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

Study I. Treating Female Infertility With a Manual Physical Therapy Technique

Subjects

Selection. The primary criteria for inclusion in this prospective study were (1) the inability to conceive following at least 12 months of unprotected intercourse, and (2) suspected or confirmed pelvic adhesions attributed to abdominal and/or pelvic surgery, infectious or inflammatory disease (eg, endometriosis, PID), miscarriage, or trauma within the abdominopelvic area. A total of 17 women were selected to receive a series of site-specific manual physical therapy treatments; 3 were lost to follow-up.

Gynecologic History. All 14 patients in this study had proven or clinically well-supported suspicion of adhesions. Medical diagnoses included:

Infectious/inflammatory disease	(13)	92.8%
Abdominopelvic trauma	(12)	85.7%
Abdominopelvic surgery	(11)	78.6%
Endometriosis	(7)	50.0%
Confirmed pelvic adhesions	(5)	35.7%
Pelvic inflammatory disease	(2)	14.3%

Characteristics. Study participants were a multiethnic, primarily white group, ranging in age from 25 to 44 years. The mean age was 33.5 (median, 32); and duration of infertility ranged from 1 to 20 years, with a mean of 4.9 (median, 4) years.

Procedures/Intervention

Largely on the basis of standard physical therapy practices, completion of a minimum of 20 treatment hours (or pregnancy during the course of therapy) was one of the few criteria for inclusion in the study.^[24] None of the patients received concurrent infertility therapies during the treatment period.

Data Collection

Study patients were evaluated and treated between May 1998 and February 2002 and tracked for at least 1 year following therapy. This does not imply that failure to become pregnant within a year was deemed permanent infertility,^[4] but in terms of facilitating fertility in a timely manner, 1 year sufficed for outcome assessment. Patients who became pregnant during treatment were tracked through expected delivery date. Follow-up data were obtained via questionnaires, telephone calls, letters, and email.

The final data set includes 14 patients who completed the recommended 20 hours of therapy or else became pregnant before completing therapy. Three patients were omitted because they did not respond to follow-up attempts.

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

Introduction
Pilot Studies
Studies I and II (1998 to 2003)
Study I. Treating Female Infertility With a Manual Physical Therapy Technique
Results
Study II. Improving IVF Pregnancy Rates With a Manual Physical Therapy Technique
Conclusion
References

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*

Study I. Treating Female Infertility With a Manual Physical Therapy Technique

Subjects

Procedures/Intervention

Data Collection

Tables

Tables

Tables

Tables

Tables

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

Comments

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