Results
For purposes of evaluating the effectiveness of site-specific manual soft-tissue therapy in facilitating fertility in women with a history indicating probable abdominopelvic adhesion formation, positive clinical outcomes were defined as (1) natural pregnancy within 1 year of the last treatment date, and (2) subsequent full-term delivery.
The duration of therapy was 1 to 24 weeks; median hours of therapy, 11. Of the 10 subjects who became pregnant, 9 conceived before receiving the full 20 hours of therapy. Having achieved their objective (pregnancy), continued treatment was deemed unnecessary.
As shown in Table 1 , 10 of the 14 study participants (71.4%) demonstrated posttreatment pregnancy, and 9 of 14 (64.3%) subsequently delivered a full-term baby. Hence, 90% (9/10) of the women who conceived had a live birth delivery, including 3 patients who had reported unilateral or bilateral tubal occlusion. The one "unsuccessful" patient (age 32) lost her baby at 28 weeks gestation because of umbilical cord strangulation.
Various studies over the decades have unequivocally demonstrated the statistically significant decline in female fertility with age. Indeed, as one expert claims, "a woman's 35th birthday marks a watershed that irreversibly lowers the probability of reproduction in her life."[4] The 1987 - 1989 Mojzisovà study (see above) pointedly excluded subjects older than 30 years of age.[22] In view of the import of this factor, Table 2 shows the rate of pregnancy by age range in the current study. Of the patients in the 31 to 45 age range, 63.6% (7/11) conceived compared with 100% (3/3) patients in the 25 to 30 age range.
As age 35 is considered the "watershed" for reproductive probability, Table 3 shows the pregnancy and live birth delivery rates obtained by patients in the younger than 35 and 35+ age groups. Of the 9 patients in the < 35 group, 77.8% (7/9) conceived and 66.7% (6/9) delivered, as compared with the 60% (3/5) pregnancy and live birth delivery rates of patients in the 35+ age group.
Treatment Safety
None of the patients in the study reported any observable complications or adverse side effects as a result of their treatment. Indeed, whereas all 14 patients presented with pain at their initial evaluation, 13 of the 14 reported decreased pain during or after treatment.
Discussion
Approximately 40% of cases of female infertility are biomechanical and attributable to scarring and/or pelvic adhesions resulting from previous abdominal/pelvic surgery, endometriosis, abdominopelvic infection, inflammatory disease, postinfection tubal damage, ruptured appendix, ruptured ovarian cysts, bowel disease, or foreign body reaction. Clinically, women with known pelvic adhesions and chronic pelvic pain have responded well to this manual physical therapy.
Related Research. Although our results can be compared with those of the Mojzisovà study (1987-1989), the inclusion criteria differed markedly; ie, most of our patients were > 30 years of age, and 4 reported tubal occlusion. Women with these characteristics were specifically excluded from the Mojzisovà study. Moreover, we purposely sought to treat women with other factors known to decrease the chance of positive results, ie, hormone problems, PID, abdominal and/or pelvic surgery, and ectopic pregnancy. Nevertheless, the mean conception rate for the study group was 71.4% vs 34.3% for the group treated by the Mojzisovà method.[22]
Current and Future Research. On the basis of the encouraging results (see above), a number of future studies in facilitating natural fertility are planned. One of these, a virtual replication of the present study, will use a much larger sample of infertile women, with subjects randomized into experimental (treatment) and control (no-treatment and/or pseudo-treatment) groups.
As Pilot Study #2 suggested, this therapy seemed capable of assisting women with occluded fallopian tubes. The present study supported this finding in that 3 of the 4 patients who reported tubal occlusion had live births following therapy, including 1 woman who had been diagnosed (by laparoscopy) with total bilateral occlusion. The therapy also appears efficacious for some women who have had no success with traditional infertility treatments alone, including fertility drugs, IUI, IVF, and other assisted reproduction techniques. Separate investigations in these related areas are now being conducted.
Another area of future investigation is the long-term duration of positive effects. In Study I, 3 patients who delivered following therapy reported a subsequent pregnancy: 2 women have had a second live birth, and the third is still pregnant. In time, it might also be possible to analyze positive outcomes in relation to factors such as specific dysfunctions, pain complaints and resolution, previous miscarriages, primary and secondary infertility, duration of infertility, type and number of prior infertility therapies, prior surgeries, and the optimal number of therapy hours for individual patients.
Lastly, there are strong indications of the efficacy of this therapy as a pre-IVF adjunct, as shown in Study II.
© 2004 Medscape
Cite this: Treating Female Infertility and Improving IVF Pregnancy Rates With a Manual Physical Therapy Technique* - Medscape - Jun 21, 2004.
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