Jen is a 37-year-old female who is happily married and has been very dedicated to her career as a veterinarian. She has enjoyed the challenge of starting her own practice and treating a variety of patients. About a year and half ago, Jen and her husband decided they were ready to start trying for a baby. Unfortunately, their efforts have not resulted in a little one of their own. Jen is not quite ready to go through the IVF process and has been discussing other options with her physician. Her physician referred her to pelvic floor physical therapy to see if this conservative approach would be helpful to conceive.
The Center for Disease Control and Prevention (CDC) defines infertility as the inability to conceive after at least one year of unprotected sex. For women 35 years and older, evaluation may occur after 6 months as a women’s egg quality and quantity decline over time. In the United States, there is a 1 in 5 (19%) chance that women aged 15 to 49 without prior birth will experience infertility. About 1 in 4 women (26%) will have difficulty getting pregnant or carrying a pregnancy to term. About 1 in 5 (22%) of women aged 30 to 39 will have difficulty conceiving their first child as compared to 1 in 8 (13%) of women younger than 30 years old. Of course, men can also experience infertility, so it is important for both partners to be medically evaluated.1
There are many contributing factors to infertility, including scar tissue, fascial restrictions, and lymphatic congestion in the pelvic region. Luckily, there is some research available to support physical therapy, specifically manual techniques, to increase fertility. In a case study of 10 infertile women, techniques such as muscle energy, lymphatic drainage and visceral manipulation was used over 1 to 6 sessions with 6 out of 10 women conceiving within 3 months and delivering to full term. The 60% fertility rate over 3 months in this case series was the same fertility rate in fertile couples over a 3-month period.2
A retrospective study looked at 1,392 females who were treated between 2002 and 2011 with infertility diagnoses that included occluded fallopian tubes, hormonal dysfunction, and endometriosis. Some women were undergoing in vitro fertilization (IVF). All women were addressed using “whole-body, patient-centered treatments” that used manual therapy to improve mobility and motility of reproductive structures. Of those with occlude fallopian tubes, 60.85% experienced clearing with a 56.64% rate of pregnancy. Those with endometriosis experienced a 42.81% pregnancy rate. Women with PCOS (polycystic ovarian syndrome) had a pregnancy rate of 53.57% while 39.94% of women with elevated follicle stimulating hormone (FSH) achieved pregnancy. Additionally, 49.18% experienced a lowering of elevated FSH. This study indicated that manual based physical therapy can be helpful to reverse female infertility.3
In another study, infertile women who were either hoping to conceive naturally or were planning to undergo IVF within 15 months were treated with manual physical therapy treatments. Of the women looking to conceive naturally, there was a variety of medical histories including inflammatory disease, abdominopelvic trauma or surgery, endometriosis, confirmed pelvic adhesions and pelvic inflammatory disease (PID). Ten of 14 patients (71.4%) became pregnant naturally within 1 year of treatment and 9 achieved full-term delivery. Women were intended to be seen for 20 hours over the course of 1 to 24 weeks. Nine of the 10 patients became pregnant prior to completion of their 20 hours of treatment.4
Twenty-five women who were planning to undergo IVF within 15 months of physical therapy treatment presented with similar medical histories, including endometriosis, PID, surgery and trauma. Nineteen out of 25 women achieved clinical pregnancies. It is important to note that none of the women in this study received infertility therapies outside of their physical therapy treatment cycle.4
Overall, more research is needed to determine the full benefit of physical therapy regarding fertility; however, the available research indicates that it is an intervention worth utilizing during your conception journey. There is little to no risk associated with participating in physical therapy, the majority of women report a decrease in pain during and after treatment as an added benefit, and PT is a relatively inexpensive treatment approach as compared to medical procedures.2,4 If you are struggling to conceive, please consider reaching out to a pelvic floor physical therapist to help you on your journey to parenthood!
Written by Jordan Schmidt, PT, DPT