Can Pelvic Floor PT Help Optimize Fertility?
Did you know that according to the CDC, 19% of people in the United States ages 15 to 49 will experience infertility? That’s nearly 1 in 5.
Infertility is complex and common treatment options are expensive with varying levels of success. Common treatment options include hormone therapy, intrauterine insemination (IUI) and in vitro fertilization (IVF). These options are costly, often not covered by insurance, with efficacy rates ranging from 5% to 50% depending on age and cause of infertility. The average IUI cycle can cost around $1,000 with an IVF cycle costing up to $25,000. It’s not uncommon to go through multiple cycles of IVF prior to having a full term pregnancy.
Despite an abundance of research that manual therapy techniques performed by PTs can optimize fertility — particularly for folks experiencing mechanical infertility — and despite the relative affordability of manual therapy methods, manual therapy is still not a routinely proposed treatment option. It’s important to note that abdominal manual therapy techniques may be relatively new to modern medicine but have been used in Central and South American culture for years. Mayan Abdominal Massage and Sobada are traditional forms of abdominal massage used to support fertility.
Let’s talk a bit more about definitions and causes of infertility before diving into the evidence behind manual therapy practices performed by physical therapists.
The definition of infertility depends on age. For folks under 35 years old, infertility is defined as not being able to get pregnant or stay pregnant after one year of unprotected sex. For folks 35 years old and above, infertility is defined as not being able to get pregnant or stay pregnant after 6 months.
Infertility is further broken down into primary and secondary infertility. Primary infertility is define as the inability to conceive within 6-12 months of trying, while secondary infertility is defined as the inability to carry a pregnancy to full term within that timeline. Up to 1 in 4 will experience secondary infertility.
Causes for infertility vary significantly, including but not limited to ovulation disorders, male factors, tubal disorders, endometriosis, scar fascial or lymphatic restrictions and unexplained factors with 2010 data indicating that 18% of folks undergoing IVF report multiple factors.
Now, on to the good stuff. There is evidence to suggest that manual therapy techniques performed by physical therapists are a relatively affordable option to optimize fertility outcomes for folks experiencing infertility.
A 2012 study looked at 10 women considered infertile by the definition outlined above. These women were not undergoing any fertility treatment, had partners with normal sperm count, had no known reproductive abnormalities (their verbiage, not mine). 5 had undergone unsuccessful fertility treatment in the past. Participants were evaluated for soft tissue restrictions and mobility restrictions throughout the pelvis, pelvic alignment, lymphatic drainage and visceral mobility, and any restrictions found were treated with manual therapy protocols. They were treated for 1-6 sessions of manual therapy and were followed up with after treatment concluded. 3 months after treatment concluded, 6 had become pregnant. 6 out of 10 participants conceived and delivered at full term following the manual therapy treatment.
That means that 60% of participants in this study, participants who had been diagnosed with various causes of infertility, were able to conceive within 3 months of treatment after 1-6 visits of manual therapy, a rate of success higher than typical expectations following a round of IVF. While it’s important to keep in mind that sperm count and reproductive abnormalities were ruled out for this group of participants, the evidence remains compelling.
A 2015 study assessed the benefit of manual therapy techniques for 1,392 participants with various diagnoses contributing to infertility including hormonal dysfunction, blocked fallopian tubes, endometriosis and PCOS. Of those who underwent manual therapy treatment, 60.85% had a clearing of occluded fallopian tubes with a resulting pregnancy rate of 56%. 42% of patients with endometriosis and 53% of those with polycystic ovarian syndrome were able to conceive.
So what does all of this mean?
Infertility is complex. It’s multifactorial. There’s no one solution that’s right for everyone nor is there a guarantee of success with any treatment option. With that said, it’s important for providers to educate their patients on their options so people can make informed decisions as they navigate infertility.
To learn more about how pelvic floor physical therapy can support your fertility journey, contact us here!
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.