Statistics show that fertility struggles can affect 17.5% of the reproductive-age population (World Health Organization). Infertility arises from various causes, encompassing issues related to sperm, endometriosis, ovulation or tube difficulties, among others. However, when focusing on female infertility, mechanical factors such as adhesions and endometriosis are believed to contribute to 30-50% of infertility instances. These adhesions and limitations can emerge following pelvic surgery, but are also frequently associated with conditions like endometriosis, PCOS, pelvic inflammatory disease (PID), tubal obstruction, polyps, pelvic floor muscle dysfunction, bowel obstruction, and chronic abdominopelvic pain. Additionally, secondary infertility has been identified post-Cesarean birth, potentially linked to mechanical factors. These adhesions can constrain the movement and functioning of organs, ligaments, fascia, and nerves within the pelvis, thereby influencing movement and mechanics across the entire abdominopelvic region.
How Can Manual Therapy Interventions Make A Difference?
Specific manual therapy interventions (termed visceral mobilization) at specific sites in the pelvis can help to improve tissue mobility and the response of the nervous system to that part of the body. This was first studied in the 70’s and 80’s in the Czech Republic; however, the first published paper I was able to find on this was published in 2004 by Wurn and colleagues. They evaluated the effect of manual physical therapy intervention on 53 individuals dealing with infertility, 36 of which were planning to undergo IVF within 15 months. Their results showed that 71% of the patients who were trying to get pregnant naturally achieved pregnancy within 1 year. Of those undergoing IVF, 67% achieved a successful embryo transfer.
An additional study by Kramp et al., 2012 looked at manual therapy interventions for 10 women with diagnosed infertility. Following treatment including improving pelvic symmetry and sacral mobility, treating myofascial dysfunction around the pelvis, manual lymphatic drainage, and visceral mobilization, 6 out of the 10 women were able to achieve pregnancy.
Rice et al. (2015) published a retrospective review of 1392 patients treated with visceral mobilization. They found that those who were post-surgical had 35% success and non-surgical patients had 69% success in achieving pregnancy. So, the thought here is that post-surgical adhesions may lead to more difficulty in improving tissue mobility.
What Is Involved In Physical Therapy To Improve Fertility?
During the initial evaluation, the physical therapist will talk with the patient about their history and the current challenges. This can include an evaluation from head to toe including:
- Posture/body mechanics screen
- Breathing and ribcage assessment
- Abdominal wall assessment
- Hips, Spine and Pelvis range of motion testing
- Pelvic Floor Muscle, hip, and abdominal muscle testing: Pelvic floor muscle testing is performed internally if the patient feels comfortable with this. This allows us to assess overall muscle tone, strength, and coordination.
Following the initial evaluation, the Physical Therapist and client will establish a treatment plan. This will be customized to the individual, but often will include education on strategies to increase reproductive success, specific exercises to optimize pelvic and spinal mobility, and specific visceral manual therapy techniques.
Did you know that certain pelvic health therapists can help with fertility? Our clinic has therapists highly trained in techniques such as Mercier Therapy, the Vodder method of Manual Lymphatic Drainage, and general Visceral Mobilization to assist in improving fertility.
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 May-Jun;21(3):36-44. PMID: 26026143.
Wurn BF, Wurn LJ, King CR, Heuer MA, Roscow AS, Scharf ES, Shuster JJ. Treating female infertility and improving IVF pregnancy rates with a manual physical therapy technique. MedGenMed. 2004 Jun 18;6(2):51. PMID: 15266276; PMCID: PMC1395760.
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.