EC Gynaecology

The New England Journal of Medicine (NEJM) has recently published a clinical case of an unsuccessful infertile couple with a desire to become pregnant after one year of having intercourse two to three times a week without contraception [1]. This article presents this short anamnesis to study the clinical pathways to resolve the infertility problem of the couple who would like to have three children. This is a very rare situation that does not represent a reason for consulting in the regular clinical practice to be an example in the solving of fertility problems with assisted reproductive techniques (ART), as well as to be published as a reference clinical case in the evaluation and treatment of infertility in the NEJM.

 Keywords: Fertile Window; NaProTechnology; Fertility Awareness; Subfertility; Restorative Reproductive Medicine (RRM)

1. Santoro N and Polotsky AJ. “Infertility evaluation and treatment”. New England Journal of Medicine 11 (2025): 1111-1119.
2. Practice Committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Reproductive Endocrinology and Infertility. “Optimizing natural fertility: a committee opinion”. Fertility and Sterility1 (2022): 53-63.
3. Stanford JB., et al. “International Natural Procreative Technology Evaluation and Surveillance of Treatment for Subfertility (iNEST): enrollment and methods”. Human Reproduction Open 3 (2022): hoac033.
4. Kuroda K., et al. “Novel approaches to the management of recurrent pregnancy loss: The OPTIMUM (Optimization of Thyroid function, Thrombophilia, Immunity, and Uterine Milieu) treatment strategy”. Reproductive Medicine and Biology 4 (2021): 524-536.
5. Marshell M., et al. “Stratification of fertility potential according to cervical mucus symptoms: achieving pregnancy in fertile and infertile couples”. Human Fertility (Camb)5 (2021): 353-359.
6. Murcia Lora JM. “Multidisciplinary Fertile Window Assessment for Ovulation Diagnosis”. Academia Letters (2021): 3980.
7. Hilgers Thomas W. “The Medical & Surgical Practice of NaProTechnology”. 1^st Pope Paul VI Institute Press: Omaha, Nebraska, USA (2004).
8. Huang Y., et al. “Using anti-Müllerian hormone to predict premature ovarian insufficiency: a retrospective cross-sectional study”. Frontiers in Endocrinology (Lausanne) 15 (2024): 1454802.
9. Steiner AZ., et al. “Association between biomarkers of ovarian reserve and infertility among older women of reproductive age”. Journal of the American Medical Association 14 (2017): 1367-1376.
10. Boyle PC., et al. “Healthy singleton pregnancies from restorative reproductive medicine (RRM) after failed IVF”. Frontiers in Medicine (Lausanne) 5 (2018): 210.
11. Murcia Lora JM. “Assessment & diagnostic test to check free pathways for sperm swimming in the genital tract”. Academia Letters (2021): 3309.
12. Somigliana E., et al. “Fibroids and natural fertility: a systematic review and meta-analysis”. Reproductive BioMedicine Online 1 (2021): 100-110.
13. Blanco-Breindel MF., et al. “Septate Uterus”. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing (2025).
14. Yeung P., et al. “The long-term rate of repeat surgery after optimal excision surgery of endometriosis at a single tertiary referral center”. Preprints (2024): 2024091485.
15. Alcázar Zambrano JL. “Riesgos para la salud en los niños concebidos mediante Técnicas de Reproducción Asistida”. First edition. Early Institute, A.C. earlyinstitute.org. (2018).