Physical Therapy for Infertility
FRESNO, Calif. -- 1.5-million women in the U.S. have problems with fertility, according to the latest data by the Centers for Disease Control. While many of them turn to surgery or in vitro fertilization, there is another option that doesn't require surgery or medication.
Joshua and Julie Ledbetter always knew they wanted children, but two years ago Julie learned both of her fallopian tubes were blocked.
Julie told Ivanhoe, "The first thoughts you think of are guilt because you waited so long."
They were told their only options were adoption or in vitro, but the Ledbetters' sought out a third option and just six months after treatment Julie became pregnant.
Belinda Wurn, PT, is a physical therapist and Director at Clear Passage Therapies in Gainesville, Florida. She specializes in treating people for lower back and pelvic pain, caused by adhesion- scar tissue that forms internally after surgery, infection, or endometriosis.
In a technique similar to massaging out a knot in a muscle, Belinda massages away the adhesions that are blocking the fallopian tubes.
"You just hold, and the longer you stretch it all of a sudden it will give; it feels like it gets longer, that's what it feels like to us," Wurn explained.
In an analysis of 14,000 women with blocked fallopian tubes, 57-percent became pregnant after treatment at Clear Passage, compared to national data that shows the success rate of surgery is just 22 to 34-percent.
Julie exclaimed, "They completely fixed the problem the first time around." In fact, Julie is now pregnant with her second child.
The data, published in the journal Alternative Therapies, also showed that 54-percent of women whose infertility was caused by polycystic ovarian syndrome became pregnant after therapy with Clear Passage, compared to just 33-percent of women who had surgery. The average treatment at Clear Passage takes 20 hours over the course of five days and the total cost is around $6,000.
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BACKGROUND: According to the Centers for Disease Control, one out of every eight couples has trouble getting pregnant. Infertility is the abnormal functioning of a male or female reproductive system. Infertility can be caused by many different factors. In men, sperm count, shape, or motility can lead to infertility. Stress, drug use, and age-related testosterone decreases can also affect fertility. In women, infertility can be caused by an ovulation disorder or physical irregularities in the pelvis, such as a blocked fallopian tube. Still in other cases, the cause is unknown. The treatment for infertility can vary from surgery and hormone therapy to in vitro fertilization (IVF). IVF involves taking eggs from a woman's ovaries and mixing them with sperm in a tube, fertilizing the eggs. The embryos are then returned to the mother's uterus. Other ways that prospective parents try to resolve the issue of infertility include freezing eggs and sperm, using donor eggs, or finding someone to carry the baby for the couple.
(Source: http://www.resolve.org/about/fast-facts-about-fertility.html, http://infertility.wustl.edu/about-infertility/ )
BLOCKED FALLOPIAN TUBES: The fallopian tubes are narrow ducts that connect the ovaries to the uterus. The fallopian tubes are also where the egg is fertilized by sperm during conception. When one of the fallopian tubes becomes blocked, there is still a chance for the woman to get pregnant, but when both of these tubes get blocked or damaged by disease or infection, infertility results. Blocked fallopian tubes account for 40 percent of infertility cases in women. Sometimes, doctors can clear the blockage or remove the scar tissue with surgery. Other women may choose to undergo IVF.
(Source: http://www.webmd.com/women/endometriosis/endometriosis-and-fallopian-tube-problems?page=2, http://infertility.about.com/od/causesofinfertility/a/blocked_tubes.htm)
NEW RESEARCH: Researchers have found that surgery and IVF aren't the only ways to treat blocked fallopian tubes. In fact, the 10-year study showed that physiotherapy was able to totally open blocked fallopian tubes, something that previously was only thought possible with surgery. The physiotherapy is called the Clear Passage Approach, and according to the study, it achieved pregnancy rates double those of surgery.
(Source: http://alternative-therapies.com/openaccess/ATHM_23_3_Rice.pdf, http://www.alternativemedicine.com/news-item/physical-therapy-exceeds-medical-success-treating-female-infertility )
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Physical Therapy for Infertility -- In-depth Doctor's Interview
Belinda Wurn, Physical Therapist and Director of Services for Clear Passage Therapies, explains how physical therapy can help women suffering from infertility and more.
Interview conducted by Ivanhoe Broadcast News in March 2015.
How you have gotten to this point?
