Combined Manual Therapy Techniques for the Treatment of Women With Infertility: A Case Series
Mary Ellen Kramp, DPT, CLT-LANA
J Am Osteopath Assoc October 1, 2012 vol. 112 no. 10 680-684
Abstract
Current management options for infertility, including hormone therapy, intrauterine insemination, and in vitro fertilization, tend to be expensive, are not necessarily covered by insurance, and carry different levels of short-term and long-term health risks. Many of the issues that contribute to infertility can be traced to scar tissue, fascial restriction, and lymphatic congestion in the pelvic region. Manual therapy techniques exist to release fascial restrictions, to mobilize tight ligaments, and to drain congested lymphatics, all of which can be applied to the reproductive system. In this case series, 10 infertile women were treated with 1 to 6 sessions of manual therapy applied to the pelvic region. Techniques included muscle energy, lymphatic drainage, and visceral manipulation. Six of the 10 women conceived within 3 months of the last treatment session, and all 6 of those women delivered at full term.
Women in their childbearing years who have not been able to conceive after 1 year of unprotected intercourse are considered infertile according to the Centers for Disease Control and Prevention (CDC).1 The CDC reports that 6.7 million women aged 15 to 44 years have impaired fecundity, and 1.5 million married women are infertile.1Worldwide, 15% of couples are reported as infertile.2 In general, 27% of cases of infertility are caused by ovulation disorders; 25%, male factors; 22%, tubal disorders; 17%, unexplained factors; 5%, endometriosis; and 4%, other factors.3,4 According to Williams Gynecology,4 women who have not previously been able to conceive are considered to have primary infertility. Those who have previously conceived, whether or not the pregnancy was successful, are considered to have secondary infertility.
Average fertile women (aged 22-40 years) who have coitus in the week prior to ovulation have a 20% chance of developing a clinical pregnancy during each ovulatory cycle. Fifty-seven percent of fertile couples will conceive in the first 3 months, 72% in 6 months, and 85% in 1 year.4
Women whose infertility is unexplained have monthly fecundity rates of 10% to 15% with hormone therapy and intrauterine insemination (IUI).3 In Canada, Collins et al5found that pregnancy rates for 873 infertile couples without any treatment were 35% after 3 years and 45% after 7 years. In the Netherlands, van der Steeg et al6found that, overall, untreated infertile couples were able to achieve spontaneous pregnancy 29.5% of the time within 12 months. Katz et al7 reported that the incidence of infertility increases steadily in women after the age of 30.
Current options for treatment are dependent on the cause of infertility. Treatment options include fertility drugs, IUI, and in vitro fertilization (IVF). However, these treatments come with several considerations. First, procedures such as IVF are invasive and carry risk of infection. Second, the treatments can be expensive; the median cost of IVF is $24,373.4 It is often not covered by insurance and frequently needs to be repeated.4 Success rates are approximately 38%,3 and the successes have a high rate of multiple births, which places increased risks on the mother and the fetuses.7 Even though fewer embryos are being implanted now than a decade ago, multiple pregnancy remains the single highest risk of IVF.8
According to 2010 data on assisted reproductive technology, women attempting to conceive by means of IVF are doing so because of tubal factors (7%), ovulatory dysfunction (7%), diminished ovarian reserve (15%), endometriosis (4%), uterine factors (1%), male factors (17%), other factors (7%), or unknown factors (12%).8 In couples undergoing IVF, 11% reported multiple factors in women and 18% reported multiple factors in both men and women.8 In 2010, the national percentage of IVF cycles using fresh embryos from nondonor eggs that resulted in live births ranged from 5.0% to 41.5%, depending on age group.9 Of cycles that resulted in conception, 56.6% resulted in a singleton pregnancy, 24.9% resulted in a multiple fetus pregnancy, 16.4% resulted in miscarriage, 0.9% resulted in induced abortion, 0.7% resulted in stillbirth, and 0.4% resulted in an unknown outcome.10Pregnancy rates after IUI, according to Katz et al,4 are 25% to 35%.