How to boost fertility with physiotherapy

Today, assisted reproduction is one of the increasingly popular solutions to infertility for many couples and single mothers. But how can I boost my fertility to get pregnant without going down that route? Infertility treatments are becoming more and more precise as science advances, but their average cost is also high, so any help to maximize the chances of conception is welcome.

Physiotherapy is precisely one of those ‘extras’ that will improve your chances of pregnancy, along with diet and lifestyle, among others.

How can gynecological physiotherapy help me boost my fertility?

If a couple chooses assisted reproduction to achieve a pregnancy, it’s presumably due to a dysfunction in one of the partners. Gynecological physiotherapy aims to work on the woman’s body to achieve improvements on three levels:

• Mechanical: balancing muscle, joint and fascial tension and normalizing tension in the organs.
• Circulation: improving lymphatic and venous drainage.
• Neuroendocrine: balancing the autonomic nervous system, which handles the body’s involuntary functions such as digestion or menstruation… and improving the function of the hormonal axes.

Which exercises and areas of the body does gynecological physiotherapy work on?

Physiotherapy treatments in assisted reproduction are based on exercises for the deep muscles of the pelvis (the pelvic floor), the deep abdominal muscles (transverse abdominis) and the thoracic diaphragm.

In most cases, the exercises are combined with manual treatment: intravaginal work, manipulation of the pelvic joints, relaxation of the internal ligaments of the pelvis and visceral work.

Areas physiotherapists treat to boost fertility

Given the wide variety of causes of infertility, the areas physiotherapists treat to boost fertility are the following:

1. 1. Pelvic area: the female reproductive system attaches directly or indirectly to the bony pelvis. Any structural change in the pelvis or lumbar spine causes restriction and a lack of movement of the internal structures. The correct function of the pelvic organs depends on:
      • The tone of the pelvic floor muscles.
      • The tension of the pelvic ligaments (broad ligaments, uterosacral ligaments, round ligaments).
      • The tension of the fasciae (endopelvic fascia, the sacro-recto-genito-pubic lamina).

All these structures determine the correct position of the uterus, fallopian tubes and ovaries.

Pelvic techniques are usually applied in dysfunctions such as:

1. 1. • • • Dysmenorrhea
          • Dyspareunia
          • Menstrual cycle disorders
          • Chronic pelvic pain
          • Functional infertility
          • Vaginismus
          • Vulvodynia
          • Endometriosis (adhesions)
          • Genital prolapse

      In dysfunctions such as dyspareunia, vaginismus, chronic pelvic pain and tension in the pelvic fasciae and muscles, treatment with a vaginal dilator is often used. This device works by gently stretching the vaginal walls. To reduce discomfort, burning and tension, it’s recommended to apply lubricant gel, which makes it easier to insert the dilator.

      Another treatment often used with patients who have pelvic pain such as dyspareunia or vaginismus is stretching with the Epi-No. Almost more than half of patients in infertility treatment have endometriosis, a chronic disease that can cause tension, pain and adhesions in the pelvic area. With the Epi-No device we can improve pelvic floor flexibility and relieve these symptoms.

   2. Thoracoabdominal area: patients with increased pressure in the chest tend to have a tense, spasmodic diaphragm and, as a result, often have increased abdominal and pelvic pressure. The adrenal glands sit below the diaphragm, at the back of the abdomen, just above the kidneys. Among other things, they produce cortisol. If we get the diaphragm working properly, we’ll improve the pumping action in the abdomen and of the glands. At the level of the spine, the thoracolumbar junction (where the thoracic and lumbar vertebrae meet) is where the nerves of the autonomic nervous system (sympathetic system) that supply the pelvic organs are found. Poor vertebral function at this level can also affect normal function. In gynecological physiotherapy treatments, techniques are used to release this region to improve its function and, as a result, female fertility.
   3. Cervical fascial area: The middle cervical fascia (one of the different fascial layers in the neck) is related to the thyroid gland, and easing tension in the cervical fasciae improves blood supply to the gland and, therefore, its function.
   4. Cranial area: Mainly related to the neuroendocrine system. This area is essential for improving the relationship of the hypothalamic-pituitary axis. This is achieved by addressing cranial restrictions and releasing the cranial membranes.

These membranes are directly related to the junction between the hypothalamus and the pituitary gland (through a structure called the ‘diaphragma sellae’). Cranial treatment helps improve this relationship, increase proper blood supply and improve craniosacral harmony, which helps energize and balance the autonomic nervous system.

It has benefits for stress and anxiety and improves nociceptive conditions (the sensation of pain) related to the cause.

So it’s an area of special attention in cycle disorders and infertility, as it contains the hypothalamus and pituitary gland, which produce FSH and LH, as well as prolactin and ACTH, which, as we’ve seen, can disrupt normal function in connection with emotional causes.

Scientific evidence for the role of physiotherapy in infertility treatment

In short, based on scientific studies with published results, such as ‘Ten-year Retrospective Study on the Efficacy of a Manual Physical Therapy to treat Female Infertility’, ‘Treating fallopian tube occlusion with a manual pelvic physical therapy’ and ‘Massage Therapy Improves In Vitro Fertilization Outcome in Patients Undergoing Blastocyst Transfer in a Cryo-Cycle’, it has been shown that physiotherapy has a positive impact on the success of assisted reproduction treatments, by achieving goals such as:

• Improving female fertility by increasing the secretion of reproductive hormones.
• Reducing pelvic and abdominal adhesions.
• Relieving physical and mental discomfort (massage and relaxation techniques).

Among the conclusions of these studies, a scientific basis was identified showing that physiotherapy helps embryo implantation in infertility treatments. Reduced stress, fewer uterine contractions and better blood flow in the abdominal region, among others, were some of the most notable positive results.