Belinda Wurn: I had cervical cancer about 30 years ago and had a lot of external, as well as internal radiation therapy, which killed the cancer, but at 33 it threw me into menopause. Over the next year and a half, maybe two years after the treatment was completed, I started having all kinds of chronic pain. I had intestinal problems. I had pain with intercourse. I had tailbone and low back pain, and it started spreading up my back. At that time I had been a therapist for 10 years already, and I was not able to work for about two years because I had so much pain. It must have been, I don't know six, seven or eight different kinds of specialists and I got really tired of hearing "It's all in your head" or "You have to learn to live with it." This is because adhesions don't show up on any of the typical medical diagnostic tests such as x-rays or CAT scans or MRI's. At 34 or 35 that was an unacceptable answer to me. That was what started us searching for answers for any kind of alternative technique that sounded like it might help with complex pain. I traveled all over the country, for about a week, every three months, for a year and a half, and I got treated by many different wonderful practitioners and anyone who did anything that helped me I started studying with them. Then Larry got tired of me traveling so frequently, so he started studying with the same people and he kept working on me and treating me. By the end of 1989, he had gotten me back to the point where I was relatively pain-free. That was when we decided to open our first private practice treating complex chronic pain patients. Patients with headaches, neck pain, back pain, pelvic pain and within the first year of our practice we had a woman who had a work-related slip and fall injury. We were treating her for headaches, neck pain and back pain and pain with intercourse. She had also had the bikini incision for a uterine fibroid cyst, and it had healed very badly. It was very lumpy and bumpy so she asked if we would treat her scar while we were treating her neck and back and pelvis and we said sure. She came in one day and said she was pregnant and we congratulated her and she said "Wait, you don't understand." She had the HSG dye test done seven years prior to our treatment, and it showed that both of her fallopian tubes were totally blocked. She hadn't bothered using birth control, and low and behold, she was pregnant. We then started talking to a friend of ours who was a chiropractor, and he asked us if we thought we had something to do with it and we said, "We don't have a clue." He told us, "I'm going to send you two of my patients who have been trying for almost two years to get pregnant unsuccessfully, and they also had low back pain." We treated them, and they got pregnant. Then the chiropractor referred his wife, and they'd been married for about 15 years and had adopted a baby. He was six at that time. She had been trying unsuccessfully to get pregnant and had many ovarian cysts and had to have one ovary and tube removed and the remaining tube was blocked. She came to see us for some pain issues that she was having, and we treated her. She came in one day and said, "Belinda I don't know if I should hug you or punch you" because she was pregnant, and she was about to turn 42. At that point her husband said that you have to go meet with Dr. Richard King, a research gynecologist.
You got in touch with Dr. King?
Belinda Wurn: We got in touch with Dr. Richard King, a research gynecologist, and at the time he was the head of our local women's health section of North Florida Regional Hospital in Gainesville. We met with him, and we took our four infertility patient's charts. He was a bit skeptical, but he was open-minded, and he said that our results were very interesting. Looking through the patient's charts, he said, "Well four out of four is pretty interesting. You're doing things with your hands that I don't know that I can do surgically." He said, "I think we need to get some science behind this and start doing some studies." That was when he became our medical director, and this is back '92 or '93, so we've been working with him for a while.
You guys knew you were on to something. What forms adhesions and where do they come from?
Belinda Wurn: Adhesions form whenever the body heals from tissue trauma. The primary thing that causes adhesions is surgery. When you cut through tissues you want the body to heal, and adhesion formation is what heals and closes the scar. If you're in a trauma, such as a car accident, a slip and fall, or a rape or abuse, it is very traumatic. The body tries to heal these areas and clean these areas out so it lays down these adhesive bonds. It's like internal scars. The way the adhesions form is sort of like a spider web. They can start sticking to anything and everything in the vicinity, pulling on pain sensitive structures, causing pain and decreasing the ability of the organs to function at 100 percent efficiency. If you have adhesions that are sticking to your uterus, pelvis, bladder or to your intestines, when you move in certain directions, these organs are getting pulled, and it can cause pain and can also decrease their ability to function as normally as they should be able to.
When you were reaching out to other doctors and surgeons, what was their reaction?
Belinda Wurn: We were met with a great deal of skepticism, but fortunately we were able to meet enough physicians who were open-minded enough to at least listen to us. If they think about the mechanism of adhesion formation, if you apply a stretch or a resistive force long enough where things are stuck together, eventually those adhesions will start to deform and free up. The organs that used to be stuck together can now slide and glide over and around each other like they used to be able to. Pain symptoms then start to get better and go away, and the organs are able to function more normally. It's like we're taking the straight jacket off of them.
Is this something that you just stumbled upon by trial and error?
Belinda Wurn: Absolutely. We started hearing feedback from patients. For example, patients coming in and telling us they were pregnant, and that was a real eye-opener. Then we got calls from women telling us other sorts of issues that were resolved with our treatment. We had one woman, I think it was back in '92 or '93, and she was a little embarrassed and sort of hesitant and she said, "I just had to call you, and I don't know if anyone has ever told you this before or not, but you know I came to you, and I had pelvic pain, and pain with intercourse, but I also had difficulty achieving orgasm." She went on to say, "Since you guys treated me, I'm having incredible orgasms and improved lubrication and improved libido." We talked to Dr. King about these conversations and he said, "Well that's really important." Approximately 60 percent of women have some discomfort or pain with intercourse, and as physicians, we really have nothing to offer them. We can offer them numbing gels or tell them to drink a glass of wine to relax them, but they really had nothing to offer to address that.
