Infertility is often times a very sensitive subject for couples who are struggling to conceive. In the US, there are approximately 6.7 million women who are facing challenges on how to get pregnant. (CDC 2006). In 2015, a ten-year retrospective study examined the efficacy of manual physical therapy to treat female infertility and discovered significantly positive outcomes.
In Nigeria, 25% of married couples suffer infertility. Gynecologists report that 40 -45% of the visits they have are due to casesof infertility. Currently, the ‘best’ available form of treatment is IVF and IUI ; the success rate of IUI is 10 – 15 per cent, The success rate of IVF is 25 – 30 per cent .
Researchers found that after they went through physical therapy, the women experienced a 40 to 60 percent success rate in getting pregnant (depending on the underlying cause of their infertility). The therapy specifically benefited women with blocked fallopian tubes (60 percent became pregnant), polycystic ovarian syndrome (53 percent), high levels of follicle stimulating hormone, an indicator of ovarian failure, (40 percent), and endometriosis (43 percent). This specialized physical therapy has even helped patients undergoing IVF raise their success rates to 56 percent and even 83 percent in some cases, as shown in a separate study.
The study looked at data collected from 2002-2011, which included approximately 1,392 patients treated for infertility.
It specifically included those with single or multiple causes for infertility that involved:
- Elevated FSH (follicle stimulating hormone) of 10 mIU/ml or higher
- Fallopian tube occlusion
- Endometriosis- when the lining of the uterus grows outside of the uterus causing significant pain, abnormal bleeding, infertility
- Polycystic Ovarian Syndrome (PCOS)- a condition that affects female hormone regulation at times producing multiple follicles that remain as cysts in and around the ovary
- Premature Ovarian Failure (POF)-loss of ovarian function before a woman is 40 years old and
- Unexplained Infertility (Rice, 2015)
Patients were treated using an individualized physical therapy treatment plan that was named the CPA (Clear Passage Approach) protocol. This protocol was tailored to meet the individual needs of the patients and to treat specific sites of restrictions and immobility within each patient’s body. Treatment included integrated manual therapy techniques focused on minimizing adhesions and decreasing mechanical blockages in order to improve mobility of soft tissue structures. Visceral manipulation was also used to help restore normal physiologic motion of organs with decreased motility.
The application of these specific manual therapy modalities are thought to activate the central nervous system by stimulating a local tissue response and thus increasing communication with higher control centers in the brain that have the ability to positively influence the activity of the ovary and uterus, as a result effecting hormone production and regulation.
This isn’t your regular ol’ PT though. The specialized method of physical therapy decreases adhesions, or internal scars that occur wherever the body heals from infection, inflammation, surgery, trauma or endometriosis (a condition where the uterine lining grows outside the uterus), says Larry Wurn, lead author and a massage therapist who developed the technique used in the study. These adhesions act like an internal glue and can block fallopian tubes, cover the ovaries so eggs cannot escape, or form on the walls of the uterus, decreasing the chance for implantation. “Reproductive structures need mobility in order to function correctly. This therapy removes the glue-like adhesions that bind structures,” he adds.
A similar method widely used by niche physical therapists is called the Mercier technique, says Dana Sackar, member of the American Academy of Fertility Care Professionals and owner of Flourish Physical Therapy, a Chicago-based clinic that specializes in physical therapy for fertility. During treatment, the therapist manually manipulates the pelvic visceral organs from the outside—a process that Sackar says isn’t terribly painful, but isn’t exactly a spa treatment either.
So how does pushing on a woman’s abdomen help boost her baby-making chances? Primarily by increasing blood flow and mobility. “A malpositioned uterus, restricted ovaries, scar tissue, or endometriosis, can all reduce blood flow to the reproductive organs, limiting fertility,” Sackar explains. By repositioning the organs and breaking up scar tissue, blood flow is increased, which, she says, not only makes your reproductive system healthier, but also helps your body to balance out its hormones naturally. “It prepares your pelvis and organs for optimal function, sort of like how you do training runs to prepare your body to run a marathon,” she adds.
These techniques also help fertility by addressing the emotional roadblocks, as therapists work closely with patients to address mental needs as well as physical. “Suffering from infertility is extremely stressful, so anything we can do to help reduce that stress is good too. The mind-body connection is very real and very important,” Sackar says.
Because it’s non-invasive and cost-effective, Sackar recommends trying physical therapy before other fertility treatments. She says she also works closely with patients’ OBGYNs and other fertility specialists, using the therapy to enhance their medical options. Alternative therapies can sometimes get a bad rap, which is why Sackar thinks scientific studies like this are so important. “It doesn’t have to be an either/or situation—the two types of medicine can work together,” she says.
At the end of the day, everyone wants the same thing—a successful pregnancy and a happy, healthy (and preferably not bankrupt) mama. So it’s worth trying a variety of options to achieve that. “Some women can snap their fingers and get pregnant like that,” Sackar says. “But many women need an ideal situation to conceive and that can take work. So that’s what we do with this physical therapy, we help them get to that point.”
The study compared manual physical therapy treatment to previously published success rates with standard, conventional treatments for female infertility. The results were astounding. Researchers discovered that with the application of the CPA manual therapy approach, fallopian tube patency of at least one fallopian tube was 60.8% successful. When compared with the reported success rates in the literature, “it was observed that the CPA performed as well as or at higher rates of success than surgery did.” The rate of pregnancy for those patients with at least 1 open fallopian tube was also very successful with an overall pregnancy rate of 56.64% post CPA treatment.
For those women with endometriosis (n=558), the success rates for pregnancy post CPA treatment was 42.8%. For those who underwent IVF (In Vitro Fertilization) after CPA treatment, the pregnancy rates were even higher at 55.4%. These findings were also comparable to or better than standard medical interventions published in current literature.
Manual therapy has even shown to decrease elevated FSH levels and improve pregnancy rates by almost 50%. Researchers acknowledge that, to date, there are no medical treatments that represent standard care for women with elevated FSH levels and require more investigation for comparative results.
Of the 59 women with PCOS, the overall pregnancy success rate was 53.57%. The only significant and direct comparison with standard of care literature was with the use of metformin. Comparably, CPA produced significantly higher rates of pregnancy than with metformin alone. No statistically significant outcomes were reported. Unexplained infertility and POF had the least success rates of pregnancy reported. This is most likely attributable to a lack in subject size and/or no published medical treatment in these specific patient cases, further warranting the need for future investigation.
In conclusion, manual physical therapy has been shown to reverse female infertility in cases such as occluded fallopian tubes, endometriosis, hormone dysregulation, and PCOS. With all of the conventional options available, it is wonderful to know that manual therapists specializing in pelvic health have a clinical significance in helping change the lives of women struggling with infertility.
Center for Disease Control and Prevention (2006-2010). Infertility. Retrieved from http://www.cdc.gov/nchs/fastats/infertility.htm
Rice AD, Patterson K, Wakefield LB, Reed ED, Breder KP, Wurn BF, King CR, Wurn LJ. Ten-year Retrospective Study on the Efficacy of a Manual Physical Therapy to Treat Female Infertility. Alternative Therapies. 2015.(21)3;32-40.