LDN use in Fertility Treatment

1. LDN use in Fertility Treatment Glasgow, Scotland Saturday 25th April 2009 Dr. Phil Boyle, FertilityCare Specialist Galway Clinic, Ireland

2. Eyre Square - Galway

3. The Galway Clinic

4. Dr. Phil Boyle • Director of the FertilityCareCentres of Europe • Registered Charity CHY17434 www.fertilitycare.net

7. Natural Procreative TechnologyNaProTechnology (NPT) Essentially uses modern medical and surgical techniques to facilitate conception through a normal act of intercourse

8. NaProTechnology Developed by Obstetrician & Gynaecologist, Prof. Thomas W. Hilgers, in 1990 through the Pope Paul VI Institute In association with Creighton University Omaha, Nebraska, USA

9. NaProTechnology • Inspired by Catholic thinking • Application is universal….. • Any medical patient can benefit from it! • Over 800 Irish babies • An additional 100 conceptions since Jan 2009! • Majority of Irish patients come…..because they want a baby

10. NaProTechnology • Average success rate is 50% for infertile couples • Even couples with failed IVF have 20% to 30% chance of success • Effectively treats recurrent miscarriages with around 80% success

11. NaProTechnology Published JABFM Sept 2008

12. NaProTechnology www.NaProTechnology.com

13. The FertilityCare Chart is the Foundation of NaProTechnology

14. Could the FertilityCare Charts be telling us something more ?

17. The FertilityCarePhysician • Can predict which couples are at increased risk of … • Infertility • Miscarriage • Abnormal pregnancy outcome

18. ABNORMAL CYCLES

19. Furthermore….. The FertilityCare chart can let us know if the treatment plan is effective ….or not!

23. Naltrexone • Has been a part of NaProTECHNOLOGY infertility treatment since the drug became available in 1985 • Used in Ireland since 2004.

24. Naltrexone & NaProTECHNOLOGY Used to treat Endorphin Deficiency - Dr. Hilgers • PMS • Infertility • Miscarriage

25. Naltrexone & NaProTECHNOLOGY • Beta Endorphin levels were known to be lower in women with PMS • Publications in 1985 & 1987 Premenstrual Syndrome Chapter 29, Medical and Surgical Practice of NaProTECHNOLOGY

26. Naltrexone & NaProTECHNOLOGY • Double blind placebo controlled study using naltrexone 25mg bid to treat PMS Clinical trial of Naltrexone in Premenstrual Syndrome Chuong and Coulam et al Obstet Gynecol 72: 332-336, 1988

28. Naltrexone & NaProTECHNOLOGY • Part of Mechanism of Action • Low endorphins impaired hypothalamic function, causing poor follicular function, PMS and sub-fertility • Improving endorphin levels should improve hypothalamic and follicular function, reduce PMS and improve fertility • IMPORTANT • Need to correct progesterone and estradiol deficiencies as well

29. Naltrexone in low dose & NaPro • INITIAL RESULTS • Not very convincing…..

30. Naltrexone • Impossible to get Beta Endorphins measured in Ireland or UK • Perceived as a less important adjunctive treatment

31. Naltrexone Initially Not Prescribed in Ireland

32. Low Dose Naltrexone - LDN • 2002/3 – Mary Anne wanted her husband to take LDN for his MS • “New treatment” found on Internet, recommended by a New York Neurologist • Primary Progressive MS getting worse and not halted by interferons (unlicensed for this anyway!)

33. Low Dose Naltrexone - LDN • “Primum Non Nocere” • “First do no Harm” • Advised - nothing to lose by trying it

34. Low Dose Naltrexone - LDN • Brother In Law, Noel on LDN for MS since 2002/3 • Mary convinced that at last the progression had stopped!

35. Low Dose Naltrexone - LDN • Robert (MS Patient) commenced LDN in Galway on Mary’s advice in 2003 • He gave a presentation in Galway in 2003. • “Miraculous” Case Incredible response to treatment

36. Robert – LDN 2003 • Chronic Progressive MS AND Rheumatoid Arthritis • Deteriorating despite Interferons • Very tired all the time • Started LDN - DRAMATIC improvement in fatigue, joint pain • No progression of MS since – except when LDN ran out!

37. A New Low Dose Naltrexone - LDN • Unlicensed use (“off label use”) Dr. Bahari • To treat Endorphin Deficiency • Improves immune function !?!

41. A New Low Dose Naltrexone - LDN • Compounding Pharmacist • Dose • 1.5mg, 3.0mg or 4.5 mg fast release tablet nightly before sleeping (9pm -2am)

42. A New Low Dose Naltrexone - LDN • This will give a 3 fold increase in beta endorphin levels.

43. A New Low Dose Naltrexone - LDN • Improving Endorphin Levels • Has a “Stimulatory effect” on the immune system • Improves immune function

44. A New Low Dose Naltrexone - LDN • Improving Endorphin Levels • Halts the progression of HIV • Halts the immune system when it begins to attack “SELF” (Auto-immune illness) • Reduces Lifetime risk of developing cancer

45. Low Dose Naltrexone - LDN • A “No Brainer” • Obviously fantastic treatment • Low toxicity – “first do no harm” • Inexpensive • Seems Effective Clinically • Easy to take • No Need for specialised Physician training • Few Ethical issues • Anticipate widespread use and acceptance very quickly

46. Low Dose Naltrexone - LDN • Surprise!! • Huge resistance among many doctors to even try it out!

47. Low Dose Naltrexone - LDN • Unlicensed for Auto-immune disorders • Experimental treatment • Not “evidence based” medicine • Doctors not covered by medical insurance • Too Risky!

48. Evidence Based Medicine • What level of evidence is available to support a chosen treatment? • Theoretical √ • Clinical experience √ 400 MS Pts, Dr. Bahari √ over 2000 pts in USA • Published trials in peer reviewed journal X

49. Evidence Based Medicine • What level of evidence is available to support a chosen treatment? • Theoretical √ • Clinical experience √ 400 MS Pts, Dr. Bahari √ over 2000 pts in USA • Published trials in peer reviewed journals √

50. Published trials in peer reviewed journals • Results • Proven safety • Improved condition ( MS / Crohn’s 66% Remission and 89% improved) • Conclusion • More study is needed……!!