Why does it improve intercourse?
Belinda Wurn: Well if a woman has had a surgery to her cervix or any kind of vaginal infection, such as a yeast infection, or a slip and fall where she's landed on her sacrum or tailbone or buttocks, the tailbone and the cervix should be able to move freely and they should be able to move out of the way during intercourse. There are ligaments that attach to the cervix, as well as to the tailbone, and if those become adhered and too tight, the cervix and coccyx, the tailbone can't move out of the way so certain positions are going to hurt because they're getting hit.
The therapy that you guys do, is it 20 hours over a week?
Belinda Wurn: Yes.
Why is it that many hours? What goes on during that week?
Belinda Wurn: At one point, we decided that we had so many people calling us from out of town, other states and other countries, and we were trying to figure out what was the minimum number of hours that we were able to successfully reverse infertility and what was the maximum number of hours. The majority of our patients fell right around the 20 hours. In order to make it feasible for out-of-state and out-of-country patients to come for the treatment, that was how we decided the week-long 20 hours of treatment. Monday through Friday, two hours in the morning, two hours in the afternoon with at least a one-hour break made sense. We started treating people using that protocol, and at first we were thinking, "Wow, was that too much? Will people get too sore?" But it seemed to work, and people were able to tolerate it with no problem.
As a therapist, for women with blocked fallopian tubes, are you able to feel the tubes and the uterus? What does it feel like for you as a therapist to go in there and feel around?
Belinda Wurn: The tubes are so tiny. Again if it's a hollow tube, and you push on it, it's going to collapse, but the uterus is very muscular. It's very palpable and the ovary as well. If we try to stretch the ovary away from the uterus, or if we stabilize the ovary and try to stretch the uterus away from it and we feel a line of tension between that, then we know that's the tube. We stretch them away from each other until we feel no more resistance. We're indirectly affecting the tube.
The patient can feel what you're doing as well?
Belinda Wurn: Oh yes. We're talking to them and showing them and asking "Can you feel how when I try to stretch this away from this, there is something not letting it move freely, there's some tension." They definitely feel it, or they feel tender or sore. As it releases, they definitely can feel a sense of release, or the soreness is no longer there.
What does it feel like on your end to feel that?
Belinda Wurn: If you've ever stretched salt water taffy, when you first pull both ends, it's very firm. You just hold and the longer you stretch it, all of a sudden, it will give and feels like it gets longer. That's what it feels like to us.
How does it make you feel when you're working on these people, and you know that you're doing so much just to change their quality of life or change their life for the better?
Belinda Wurn: It's very rewarding. To be able to help a couple that wasn't able to conceive to bring life in to the world is just fabulous. It's very exciting for us. I was not able to have children so in a way; it's a way of healing that part of me and also having been a chronic pain patient. Being able to give people a more active, pain free, significantly improved quality of life is just so incredibly rewarding. Seeing people in pain on Monday when they come in and the difference on Friday, they just glow, it's very exciting and very rewarding.
You all were met with resistance at first but now you have the study to back up what you guys are saying?
Belinda Wurn: Well we actually have published quite a few smaller studies. This most recent study published last month was the 10-year study of almost 1,400 women with infertility. That was a huge study, but we have published smaller studies on treating women with infertility, women with female sexual dysfunction, including pain with intercourse, problems with orgasm, lubrication and decreased libido. We also started having success treating people with small bowel obstructions and we've published smaller studies. We're looking to do a larger study, and we always have believed that doing the research and doing studies was vitally important for us to understand how what we do works and for the credibility in the medical community. About two or three years ago, we hired a double PhD researcher who is brilliant, and she has been putting together many, many studies that we are in the process of trying to get published.
What is your hope for this in the future?
Belinda Wurn: I was in a bad car accident in 2001, and couldn't work again for about nine months. I started writing a therapist training manual, and it became sort of an obsessive compulsive project. I ended up spending about four years writing a 550 page therapist training manual, and we hired artists who did original anatomical artwork and drawings of the hand techniques and the placement techniques of over 200 techniques. We have put together a therapist training program, sort of like a clinical internship. We have begun training physical therapists who love doing hands on manual work so we have expanded and trained therapists and we now have clinics in Miami, in the Denver area, in Indianapolis, in Northern Virginia about a half hour south of Washington and in Westchester County upstate New York, and we're very excited that we're now international. We have certified therapists in Cranbury, England, and two therapists just completed training in London.
Is your hope that everyone who's in pain or who isn't fertile has access to this?
Belinda Wurn: Yes, our hope would be that because we are publishing studies in peer reviewed journals that more and more physicians start thinking about referring their patients as an adjunct to what they do and not seeing us as competition. We would love to see more people have the work that we do more accessible to them more locally in the states as well as internationally.
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