.
16
Endometriosis
Endometriosis is a condition in which tissue that looks and acts like endometrial tissue is found in
places other than the lining of the uterus, such as ovaries, tubes, bowels, outer surface of the uterus
and other pelvic structures. Endometriosis may also develop on body tissues located anywhere in the
abdomen. These tissues respond to the cycle of changes brought on by the female hormones just as
the endometrium normally responds in the uterus. Endometriosis can cause pelvic pain,
dysmenorrhea, and infertility.
Diagnosis
An accurate diagnosis can be obtained only by a procedure called laparoscopy. This is an out-patient
surgery done under general anesthetic, with a slender light-transmitting telescope that is inserted
through a tiny cut made in the lower abdomen. This enables the doctor to view the pelvic organs and
to actually see if endometriosis is present.
Treatment
Different types of treatment may be needed for endometriosis:
• Laser Laparoscopy
Spots of endometriosis can be removed from their abnormal locations by laser at the time of
the diagnostic surgery. This procedure is often recommended for mild and moderate
endometriosis. About 50-70% of patients can be treated by laser laparoscopy and can avoid
major surgery. Removal by cautery is not recommended as there is an extremely high
recurrence rate.
• Laparotomy (major surgery)
In cases of severe endometriosis, it may be necessary to have major abdominal surgery. A
laser is used in this procedure. With this procedure, you will be in the hospital for a few days
and will need 4-6 weeks to recover fully. With surgical treatment, the actual chances of
recurrence are low and, when there is recurrence, it is minimal.
• Hormone Therapy
Hormone therapy is sometimes recommended as a treatment for endometriosis. The
hormones treat the illness by stopping ovulation and have many side effects. They do not
correct the problem.
17
Postpartum Depression
Postpartum depression is a major depressive disorder which generally begins within the first four
weeks following delivery. The symptoms are typically very distressing to the patient and to her
family. Changing reproductive hormones and the withdrawal of naturally occurring progesterone
following delivery may be a causative factor. Traditional treatment involves psychiatric evaluation
and possible antidepressant therapy.
Symptoms
• Depression
• Fatigue
• Changes in appetite
• Changes in sleep
• Thoughts of suicide
• Anxiety
At the Pope Paul VI Institute, the physicians have developed an assessment tool and a treatment
protocol for postpartum depression. The patient's symptoms are evaluated. If indicated, the patient
is given a dose of natural progesterone. She makes frequent contact with the physician in an ongoing
assessment and additional doses are given as needed.
The effect of the treatment is often quite immediate and the patient reports feeling significantly
better. So often, physicians treat this condition with antidepressants. These medications take a
significant time to work and also have side effects that many patients find to be hard to tolerate. If
you are interested in this service, please call the nurses. Indicate that you are needing help for
postpartum depression.
18
Progesterone Support in Pregnancy
Studies have shown that progesterone support can be helpful in those patients with previous
infertility or miscarriage. In additional individuals who can be considered candidates for
progesterone evaluation and subsequent supplementation would be those who have had a previous
abruptio placentae, previous stillbirth, pregnancy-induced hypertension, previous prematurity,
previous premature rupture of the membranes, previous or current intrauterine growth retardation,
hyper-irritability of the uterus, congenital uterine anomaly, or patients with cervical cerclage.
Key principles to the use of progesterone in pregnancy are that natural progesterone can be used and
that it be started as early as possible in the pregnancy. During the course of the pregnancy,
progesterone levels are drawn every two weeks and progesterone is supplemented based on the
progesterone level. Through research done at the Pope Paul VI Institute, the physician have
developed a graph identifying average level of serum progesterone during the course of the
pregnancy. A treatment protocol has been established based on this graph.
The Institute offers the service of progesterone monitoring to women who are seeing other physicians
for all other aspects of their prenatal care. The woman has her blood drawn every two weeks and the
serum is sent to the National Reproductive Hormone Laboratory for assay. Dr. Hilgers will then
interpret the level and dose the progesterone supplementation accordingly.
If you are interested in this service, please call the nurses and ask for information on getting started
(402) 390-6600.
19
Menopausal Symptoms and Estrogen Replacement
During the menopausal period, a woman is often aware of a variety of different symptoms that can
be extremely annoying to her.
Symptoms
• Hot flashes
• Irregularity in the menstrual cycle
• Vaginal dryness
• Discomfort with intercourse
• Irritability
• Bloating
• Weight gain
• Carbohydrate craving
• Depression
• Headaches
• Fatigue and insomnia
Treatment
In managing the menopausal symptoms, many physicians recommend estrogen replacement therapy.
