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 with getting 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. Show
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: 1) elevated FSH (follicle stimulating hormone) of 10 mIU/ml or higher 2) fallopian tube occlusion 3) Endometriosis- when the lining of the uterus grows outside of the uterus causing significant pain, abnormal bleeding, infertility 4) 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 5) Premature Ovarian Failure (POF)-loss of ovarian function before a woman is 40 years old and 6) 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. 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 April 24-April 30 is National Infertility Awareness Week! Long gone are the days where women were expected to get married and have countless children (in many cultures). Teenagers were often married off after their first
menstrual cycle. Series like Bridgerton make light of how society once viewed these arrangements. Bridgerton also broached the subject of infertility with its two main characters in the first season. This subject is something that globally 186 million individuals have experienced. What is Infertility?Current terms define infertility as difficulty conceiving after one year of trying, less if you are over 35. This works out to about 10-15% of couples. Broken down 1/3 is due to female causes, 1/3 male causes and 1/3 a combination of both. We have discussed male and female infertility in previous blogs. This blog discusses what couples can do to combat infertility. If a couple is unable to become pregnant after a year of trying each individual is evaluated. Both parties may do hormone and genetic testing, reproductive organs analyzed, biopsied and/or imaged. Testing can be invasive and uncomfortable. In the majority of cases the issue is either:
In 5-15% of cases tests come back normal and the cause is frustratingly unknown. There are several options available for couples that struggle with infertility ranging from conservative lifestyle changes to an invasive surgical option depending on the circumstances. The most conservative is lifestyle changes which includes:
The next step up in treatment involves medications. This includes:
Surgical interventions that may be recommended include:
Assistive Reproductive Technology (ART)Conception can also be assisted with ART through:
ART can be done with donor eggs or sperm or both. Women who have difficulty carrying can have another woman carry the couples embryo. ART changes and adjusts all the time as more techniques are developed to improve the odds of a successful pregnancy. Where does pelvic physical therapy come into play?Pelvic health physical therapy has played a significant role in helping women and men who have mechanical blockages within their reproductive systems. This includes:
How does pelvic physical therapy help?Pelvic health physical therapists are uniquely trained to identify and mobilize tightness within the pelvic organs including the uterus, fallopian tubes and ovaries. This is part of the realm of visceral mobilization (organ mobility). This is typically done over the lower abdomen through non invasive manual techniques on the skin (externally). Pelvic health physical therapists can also reduce adhesions and tightness internally within the pelvic floor muscles improving the strength, tone and circulation. The Science Behind Manual TherapyManual therapy aims to reduce any adhesions between organs to allow natural organ alignment and movement and reduce mechanical blockages so the egg can reach the uterus and implantation can occur. When combined with ART, manual therapy techniques have been successful in assisting women with fertilization 40-60% of the time in PCOS, endometriosis, elevated FSH and/or fallopian tube occlusion than using just ART alone. In another study manual therapy was shown to give a 3.2:1 better odds of becoming pregnant when compared to no treatment for women with mechanical adhesions or blockages present. One study broke down the rate of pregnancy amongst specific conditions. The results were:
The reported pregnancy rate for patients who later underwent IVF after the therapy was 56.16%. In men, manual therapy techniques aim to reduce adhesions and restrictions within the reproductive system and pelvic floor muscles to improve tone, strength and increase circulation into the penis. We Can Help!Body Harmony Physical Therapy offers up to one hour treatment sessions in a private treatment room. We recommend getting a referral from your MD before starting. Pelvic physical therapy should be timed before invasive fertility treatment options are carried out like IUI, IVF etc so that the biomechanical blockages are worked on beforehand. Please contact 212-233-9494 or to speak to a pelvic health specialist for more information. References
Can massage unblock fallopian tubes?They say the intensive massage therapy is highly effective for clearing blocked fallopian tubes and can also help women with other infertilities caused by adhesions.
How do you unclog a blocked fallopian tube?If your fallopian tubes are blocked by small amounts of scar tissue or adhesions, your doctor can use laparoscopic surgery to remove the blockage and open the tubes. If your fallopian tubes are blocked by large amounts of scar tissue or adhesions, treatment to remove the blockages may not be possible.
How can I open my blocked tubal naturally?2. Boost immunity with Vitamin C: Vitamin C is essential to helping our bodies absorb iron from the food we eat. Tubal blockages caused by infection can naturally unblock by increasing your intake of Vitamin C with different citrus foods like oranges and lemons or with vegetables like broccoli and green peppers.
Can pelvic floor therapy help with infertility?Pelvic floor physical therapy has been proven to help reduce mechanical infertility through various manual therapy techniques and self-management strategies. Origin's trained physical therapists can help improve your scar tissue mobility and reduce adhesion restrictions using hands-on scar and myofascial mobilizations.
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Manual pelvic physical therapy for blocked fallopian tubes
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