Infertility is a prevalent problem that affects approximately 5 million women in the United States. ¹ Not only is infertility describing the difficulty of getting pregnant, but it is also about the difficulty of staying pregnant. ² Out of those 5 million women experiencing infertility, about 40% have mechanical infertility. Mechanical infertility is referring to dysfunctions of the musculoskeletal system as the reason for infertility, with pelvic adhesions as one of the primary causes. These pelvic adhesions may be due to trauma, infection, inflammation or surgery, and are a natural response to tissue damage. The interesting thing about pelvic adhesions is that they can still be present even after the damaged tissue has healed. Wherever the pelvic adhesions occur, they can cause a decrease in mobility and function, causing increased difficulty to conceive. ¹ Certain manual physical therapy techniques have been shown to improve these adhesions and restore mobility. ³
Common conditions where pelvic adhesions are present (this is not an all-inclusive list): ¹
Pelvic Inflammatory Disease
Chronic abdominopelvic Pain
Another primary cause of infertility is blocked fallopian tubes, with it being estimated to affect 25-35% of infertile women. ³ The standard of care for blocked fallopian tubes is currently surgery, however, as seen previously, surgery increases the likelihood of pelvic adhesions. When comparing the effectiveness in treatment between surgery and manual physical therapy techniques to open the fallopian tubes, it was shown that the manual techniques performed just as well or even better than the outcomes seen with surgery. Individuals that received the surgery prior to manual therapy did not have as much success than those who received just manual therapy treatment. The success rates of becoming pregnant after completing their plan of care, which included manual therapy techniques, were 68.9% for those who did not have a prior fallopian tube surgery, and only 34.5% for those that did have the surgery. ³
Endometriosis is another common cause of infertility. ³ Endometriosis is present in only about 11% of women, but has been seen to cause infertility in up to 68% of infertile women. Manual physical therapy techniques have also been seen to have similar or better results than with medication or surgery to improve a patient’s chances of conceiving. ³
The national average for pregnancy after IVF treatment in the United States as reported in 2010 was approximately 37.3%. ³ According to a study that was analyzing the effects of manual physical therapy techniques prior to undergoing IVF showed a pregnancy rate of 56.16%, which is 1.5 times higher than the national average for pregnancy after just IVF treatment alone. ³
The evidence supporting manual physical therapy techniques to decrease the physical barriers to conceiving is overwhelmingly positive. Not all causes of infertility are mechanical, but there are a large number of conditions that contribute to infertility that can benefit from manual treatment.
So, what do these manual techniques do to help with infertility? ²
Improve sexual dysfunction
Normalize pelvic alignment/function
Optimize nervous system function to address stress and anxiety
Increase scar mobility and decrease adhesions
Address any post-surgical dysfunction
We have seen large improvements in adhesions and restrictions with the manual therapy techniques we use here in our clinic, and found these techniques to vastly help with pelvic dysfunction. If you or someone you know is struggling to conceive, these techniques may benefit you and decrease any adhesions you may have to restore mobility and improve your chances of conceiving.
Wurn, B. F., Wurn, L. J., King, C. R., Heuer, M. A., Roscow, A. S., Scharf, E. S., & Shuster, J. J. (2004). Treating female infertility and improving IVF pregnancy rates with a manual physical therapy technique. MedGenMed : Medscape general medicine, 6(2), 51.
Abraham, Yeni. "Rehabilitation Interventions to Support Fertility." Pelvicon, 9 Sept. 2023, Atlanta, GA.
Rice, A. D., Patterson, K., Wakefield, L. B., Reed, E. D., Breder, K. P., Wurn, B. F., King Iii, R., & Wurn, L. J. (2015). Ten-year Retrospective Study on the Efficacy of a Manual Physical Therapy to Treat Female Infertility. Alternative therapies in health and medicine, 21(3), 36–44.
Written by Regina Goeke, DPT - January 2024