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Institute Practices Reproductive Medicine -- and Catholicism

By Rob Stein
Washington Post Staff Writer
Tuesday, October 31, 2006

OMAHA -- Craig Turczynski traveled from Texas to find ways to help infertile women that do not conflict with his religious beliefs. Cherie LeFevre came from St. Louis to learn how to treat her OB-GYN patients in obedience to her Catholicism. Amie Holmes flew from Ohio so she could practice medicine in conformity with church teachings when she graduates from medical school.

On a journey that would blend the aura of a pilgrimage with the ambience of a medical seminar, the three arrived at an unassuming three-story red-brick building on a quiet side street in this Missouri River city.

Their destination was the Pope Paul VI Institute for the Study of Human Reproduction, which has become perhaps the most prominent women's health center serving Catholics and other doctors, medical students and patients who object for religious reasons to in vitro fertilization, contraceptives and other aspects of modern reproductive medicine.

"We have built a new women's health science," said Thomas W. Hilgers, who runs the institute. "Our system works cooperatively with the natural fertility cycle and enables doctors to treat women and married couples, especially Catholic married couples, in a way that allows them to live out their faith."

Hilgers and his supporters say the approach, called "natural procreative technology" or "NaProTechnology," can address a spectrum of women's health issues, including family planning, premenstrual syndrome, postpartum depression and infertility, without the use of birth control pills, sterilization, abortion or in vitro fertilization (IVF). Instead, Hilgers said, he uses diagnostics, hormones and surgery to identify and treat underlying causes of reproductive ailments that other doctors often miss.

Although the institute is not formally affiliated with the church, Hilgers's work is endorsed by groups such as the U.S. Conference of Catholic Bishops and the Catholic Medical Association.

But many mainstream authorities question Hilgers's assertions that his techniques are equal or even superior to standard therapies. They worry that women are being misled and given unproven, ineffective treatments, denying them the best available care.

"This is anti-science," said Anita L. Nelson, a professor of obstetrics and gynecology at the University of California at Los Angeles. "I respect people's personal values. But I am deeply concerned that they are giving treatments and making claims that are not scientifically proven as safe and effective."

Although some independent experts say that some of the institute's offerings may be acceptable alternatives for religious patients, as long as they are fully informed about their options, others view its work as a disturbing example of religion intruding into secular society.

"Combining medicine and religion is dangerous," said the Rev. Carlton W. Veazey, president of the Religious Coalition for Reproductive Choice. "This tendency is creeping into our health-care system."

The trend will become particularly worrisome, some say, if religiously shaped medicine begins to displace and curtail access to standard medical care.

"If you look at what's happened with abortion services being severely limited in large parts of the country, this is not at all an unrealistic fear," said R. Alta Charo, a bioethicist at the University of Wisconsin at Madison.

The controversy is part of a larger debate over the relationship between religion and medicine, which is being sparked by conflicts between patients and religious health-care workers who refuse to provide care they find offensive, citing a "right of conscience." Such clashes are becoming increasingly common because of the rising religiosity in the United States and the advent of therapies that raise moral quandaries for some, such as the "morning-after" pill, IVF and embryonic stem cell research.

"Many Christians, whether in or out of the Catholic Church, have deep concerns about some of these new technologies," said Gene Rudd, associate executive director of the Christian Medical & Dental Associations. "This is the kind of thing that offers an alternative for those with these values."

Inspired by Pope Paul VI's 1968 encyclical, Humanae Vitae, which condemned artificial birth control, Hilgers began by helping to develop, with colleagues at nearby Creighton University, a natural family planning method called the Creighton Model, which involves meticulously charting a woman's monthly cycle. But Hilgers goes beyond simply offering an alternative form of birth control.

An obstetrician-gynecologist and reproductive surgeon who trained at the University of Minnesota Medical School, Hilgers said he combines the charting system with intensive hormonal and ultrasound studies for better diagnoses. He said he can then restore fertility and treat other ailments through individually tailored therapies, such as targeted hormones and surgical techniques he developed for conditions including blocked fallopian tubes, pelvic adhesions and endometriosis.

"We can look at a woman's cycles in ways that others simply can't," Hilgers said during an interview in his office, surrounded by images of Popes Paul VI and John Paul II. "We work cooperatively with a woman's cycle rather than suppressing it or destroying it. Many women come to us after years of being frustrated by the treatment they received elsewhere."

