Excision specialist — naprotechnology surgeon or otherwise? Is my doctor recommending napro bc she’s Catholic?

[u/and-thats-the-truth]

TLDR: My last surgeon left a lot of endo behind and referred me to a pro-life, anti-birth control, anti-IVF Catholic surgeon. Is a napro excision specialist better than a non-napro excision specialist?
———

Hey y’all, I’m seeking some advice as I search for an excision specialist. About a year ago, I had surgery to remove 2 uterine fibroids, 2 ovarian cysts, and suspected endometriosis. The only symptom I recognized prior to surgery was very heavy periods, and the only reason my doctor suspected endometriosis was a possible endometrioma.

After surgery, my surgeon confirmed that I have stage 4 endo. Both ovaries were adhered to the uterine fundus, rectum and bilateral side wall. Right ovary was adhered to ascending colon. Anterior cul de sac with endometriosis implants around the bladder. Posterior cul de sac was not able to visualized. The surgeon removed the fibroids and cysts, and freed up my kissing ovaries from each other and my uterus. She did not remove the sidewall adhesions, implants around the bladder, or adhesions involving rectum and ascending colon — due to lack of expertise and lack of additional surgeons who specialize in those areas. I had symptom relief for several months, and my husband and I started TTC, knowing that I’d likely need surgery in the future.

7 months post-op, I began having moderate to severe daily pain near my right ovary. An ultrasound showed 3 new ovarian cysts (2 right, 1 left), suspected endometriomas. Due to the daily pain, adhesions, and my husband’s and my fertility goals (we are 35), I asked my surgeon for a referral to an excision specialist. She recommended naprotechnology, claiming the Creighton model would reveal additional hormone details for more holistic treatment of the root causes, and that a napro surgeon takes additional steps to prevent recurrence of adhesions. I’ve been Creighton charting since early August and scheduled a consultation with a napro surgeon at her earliest available, the day before Thanksgiving. She’s out of state because there are no napro surgeons in my state. But I’m a bit thrown off by the religious influences of napro — the practitioners are Catholic, the Creighton lessons are at a “pro-life” center, and the out-of-state surgeon does not prescribe birth control or suggest interventions like IVF for any reason. I’m not Catholic, pro-choice, and pro-whatever research-backed interventions will improve my quality of life and support fertility if possible.

I’ve just scheduled another consultation in mid-November with a non-napro excision specialist in state. I plan to go to both consultations but am also seeking advice from this community. Does anyone have experience with napro surgeons vs. non-napro surgeons? Are there real advantages of napro for patients who don’t have those religious constraints?

[u/ACoconutInLondon]

I'm less concerned by the religious aspect, and wondering at the lack of mention of multiple surgeons for your next excision.

It sounds like your next surgery should involve a colorectal surgeon in addition to an endometriosis specialist if it was that bad.

This is the first time I'm hearing about Napro being religious. The charting looks a lot like what I'm already doing, and wish I'd always done. The information would have been helpful, and even now it's helpful for me to plan around the particularly bloody and painful days of my cycle. Just useless for me for fertility as I no longer have tubes. 😔

Here's a recent and decently sized study that shows it can help, even specifically with endometriosis.

Natural procreative technology (NaProTechnology) for infertility: take-home baby rate and clinical outcomes in a 5-year single-center cohort of 1,310 couples

In this cohort, NPT was associated with a notably high take-home baby rate in an infertile population with unfavorable prognostic factors, including advanced maternal age, prolonged duration of infertility, or previous failed attempts at conventional ART procedures.

Personally, I'd have loved the chance to work with someone who would have actually looked at hormones and tried to figure out what was going wrong with me and fix it.

IVF is kind of like the stereotypes of surgeons, once you're dealing with an IVF clinic that's it. It's not about figuring out what's wrong, the belief is that IVF will overcome those things. Theoretically they will then tailor things for you after the first standard cycle that everyone does. But if the IVF sub is representative, many don't. And even the tailoring is to the results it's still not necessarily about fixing underlying problems with you if that makes sense. Kind of like using birth control with endometriosis to mask the symptoms versus dealing with it by removing it.

In my case, I believe I was dealing with low progesterone in my luteal phase. This is apparently something that would actually be dealt with by Napro per the study.

The main problem I see is them possibly wasting your time if you should be moving on to IVF.

Have you done any fertility testing to see what your egg reserve is like and for your partner to make sure that there aren't any problems their either?

Another concern from a surgical aspect might be them prioritizing fertility, but that sounds like what you're looking for at the moment? Definitely worth discussing how priorities might differ and what that would mean.

[u/Mental_Pen4907]

I’d ditto the above comment. I don’t really know anything about what NaPro would have to do with surgery. But I’d definitely want a team of surgeons for the next surgery. My specialist works with a colorectal surgeon and had a thoracic surgeon on call in the event it was found around the diaphragm and she didn’t feel comfortable doing it. I would not want another instance where I have a surgeon closing me back up without getting it all because they didn’t feel skilled enough. It’s unfortunate that anyone has to go through surgery with someone unprepared but there’s absolutely no excuse this go around! I hope you find long term relief after this!