Trying to get pregnant? Pelvic PT can help!
I first learned about manual therapy and physical therapy interventions to help people with fertility in 2011. I was excited…but skeptical. At that time, I saw just one study, and wasn’t sure how what we did could make that big of a difference. As time went on, I started to see the changes we could make for people first hand. I worked closely with a reproductive endocrinologist when I lived in Greenville, SC, and started seeing his patients who were struggling with fertility- at that time- primarily to address the challenges they were having in sexual intercourse due to pain. It’s amazing what improving pain during sex can do to help increase likelihood of pregnancy!
That was a start to wanting to learn more about what we can do. A few weeks ago, our team at SPH furthered our training through a 3-day class on visceral manual interventions for reproductive function.
Now…. I know what you’re thinking….
Why would someone need to work with a pelvic health therapist while trying to get pregnant?
The reality is that 1 in 7 to 10 couples have difficulty getting pregnant, and this number increases as age increases (1 in 4 in those 40-44 years old). There are many different causes of infertility, including difficulty with sperm, endometriosis, problems with ovulation or tubes, and more. But, when we look specifically at uterus-owners, mechanical factors like adhesions and endometriosis are thought to account for 30-50% of infertility cases. Adhesions and restrictions can occur after a person has had a pelvic surgery, but are also known to accompany conditions such as “endometriosis, pelvic inflammatory disease (PID), tubal obstruction, polyps, pelvic spasms, bowel obstruction, and chronic abdominopelvic pain” (Wurn et al., 2004). Secondary infertility has also been identified after Cesarean birth, which could be related to mechanical factors. These adhesions can restrict the mobility and function of the organs, ligaments, fascia and nerves in the pelvis, thus can impact the movement and mechanics within the entire abdominopelvic area.
When considering fertility, adhesions can cause problems when the occur in the following areas (Wurn et al., 2004):
Uterine walls and ligaments
This could lead to difficulty with implantation
At and around the cervix
Creating narrowing of the cervix, affecting the position of the uterus, and complicating sperm transfer to the uterus
Around the ovaries
Impacting transfer of the egg to the fallopian tubes
Around the fallopian tubes
Restricted transfer and travel of the egg
How can manual therapy interventions make a difference?
An Overview of Key Studies
Specific manual therapy interventions (termed visceral mobilization) at specific sites in the pelvis can help to improve tissue mobility and the response of the nervous system to that part of the body. This was first studied in the 70’s and 80’s in the Czech Republic; however, the first published paper I was able to find on this was published in 2004 by Wurn and colleagues. They evaluated the effect of manual physical therapy intervention on 53 individuals dealing with infertility, 36 of which were planning to undergo IVF within 15 months. Their results showed that 71% of the patients who were trying to get pregnant naturally achieved pregnancy within 1 year. Of those undergoing IVF, 67% achieved a successful embryo transfer.
An additional study by Kramp et al., 2012 looked at manual therapy interventions for 10 women with diagnosed infertility. Following treatment including improving pelvic symmetry and sacral mobility, treating myofascial dysfunction around the pelvis, manual lymphatic drainage, and visceral mobilization, 6 out of the 10 women were able to achieve pregnancy.
Rice et al. (2015) published a retrospective review of 1392 patients treated with visceral mobilization. They found that those who were post-surgical had 35% success and non-surgical patients had 69% success in achieving pregnancy. So, the thought here is that post-surgical adhesions may lead to more difficulty in improving tissue mobility.
What is involved in physical therapy to improve fertility?
Initial Evaluation
First, all patients are seen for an initial evaluation. During this time, the physical therapist will talk with the patient about their history and the current difficulties they are having. We will also want to determine if the patient has other challenges related to their lumbar spine, hips, or pelvis, or any current pelvic health challenges (like painful sex, bladder/bowel dysfunction, endomeriosis or pelvic pain). From here, we will recommend a specific examination to evaluate the person comprehensively. Our evaluation typically includes:
Movement screen
From your head to toes!Posture/body mechanics screen
Breathing and ribcage assessment
Abdominal wall assessment
Hips, Spine and Pelvis screen
Pelvic Floor Muscle Evaluation
Often performed internally vaginally if the patient feels comfortable with this. This allows us to assess deeper tissues and assess readiness for internal visceral mobilization techniques around cervix and ovaries.
Treatment Plan Development
From here, we will recommend a treatment plan, which generally spans 3 months (but less if you get pregnant right away!). This will be customized to the individual, but often will include education on strategies to improve reproductive success, specific exercises to optimize pelvic and spinal mobility, and specific visceral manual therapy techniques, timed throughout your cycle. This includes addressing:
Cervix
Fornices, os, and ligamentsCervical-ovarian connections
Including the broad ligament and tubal-uterine junctionFallopian tubes
And ovary attachmentInguinal canal mobility
Small intestines, bladder, and kidney mobility
Pelvic floor and pelvis mobility
Did you know that pelvic health therapists can help with fertility? Want to learn more? Let us know, and let’s chat!