Fertility: Manual Treatment

According to the CDC, there are approximately 12% of women in the United States and 6% of married women that experience infertility (CDC 2019). And as I’m sure you are aware, fertility treatment can be a very costly and invasive experience. While doing a quick Google search for “Causes of Infertility”, the answers that pop up include:

  • Ovulation disorders - including PCOS, thyroid disorder and inadequate nutrition
  • Uterine or cervical abnormalities
  • Fallopian tube damage or blockage - often from inflammation due to an infection, STD, endometriosis or adhesions
  • Endometriosis
  • Primary ovarian insufficiency
  • Pelvic adhesions
  • Cancer & treatment

While it may not be as widely accepted, there is research that points to other environmental and lifestyle factors as well including hormonal birth control, environmental toxins, nutrient insufficiencies and poor gut health.  You can read more about those factors HERE.  

But many of the above “causes” involve mechanical factors such as fascial adhesions, scar tissue, impaired lymphatic drainage and impaired blood flow.  This is where physical therapy can come into play!  

Let's Talk Manual Techniques

In general, physical therapists utilize manual therapy techniques to break up scar tissue and adhesions in order to increase mobility and decrease pain.  This can be applied throughout the whole body.  For example, after a knee replacement, or from a back injury, or an ankle sprain.  

But as a pelvic floor physical therapist, we use these same techniques to help women eliminate pain with sex, experience pelvic pressure from a prolapse, or heal from a trauma.  They can also be used to help infertility.

Wurn et al (2004) found that 40% of cases of female infertility are biomechanical and can be attributed to scarring and/or pelvic adhesions resulting from previous abdominal/pelvic surgery, endometriosis, abdominopelvic infection, inflammatory disease, ovarian cysts, or postinfection tubal damage.  

Utilizing a highly specialized set of manual techniques, any scar tissue or adhesions present within the pelvis can be addressed and eliminated.  This allows for improved mobility of the intestines and pelvic organs. Having proper mobility of the organs is important in order for them to be in the right position for sperm to get to and for the egg to travel within.

These techniques also allow for better blood flow to the pelvic region. It is thought that increased blood flow to the pelvis assists with fertility in order to provide proper nutrient/toxin exchange.  

Another aspect to consider is the inflammation present from past infections, trauma, surgery or impairments (ie endometriosis). Occasionally, there are limitations in the lymphatic drainage within the pelvis so the lymph fluid gets “stuck”, along with all the inflammatory byproducts.  This can be a limiting factor for fertility as well.  

Research Studies

One research study performed all of these manual techniques, as well as pelvic alignment techniques, and found that 6 of the 10 women conceived within 3 months of treatment (Kramp 2012).

While that study had a small sample size (it’s currently being performed on a larger scale), another research study also found good results.  They found 56.64% pregnancy for patients with occluded fallopian tubes, 42.81% pregnancy for patients with endometriosis, and 53.57% pregnancy for patients with PCOS (Rice et al. 2015)  In addition, they also had a 56.16% pregnancy rate for patients that underwent IVF afterwards.  This is much higher than the 31% pregnancy rate for IVF reported from the CDC.

These research studies are promising and suggest that these highly specialized manual techniques have a significant impact on treating infertility. The mechanism of action may not be fully understood yet, however, the results are positive.  

It also suggests that this could be a great, non-invasive, more economical option for treating infertility with mechanical etiology. These techniques can also be done in conjunction with other fertility treatment or assisted reproductive technology to increase the probability of success.  

Our Fertility Program

All of these techniques are incorporated with our Fertility Program technique. Our pelvic floor physical therapists have done extensive training to specialize and fine-tune these skills. As part of our Fertility Program, each client will undergo 6 sessions of manual therapy, similar to the protocol performed by Kramp (2012). The goal is to restore proper pelvic alignment and mobility, mobility of the pelvic organs and tissues, eliminate adhesions and scar tissue, and improve blood and lymphatic flow through the pelvis.

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Resources:

Kramp ME. Combined manual therapy techniques for the treatment of women with infertility: a case series. J Am Osteopath Assoc. 2012 Oct;112(10):680-4. PMID: 23055467.

Rice AD, Patterson K, Wakefield LB, Reed ED, Breder KP, Wurn BF, King Iii R, Wurn LJ. Ten-year Retrospective Study on the Efficacy of a Manual Physical Therapy to Treat Female Infertility. Altern Ther Health Med. 2015 Feb 17:at5233. Epub ahead of print. PMID: 25691329.

Wurn BF, Wurn LJ, King CR, Heuer MA, Roscow AS, Hornberger K, Scharf ES. Treating fallopian tube occlusion with a manual pelvic physical therapy. Altern Ther Health Med. 2008 Jan-Feb;14(1):18-23. PMID: 18251317.

Wurn BF, Wurn LJ, King CR, et al. Treating female infertility and improving IVF pregnancy rates with a manual physical therapy technique. MedGenMed. 2004;6(2):51. Published 2004 Jun 18.

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