Jim and Allison Mueller felt blessed to have two boys, but the Salt Lake City couple felt they had room for one more.
They were surprised to find they couldn't get pregnant right away. Both in their late 30s, they had little time to spare.
But instead of looking to in vitro fertilization (IVF) or artificial insemination, the couple sought what's called "natural procreative technology," or NPT.
They saved thousands of dollars, followed their conscience, and now have a 1-year-old daughter named Brooke.
"This is a way to go ahead and follow along with a lot of the things we believe in in our faith and become pregnant," said Jim Mueller, whose Roman Catholic Church opposes the use of assisted reproductive technologies. "We think it's such a great way. A lot of people go to in vitro without ever thinking about this. They could probably achieve pregnancy."
Salt Lake City will be hosting two conferences this week that will draw attention to the natural technology: The American Academy of FertilityCare Professionals and the International Institute for Restorative Reproductive Medicine.
Both groups seek to address underlying reproductive disorders and oppose the use of contraception, artificial insemination, IVF and abortion. They favor charting when a woman is fertile, and using hormones and medications.
"Our goal is always to restore normal fertility so pregnancy happens naturally from intercourse," said Joseph Stanford, a Utah doctor and host for one of the meetings.
He will be speaking at both events to discuss the preliminary results of two international studies that may give hope to couples seeking natural methods to both boost their chances of having a baby or avoid getting pregnant.
The methods are not mainstream yet.
"People don't even know it exists how can they want it?" Stanford said. "There's a lot more people who would like to use it on both sides of the equation [to avoid or get pregnant] if we could get the awareness up."
The Muellers participated in the pregnancy study, called iNEST, which is evaluating the effectiveness of the technology among 300 couples in six locations for three years.
The methods were developed at the nonprofit Pope Paul VI Institute for the Study of Human Reproduction in Omaha.
NPT employs fertility tracking using the Creighton Model FertilityCare System, which teaches women about their menstrual cycles so they know when they are most likely to conceive. Physicians use the patients' cycle charts and targeted hormonal tests to identify possible problems. Treatments might include taking hormone supplements, medications to induce ovulation or surgery to remove endometriosis, for example.
Semen is also analyzed, and men can be treated.
Mueller said his wife needed shots of the human hormone chorionic gonadotropin for a couple of months before getting pregnant. All told, it took them about seven months and up to $1,500 to get pregnant.
"It was like, wow. Everything we went through, it all came through," he said. "It's a less invasive way and also allowing you to be intimate with your spouse."
IVF, by comparison, fertilizes the egg outside of the body. It costs at least $10,000.
According to research by Stanford, also a University of Utah professor of family and preventive medicine and director of its Office of Cooperative Reproductive Health, IVF results in a live birth for 50 percent of couples after a year of treatment.
The success of NPT is roughly the same, he said. His recently published study in the journal Canadian Family Physician on the use of NPT among infertile couples in Canada showed 50 to 66 percent conceived after two years. On average, the women were 35 years old, and the couples had been trying more than three years to conceive.
Among those who conceived, 24 percent used only charting to time intercourse; 69 percent needed medical treatment and 8 percent needed surgery. But nearly half of the couples dropped out of the NPT program before the full two years of recommended treatment.
Preliminary results from iNEST show a crude pregnancy rate of 55 percent for four sites. Stanford will also be analyzing whether the rates of preterm birth and low birth weight are lower among babies born with NPT, compared to other methods.
In another study, Stanford is testing the effectiveness of using the Creighton model to avoid pregnancy. He said previous studies have suggested charting and avoiding sex at the most fertile times doesn't work as well as other contraceptives. But he believes it is effective depending on the couple's motivations regarding whether or not to have children something the new study is measuring.
For example, an ambivalent couple willing to take a chance using natural family planning is more likely to get pregnant than if they skipped using a condom once, he said.
Preliminary results among 300 couples showed 113, or 37 percent, became pregnant. But their intentions seemed to matter. Among women who said they planned to try "as hard as possible to avoid" getting pregnant, 2 percent became pregnant. Stanford still needs to analyze whether the couples who got pregnant actually followed through on their intentions or if they had sex when they knew they were most fertile.
Anecdotally, several couples became newlyweds during the study and planned to have sex on their wedding night regardless of whether they wanted to get pregnant, Stanford said.
While Stanford said many Catholics are drawn to using natural methods to avoid pregnancy, couples who enrolled in the study to get pregnant weren't motivated by religion but to conceive using noninvasive means.
Julie Miriovsky of Buffalo, Minn., enrolled after she had her fourth child, and she and her husband decided they didn't want more children.
She said it was a "leap of faith" to try it, but the Catholics didn't want to use hormonal birth control, and condoms aren't always practical. They contemplated a vasectomy but the couple, both 33, feared they would change their minds about having more children.
For the past year, the method has worked.
"We are not pregnant nor were there any surprises whatsoever," she said. "My husband will tell you it wasn't for lack of intercourse."
Online: Get more information
O Learn more about the American Academy of FertilityCare or the International Institute for Restorative Reproductive Medicine online. > aafcp.org or iirrm.org