That was the case for Cami Carlson, 33, of Coeur d'Alene, Idaho, who came to the institute after five years of futile efforts to become pregnant with the help of her OB-GYN and a fertility specialist. Because Carlson is Catholic, in vitro fertilization was out of the question.

"Life is God's to create," Carlson said, echoing the sentiment of half a dozen other women from around the United States and Mexico interviewed this month while being treated at the clinic. "It's a huge sense of peace knowing that we're going about things in a morally sound manner."

The institute, which is attracting more than 700 new patients a year, melds modern medical facilities with the philosophy and symbols of Catholicism. The waiting room greets patients with a bust of the Madonna and Child and an illuminated stained-glass crucifix. Bulletin boards titled "Miracle Baby Hall of Fame" are filled with snapshots of children. Down the hall is a fully accredited lab for analyzing hormones. An ultrasound suite downstairs is equipped with the latest technology. A large statue of St. Therese stands in a stairway leading to the Chapel of the Holy Family, where Mass is celebrated weekly.

While most of the patients are Catholic, Hilgers accepts anyone. He said they are drawn by his holistic approach, attentive care and superior outcomes.

"Mainstream gynecology and reproductive medicine take a Band-Aid approach. Our success rates tend to be much, much better," Hilgers said.

Those claims are sharply disputed by mainstream OB-GYNs and fertility specialists.

"I don't think he understands what a traditional reproductive endocrinologist really does," said Jamie Grifo, a New York University fertility specialist. "It's simply a myth that we don't look for the underlying disease."

Experts also question how "natural" Hilgers's techniques are if they employ hormonal supplementation, and they criticize him for not publishing studies in medical journals so his methods can be evaluated independently.

"They might as well be advocating prayer for infertility," said Richard Paul, a fertility expert at the University of Southern California. "The reason that this is dangerous is because women have a biological clock, and while they are using up time with less effective therapies, time may run out."

Hilgers countered that his work is based on numerous research papers that he and others published in well-known journals earlier in his career, and that he has compiled the results of his more recent studies in a 1,243-page textbook he produced in 2004.

"The people who publish the journals are all of a certain mind-set, and that mind-set is contraception, sterilization, abortion and IVF," Hilgers said. "They reject things I submit to them and say, 'What value is this?' "

To spread his methods, Hilgers sponsors a multifaceted training program and invites recent medical school graduates to spend a year studying with him.

"This allows me to practice in a way that I see as truly good for my patients and uphold the dignity of life," said Catherine Keefe, who is in the midst of a one-year fellowship at the institute after completing her OB-GYN residency at the University of Illinois at Peoria.

The institute also instructs laypeople on how to teach the Creighton system, and it has more than 1,000 "educators" and more than 100 centers offering the system around the United States and overseas.

In addition, it offers intensive seminars every fall and spring for doctors, residents, medical students and others.

"This place has just been booming. . . . It's just incredible. And we're only at the beginning," Hilgers said. He said he has trained more than 300 doctors in the United States and overseas, including several in the Washington area.

This year's fall immersion course drew Turczynski, LeFevre, Holmes and eight other doctors, residents and medical students. For eight days this month at a hotel near the institute, the participants gathered early each morning for Mass before spending 12 hours in lectures. They will return in the spring for a follow-up session that will certify them as NaProTechnology "medical consultants."

Turczynski quit his job as head of an infertility laboratory in Shreveport, La., because he decided that creating embryos in a laboratory was wrong. He became disturbed that some of the embryos might be discarded or used for research, and that his work might help unmarried or same-sex couples have children.

"I would like to stay in the field in a way that doesn't conflict with my moral beliefs and the church's teaching," Turczynski said.

LeFevre, the St. Louis OB-GYN, decided after her daughter's first communion that she could no longer prescribe birth control pills, do sterilizations or participate in IVF. Holmes, the medical student, converted to Catholicism and pledged to devote her practice to her new faith when she graduates.

Some trainees took vacation time and paid for the course themselves. Others received funding from their schools or residencies and will get credit toward their medical education. The course is certified through Creighton University.

"In those areas where the culture of medicine differs from what the church teaches," said Karen Saroki, who is incorporating Hilgers's training into a family-practice residency at the University of North Carolina at Chapel Hill, "this will enable me to follow what the church teaches."

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