Root Cause Analysis (Fertility)

Overview

Root Cause Analysis or RCA has many different tools and methods that are used to determine the true underlying cause or multiple contributing causes to an issue. This analysis is useful in every field from business, medicine, engineering, manufacturing, or even interpersonal issues. It is a problem solving method and I will step through an example of one of the most useful tools I have used in this analysis. It is called a “Why Tree” and it is fundamentally a charting tool that continues to ask the question why at each step. We will use this tool to determine and help with a patient’s fertility issues using methods that align with Catholic teaching.

Background

NaProTECHNOLOGY (Natural Procreative Technology) is a medical and diagnostic approach that works cooperatively with a woman’s body to uncover and treat the underlying causes of fertility issues, rather than bypassing them. One of its core tools is root cause analysis (RCA)—a structured way to dig deep and identify the actual reason for a problem, not just its symptoms. Instead of jumping straight into IVF or another method that has morality issues for Catholics today, NaProTECHNOLOGY helps women to understand why their body is responding the way it is when trying to conceive.

This case study outlines how RCA was used to identify and treat the core issue behind a woman’s difficulty conceiving. RCA helps you use your time, money, and emotional energy wisely—not wasted chasing surface-level symptoms.

How To Use

Step 1 – What is the Problem?

The first step in root cause analysis is identifying the problem you are trying to solve. You may have many symptoms such as fatigue, emotional stress, miscarriage, or other health challenges, but the core problem you are trying to solve is infertility after a year of trying. Many times, it takes listing all the symptoms first to get a view of the whole picture of the problem. This list will also help later for evidence for/against certain causes.

Step 2- Ask Why

The next step is to step down logically to the next level of why this problem occurs. You can brainstorm as many ideas of why this occurs and list them under the core problem as shown below. It is best to not get super detailed ideas of why. Each level below the next drives deeper and deeper at the root of the issue. I like to just dumb down my thinking as the process itself helps to drive down into detail. Think of a little kid asking why after each explanation of something. You then go into more detail or jump into a further reason of “why” the previous “why” occurs.

Step 3- Evidence

The next step will be to determine whether there is any evidence of your “whys”. Your symptoms can be used here to confirm something or to rule something out. If a “why” is inconclusive you will need to decide whether to keep asking why or determine a way to gather evidence. Some “whys” are obviously not the cause if you know about the situation, but it helps to list them for future problems, comparisons with similar issues, and to map your thinking out.

With our “why” tree, we can see that two actions will be taken to gather evidence. Tracking the woman’s cycle using the Creighton Model and measuring the hormone levels during each phase of her cycle.

These actions will monitor biomarkers like cervical mucus, cycle length, and symptoms—to build a detailed picture of reproductive health. This cycle tracking, when paired with targeted medical testing, yields actionable data.

For example:

• Actionable Data: Peak +7 progesterone blood levels, TSH and prolactin results, mucus scores, ultrasound findings.
• Non-Actionable Data: “Irregular cycles,” “low hormones,” “unexplained infertility.”

Once quality data is collected, blood draws and diagnostic tests are scheduled at specific cycle points (e.g., Peak +7, +9) to match hormonal events with clinical indicators.

Analyze Data

After comparing symptoms with lab values, one cause emerged strongly: Luteal Phase Defect due to low progesterone. Progesterone at Peak +7 was 7.5 ng/mL (normal >10 ng/mL), correlating with short luteal phases and premenstrual spotting.

Take Action

Once the root cause was identified, a plan of action was developed—not just treatment, but targeted treatment.

NaPro-Guided Treatment Plan:

• Progesterone supplementation (oral/injection) to support luteal phase
• Thyroid support (low-dose levothyroxine) to address contributing TSH elevation (4.0 mIU/L)

This plan treated the underlying issue, not just the symptom of “not getting pregnant.” It also empowered the patient with understanding and ownership of her fertility.

Verify Results

Three cycles into treatment, the patient’s Peak +7 progesterone increased to 12.3 ng/mL, luteal phase length normalized, and symptoms of premenstrual spotting resolved. A confirmed pregnancy occurred in the fourth cycle.

The data collection and testing process were repeated to verify results, not just to confirm conception but to ensure long-term hormonal balance and cycle health. This continuous feedback loop ensured that assumptions weren’t made blindly and that every decision was rooted in real data.

Repeat

Root Cause Analysis is not a one-time process. If conception had not occurred, another cycle of analysis would have revisited anatomical, environmental, or male factor causes. Repeating the process allows for dynamic, flexible treatment that grows as new data emerges.

Root cause analysis provides hope, clarity, and direction in the face of complex challenges. In this case, it turned confusion into a concrete plan—and ultimately, success.