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

In This Article

Studies I and II (1998 to 2003)

Although each study is separately presented below, many subject characteristics and the intervention itself are common to both. Patient histories were obtained from medical records and included physical therapy and biomechanical assessments; gynecologic, surgical and trauma histories; and prior infertility tests, diagnoses, and treatments.

Subject Selection

Presence of Adhesions. The purpose of the 2 studies was to assess the effectiveness of site-specific manual soft-tissue therapy in treating biomechanical infertility in women with probable abdominopelvic adhesion formation. Thus, all enrolled subjects had histories of conditions indicating a strong probability of adhesion formation before treatment (ie, abdominal and/or pelvic surgery, infectious or inflammatory disease, or trauma). Moreover, 48.7% of patients had definite diagnoses of "adhesions" affecting the reproductive and/or neighboring structures. Although it seemed unlikely that manual soft-tissue therapy would have a direct effect on patients also having medical or hormonal infertility, no patient was excluded from the studies for these conditions.

Medical Histories. The relevant medical histories for the subjects in the 2 studies include the following:

  • Gynecologic: Abdominopelvic pain, abortion, adhered ovaries at fimbriae, adhesions (abdominal, pelvic), bicornuate uterus, bladder infection, C-section, chronic pelvic inflammation, chlamydia, cystitis, D&C, dysmenorrhea, dyspareunia, ectopic pregnancy, endometriosis, failure to ovulate, fibroids, hydatid cyst of Morgagni at tube, hydrosalpinx, interstitial cystitis, irregular menstrual periods, multiple miscarriage, partially blocked and adhered tubes, numbness at C-section scar, ovarian cysts, PID, pelvic scarring, polyps in uterine horn, ruptured cyst, thyroid and hormonal problems, uterine prolapse, tubal occlusion (unilateral, bilateral), tubal phimosis, urinary incontinence, and vaginitis.

  • Surgical: Abdominal, abortion, appendectomy, bladder repair, C-section, cervical, D&C, episiotomy, fibroidectomy, hysteroscopy, laparoscopy, laparotomy, lysis of adhesions, myomectomy, ovarian cystectomy, pelvic, tuboplasty, and uterine suspension.

  • Trauma: Broken bones; falls; injuries to low back, hip, pelvis, sacrum, and coccyx; car accidents; and physical and sexual abuse.

  • Prior infertility tests and diagnoses: Infertility tests included gynecologic physical examinations and cultures, FSH and TSH tests, ultrasound, HSG, laparoscopy, and laparotomy. Some patients also had hysteroscopy, endometrial and peritoneal biopsies. Infertility diagnoses included hormonal problems, total bilateral occlusion, unilateral occlusion with contralateral tube partially blocked, and hydrosalpinx.

  • Prior infertility treatments: In addition to HSG, laparotomy, laparoscopy, and hysteroscopy (used primarily for diagnosis), prior infertility treatments included surgery (see above); pharmaceuticals (ie, clomiphene [Clomid] , estradiol, FSH, gonadatropins [Lupron], menotropin [Repronex], micronized progesterone [Prometrium]); and assisted reproductive techniques (ie, IUI and IVF).

The Intervention

The primary goals of manual therapy are to decrease pain and restore mobility. The intent of the particular therapy used in this study is to create microfailure of collagenous cross-links, the "building blocks" of adhesions. These unique soft-tissue techniques were developed after extensive study of current, innovative physical therapy methods.

Following a thorough medical, gynecologic, and surgical history, specific sites of visceral cross-linking were deduced as likely adhesion sites. The therapist also employed sufficient palpation and evaluation skills to note areas of decreased mobility. The restricted soft tissues were engaged and cross-links were perceived to release as evidenced by increased mobility at the precise sites of visceral and myofascial restrictions after each therapy session.

After a perceived increase in histologic length (presumably due to deformation of collagenous cross-links), the soft tissues were noted to become more pliable, with increased mobility and flexibility. These changes were further demonstrated by improved alignment, biomechanics, and increased range of motion of osseous and soft-tissue structures. Many patients reported a decrease in pain symptoms, presumably as a result of decreased pressure on nerves and pain-sensitive structures.

In accord with the standards of the American Physical Therapy Association, detailed clinical records were kept of each patient's visit, including treatment dates and duration, symptomatic complaints, areas treated, and treatment techniques performed.[24] Depending on the patient's schedule and geographic location, the frequency and duration of treatment ranged from a 1-hour session at weekly or longer intervals to intensive sessions of 2 to 4 hours of treatment daily, performed over 5 days. The standard length of the therapy sessions was 1 to 2 hours, minus 15 minutes for room preparation and paperwork.


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