Hands of Hope: Massage for Infertility by Angie Best-Boss

Infertility affects one in six couples in the US. 40% of these cases are due to hormone irregularities or anovulation. 20% are idiopathic and the remaining 40% are the result of mechanical problems such as obstructed fallopian tubes, scarring or adhesions.

For all causes of infertility, stress is also a factor that can inhibit spontaneous conception. Stress causes a decrease in LHRH release which results in decreased FSH release which, in turn, can suppress ovulation (anovulatory amenorrhea) (Sapolsky:1999). In addition,stress also affects levels of estrogen, androgens, and progesterone all of which are important factors in menstrual cycles and successful conception (Sapolsky:1999).

Massage can help with stress related infertility, however, it has not been until recently that evidence has surfaced demonstrating that massage can also assist with mechanical causes of infertility. A massage and physical therapist team, Belinda and Larry Wurn started to notice that clients they treated for low back and pelvic pain were becoming pregnant. Even more interesting, these clients had a long history of infertility.

Based on these, initial, anecdotal experiences, the Wurns decided to treat 8 women diagnosed as infertile and observe the results. Four of the eight women became pregnant,a 50% success rate. As a comparison, Assisted Reproductive Techniques and Surgical Adhesiolysis to treat/compensate for adhesion induced infertility only experience pregnancies in approximately 16-17% of patients respectively. (El-Mowafi,Diamond:2001)

Currently, the Wurns are in clinical trials of their patented technique known as the Wurn Technique. Ongoing study reports indicate a 73% success rate (16 of 22 women have become pregnant). These statistics comprise women who are diagnosed as infertile and who have become pregnant as a result of the Wurn Technique, or who have completed 20 hours of therapy and have gone two years without a pregnancy (Clearpassage:2002). Results are tracked for two years after completion of therapy (Clearpassage:2002).

How does the Wurn technique work? It consists of gentle massage techniques meant to address adhesions which are often the cause of mechanical infertility. Adhesions occur in 80% of postoperative patients or as a result of trauma, infection, or inflammation as in endometriosis. The etiology of adhesion formation is not well understood but risk factors encompass, intra-abdominal infection, tissue hypoxia/ischemia, tissue dessication, rough manipulation during surgery, presence of reactive foreign bodies, intra-peritoneal blood, prior history of adhesions (El-Mowafi,Diamond:2001). It appears that adhesions will form when there is an imbalance in fibrin deposits and fibrinolytic activity (El-Mowafi,Diamond:2001). Massage can positively impact adhesions by stretching and loosening tissue and increasing nutritive blood flow to the area. There are telling contrast X-rays of fallopian tubes before and after the Wurn Technique that clearly show the resultant increase in circulation.

These types of studies in massage therapy are incredibly exciting in a field that has been so scientifically stagnant that the primary instructive text for students in the state of Ohio is well over a hundred years old. It is discoveries like the Wurn technique that allow massage to move from the fringes of the medical community into a mainstream medical modality.

However, at the same time, there is a distinct lack of hard clinical data in the article that is illustrative of the fact that rigorous scientific standards are not always followed or employed in massage therapy. This article would have been rejected outright by JAMA. Protocol is not clearly explained and actual technique description is vague. To learn more about the Wurn technique you need to pay several hundred dollars to either receive the treatment or purchase the manual the Wurns are currently writing. The article reads almost like a marketing tool, granting just enough information to ensure you will want more. To their credit, the Wurns are now working with research scientists and biostatistians, hopefully, with the result that future publications will be more credible.

With regards to adhesions, it is surprising to learn how common they are as a side-effect of surgery. Massage has always been recommended for post-operative scar/adhesion management on extremities and it is interesting that it has not been considered for abdominal surgeries. There are larger implications for the Wurns research. For example, patients with diverticultis that have had intestine removed can endure subsequent surgeries to deal with the havoc scar tissue development has wreaked in their GI tract. Could such undesirable adhesions be prevented with judicious use of massage? Prevention may not be possible as adhesion development starts just days after surgery which would, most likely, be too soon to introduce massage as a preventative. (El-Mowafi/Diamond:2001) However, that does not rule out massage as valid treatment for adhesion development. The women in Wurns study have not had to have ongoing treatment once the adhesions have been addressed suggesting that the massage protocol has long lasting effects.

Still more study is needed to examine the exciting implications of the Wurns work as well as to generate hard, empirical, clinical data.

BIBLIOGRAPHY

Drs. El-Mowafi & Diamond (9/15/01). Pelvic Adhesions http://matweb.hcuge.ch/el_mowafi/Pelvic_adhesions.htm. Retrieved October 17,2002