In the past decade, some of the most exciting research (in my opinion of course) has been on the benefits pelvic health physical therapy can have on improving fertility.
Infertility is defined as the failure to achieve a pregnancy after 12+ months of regular, unprotected sex. As of April 2023, the World Health Organization (WHO) estimates ~17.5% of the adult population experiences infertility. That’s one in every 6 couples attempting to conceive!
Infertility can be caused by a multitude of issues including ovulation disorders, tubal disorders, PCOS, endometriosis, male factors, scar/fascial or lymphatic restrictions. Additionally, if a partner is experiencing dyspareunia (painful sex) or vaginismus (involuntary spasming of the pelvic floor with attempted penetration), conceiving may be challenging.
For those experiencing infertility, there are alternative options available, such as IVF, IVI, or hormone therapy. But these options may not be feasible due to financial constraints and unfortunately insurance companies rarely cover these expensive treatments. Even if finances aren’t an issue, there’s no guarantee these procedures will be effective. Estimates for live births following IVF vary from 4% - 50%. Additionally, I’m sure we can all empathize with the fact that infertility can cause significant distress on a trying couple’s mental, psychosocial, and relationship health.
Now for the Positive News
Continued research suggests that manual therapy techniques, such as those performed by physical therapists trained in pelvic health, can reduce the risk of infertility, particularly if it is mechanical infertility.
A 2012 study observed 10 females considered infertile. Each participant met the following criteria: they were not currently receiving fertility treatments, had partners with normal sperm counts and had no known reproductive abnormalities. 5 of the 10 women had completed fertility treatments in the past unsuccessfully. Each of the participants received manual therapy for 1-6 sessions. At the 3 month follow up, 6 of the 10 women had conceived and delivered their babies at full term. That’s a success rate of 60%!
Additionally, a 2015 study assessed 1,392 patients with various diagnoses contributing to infertility including hormonal dysfunction, fallopian tube disorders, endometriosis, and PCOS. Of those who underwent manual therapy interventions, 60.85% had clearing of occluded fallopian tubes, resulting in a pregnancy rate of 56%. 42% of those with endometriosis and 53% of those with PCOS were able to conceive.
Such manual techniques include visceral manipulation, mobilization of adhesions, lymphatic decongestive therapy and soft tissue techniques to the pelvic floor muscles. These techniques are intended to improve soft tissue structure mobility and restore normal physiologic motion. Methods will vary depending on each individual’s objective findings during their assessment. 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.
For such as conservative treatment option, I struggle to understand why manual therapy is not considered a routinely proposed treatment option prior to considering alternative options. If you are facing infertility or know a loved one who may be, consider finding a certified pelvic health physical therapist with experience in visceral mobilizations or contact me here.
It may just change their life.