Treating Female Infertility and Improving IVF Pregnancy Rates With a Manual Physical Therapy Technique*

Belinda F. Wurn, PT; Lawrence J. Wurn, LMT; C. Richard King, MD; Marvin A. Heuer, MD; Amanda S. Roscow, MPT; Eugenia S. Scharf, PhD; Jonathan J. Shuster, PhD

Disclosures

Pilot Studies

Pilot Study #1 (1989 to 1992)

Facilitating fertility through this site-specific soft-tissue therapy originated as an unplanned outcome of treating physical therapy patients for a variety of pelvic pain symptoms in areas where decreased tissue mobility was noted. In brief, 4 previously infertile women became pregnant coincidental with their treatment. Two of the women, aged 28 and 42, reported infertility as a result of bilateral tubal occlusion; they had been trying to conceive for 7 and 10 years, respectively. Their treatment protocols had been designed to decrease pain and increase function by breaking adhesive cross-links at specific sites in the abdominal and pelvic regions of the body. All 4 pregnancies resulted in full-term deliveries, and 1 woman reported a subsequent full-term pregnancy and live birth. As a retrospective review of these cases, documented through clinical observation, patient reports, and gynecologic records, Pilot Study #1 was the first test of the hypothesis that the therapy could facilitate fertility in previously infertile women.^[23]

Pilot Study #2 (1995 to 1997)

In a delayed attempt to substantiate the results of Pilot Study #1, a prospective study with 4 new patients was conducted. To test the hypothesis that the therapy could decrease adhesions and therefore improve reproductive organ function, Pilot Study #2 required bilateral tubal occlusion, diagnosed by pre- and posttreatment hysterosalpingogram (HSG), laparoscopy and/or laparotomy. Although 2 patients showed no change in patency after treatment, the third patient exhibited 1 patent tube, and the fourth demonstrated 1 patent tube and 1 improved tube.^[23]

Figures 1 and 2 depict pretreatment and posttreatment HSGs for a 34-year-old woman with no prior pregnancies who had been infertile for 8 years. She was referred to physical therapy with a history of bilateral occlusion with hydrosalpinx, as diagnosed by chromotubation during laparoscopy and laparotomy. Further support for this diagnosis was provided by 2 separate pretreatment HSG studies approximately 1 year apart. In a posttreatment HSG, 1 tube demonstrated free spillage of contrast dye, and the contralateral tube was improved with increased migration of the dye (ie, the contrast medium filled more of the ampullary portion of the contralateral tube).^[23]

The promising results obtained in Pilot Studies #1 and #2 suggested the methodology for the 2 subsequent studies included in this article: I. Facilitating Natural Fertility, and II. Improving IVF Pregnancy Rates.

(Enlarge Image)

Figure 1.

Pretreatment HSG for a 34-year-old woman: bilateral tubal occlusion with left hydrosalpinx. Diagnosis was consistent with pretreatment laparoscopy and laparotomy.

(Enlarge Image)

Figure 2.

Posttreatment HSG: persistent hydrosalpinx with increased migration of the dye in the left tube; free spillage of contrast via the right tube.

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Cite this: Treating Female Infertility and Improving IVF Pregnancy Rates With a Manual Physical Therapy Technique* - Medscape - Jun 21, 2004.

Table 1. Pregnancies and Full-term Births
N	# Pregnant	# Delivered	% Pregnant	% Delivered
14	10	9*	71.4	64.3

* 9/10 (90%) subjects who conceived had a full-term delivery.

Table 2. Pregnancies by Age Range
Age Range	# of Subjects	# of Pregnancies	% Pregnant
25–30	3	3	100.0
31–45*	11	7	63.6
Total	14	10	71.4

*The Mojzisovà study excluded women above age 30.

Table 3. Pregnancies/Deliveries by Age Group
Age Group	# of Subjects	% Pregnant (n)	% Delivered (n)
Below 35	9	77.87 (7)	66.7 (6)
35+	5	60.0 (3)	60.0 (3)
Total	14	71.4 (10)	64.3 (9)

Table 4. Observed vs Expected Pregnancies
Age	Transfers	Pregnancies
Age	Transfers	Observed	CDC 2001 Rate	Expected
< 35	15	11 (73%)	47.7%	7.15
35–37	6	4 (67%)	42.0%	2.52
38–40	5	3 (60%)	33.8%	1.69
41–42	4	3 (75%)	23.6%	0.94
>42	3	1 (33%)	12.1%	0.36
Total	33	22		12.7

Observed = rate for Manual pre-IVF treatment (study)
Expected = projected from CDC Figure 13^[32]
(Expected = Transfers times published CDC 2001 probability. For example, the published CDC 2001 pregnancy rate for a <35 year old woman is 47.7%, hence with 15 transfers, one expects 15 x 0.477 = 7.15 pregnancies; the observed number was 11.)

Table 5. Observed vs Expected Live Births
Age	Transfers	Live Births
Age	Transfers	Observed	CDC 2001 Rate	Expected
< 35	15	9 (60%)	41.1%	6.16
35–37	6	2 (33%)	35.1%	2.11
38–40	5	1 (20%)	25.4%	1.27
41–42	4	2 (20%)	14.5%	0.58
>42	3	1 (33%)	6.1%	0.18
Total	33	15		10.3

Observed = rate for Manual pre-IVF treatment (study)
Expected = projected from CDC National Summary, Figure 13.^[29,32]
(Expected = Transfers times published CDC 2001 probability. For example, the published CDC 2001 live birth rate for a <35 year old woman is 41.1%, hence with 15 transfers, one expects 15 x 0.411 = 6.16 live births; the observed number was 9.)

Table 4. Observed vs Expected Pregnancies
Age	Transfers	Pregnancies
Age	Transfers	Observed	CDC 2001 Rate	Expected
< 35	15	11 (73%)	47.7%	7.15
35–37	6	4 (67%)	42.0%	2.52
38–40	5	3 (60%)	33.8%	1.69
41–42	4	3 (75%)	23.6%	0.94
>42	3	1 (33%)	12.1%	0.36
Total	33	22		12.7

Table 5. Observed vs Expected Live Births
Age	Transfers	Live Births
Age	Transfers	Observed	CDC 2001 Rate	Expected
< 35	15	9 (60%)	41.1%	6.16
35–37	6	2 (33%)	35.1%	2.11
38–40	5	1 (20%)	25.4%	1.27
41–42	4	2 (20%)	14.5%	0.58
>42	3	1 (33%)	6.1%	0.18
Total	33	15		10.3

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Treating Female Infertility and Improving IVF Pregnancy Rates With a Manual Physical Therapy Technique*

Pilot Studies

Pilot Study #1 (1989 to 1992)

Pilot Study #2 (1995 to 1997)

Tables

Tables

Tables

Tables

Tables

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

Figure 1.

Figure 1.

Figure 2.

Figure 2.

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