This causes some perplexing difficulties. For example, if a woman takes estrogen only, the risk of
both endometrial and breast cancer goes up. Thus, if a woman takes an estrogen for replacement
therapy, she also needs to take progesterone to block or inhibit the effects of the estrogen. In this
way, the incidence of endometrial and breast cancer can be normalized.
There are a variety of different approaches to estrogen replacement therapy. There are many
different estrogen products available and a number of different progesterone substitutes. The
physicians at the Pope Paul VI Institute recommend natural estrogen and progesterone supplements.
These medications are bioidentical to what a woman's own body produces. There are advantages to
the use of natural hormones. These are available by presciption through a compounding pharmacist.
The question of how long a woman should be on these hormones is a complicated one and one that
needs to be discussed with the woman and her physician.
20
Polycystic Ovarian Disease
Polycystic ovarian disease (PCOD) is a condition that is often associated with infertility. The ovaries
do not function normally and ovulate only irregularly. The ovaries have multiple cysts that form
under the capsule of the ovary. The ovaries are often enlarged. Some 60 percent of women with
PCOD will also have endometriosis.
Symptoms
• Amenorrhea
• Long and irregular menstrual cycles
• Obesity
• Hirsuitism (excessive hair growth)
• Hypertension
• Infertility
A complete evaluation includes a thorough hormone profile, a pelvic ultrasound examination, and a
laparoscopy.
Treatment
• Medical treatment:
Treatment for PCOD is aimed at several factors. A decrease in the production of the male
hormones is one aim of treatment. This can be accomplished by giving cortisone-like
medication. Fertility treatment can be accomplished by inducing or stimulating ovulation
with medications. In order to reduce the incidence of endometrial cancer associated with
long and irregular cycles, some type of progesterone withdrawal needs to be implemented on
a long-term basis.
• Surgical treatment:
An ovarian wedge resection is a surgical procedure in which a wedge of tissue is removed
from the ovary and the ovary is subsequently reduced in size and repaired. While this is an
older operation, it has been recently resurrected because of significant improvement in our
ability to prevent adhesion formation. It is extremely effective in lowering the male hormone
production and regulating the menstrual cycles, thus improving fertility. The woman will
often go back into regular cycles following this surgery. The pregnancy rate after this
procedure is about twice what it is with Clomid.
21
Reversal of Tubal Ligation
Women who have had previous tubal ligations can often have their tubal ligation reversed. This is a
microsurgical procedure. The area where the ligation occurred is excised and the tubes are
microsurgically reconnected. Success of this procedure depends upon the type of tubal ligation that
was performed and on the expertise of the microsurgeon. Dr. Hilgers has over thirty years of
experience in performing microsurgery. Fortunately, most tubal ligations fall into the category of
being able to be reversed. Unfortunately, most insurance companies do not pay for this procedure.
Getting Help
For help with one of the above conditions, make an appointment with the director of the Pope
Paul VI Institute, Thomas W. Hilgers, MD. Just call the appointments desk at the Pope Paul VI
Institute at (402) 390-6600.
An initial appointment interview, which includes a medical history, will be conducted and a
personalized and organized evaluation plan will be established. This will lead to an individualized
treatment program.
To expedite this program, enroll in a Creighton Model FertilityCare™ System (CrMS) program to
learn how to NaProTRACK the menstrual cycle. After two months or two menstrual cycles have
been tracked in this fashion, you can see the physician and the process can move quickly. Usually
after two cycles of NaProTRACKING™, it only takes two additional months to complete the
evaluation.
You can learn the CrMS by attending classes locally or in a location near your hometown. To find or
locate a teacher in your area, visit www.fertilitycare.org, or contact Pope Paul VI Institute at (402)
392-0842 or the American Academy of FertilityCare Professionals, 615 S. New Ballas Rd., St. Louis,
MO 63141, (314) 569-6495.
Once two cycles or two months of NaProTRACKING™ have been completed, then a good photocopy
of that chart can be sent to:
Please include a cover letter, outlining your history and your reason for consultation.
Fees
For a fee of $25, Dr. Hilgers will review the NaProTRACKING™ of your menstrual cycle along with
your basic medical history as outlined in your letter. A personal response will be written to you with
regard to this evaluation.
If medical records are to be reviewed in addition to the NaProTRACKING™, then the fee is $50.
If there is a videotape of a previous laparoscopy to be reviewed, the total fee would then be $75.
22
Conclusion
If there are any question with regard to your reproductive problems, do not hesitate to write to Dr.
Thomas W. Hilgers at the above address. The staff of Pope Paul VI Institute look forward to helping
you with your women's health care needs.
23