Originally published in Massage & Bodywork magazine, December/January 2000.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.
It was nearly five years ago when massage therapist Larry Wurn and his wife Belinda, a physical therapist, made a startling discovery. "We were surprised when a patient we were working on became pregnant," said Larry Wurn in a recent interview. Qualifying this statement, he went on to explain that the woman was being treated for myofascial pain at the time. Seven years earlier she had been diagnosed as having blockage in both fallopian tubes. Since that time, she had remained infertile despite being sexually active.
"Fallopian tubes do not clear on their own," said Wurn, "so her referring physician asked if we had anything to do with it. And we told him we honestly didn't know." The soft tissue massage that the Wurns had developed was basically intended to loosen adhesions and relieve pain.
Two weeks later, this same physician referred another patient who had been diagnosed with idiopathic (of unknown cause) infertility. After eight treatments she was pregnant and later delivered healthy twins. At this point, the physician approached the Wurns about treating his own wife, who, by the physician's definition, had an infertility file "an inch and a half thick." Due to adhesions from pelvic inflammatory disease, one of her tubes had been removed and the other was blocked. For the past 12 years, she had been unable to conceive. After just 11 treatments, she became pregnant. A fourth client who was self-referred also became pregnant after seven treatments. She had a three-year history of infertility prior to the treatments.
What was the connection? Armed with only anecdotal evidence, the Wurns embarked on a serious study of their newly discovered phenomenon. An additional four women were brought into treatment for a prospective pilot study. Of these, none became pregnant by the end of the study period, but two tested as having marked improvement in patency of their tubes.
"While our results to date are preliminary...they are very promising. Fifty percent of the infertile women had full-term pregnancies and 75 percent showed measurable reproductive tract improvement following treatment," said Wurn. These statistics far outshine conventional treatments for infertility.
Of the approximately 5 million women presently diagnosed as infertile, 40 percent are identified as having reproductive dysfunction due to fallopian tube obstruction.1
Some of these women will be seeking medical or surgical fertility treatments, gambling as much as $30,000 on procedures which offer no guaranteed results.2
Recent statistics indicate that medical and surgical treatments have a low rate of success, ranging from 10 percent to 28 percent, depending on the approach.3
Technically assisted reproduction has grown significantly in the last 10 years. Four of the more commonly used procedures are in vitro fertilization, gamete intrafallopian transfer, zygote intrafallopian transfer and intracytoplasmic sperm injection. Cost for each attempt may be as high as $10,000. A fifth procedure, intrauterine insemination, is the most common and least expensive, but has the lowest success rate of 10 percent.4
Successful pregnancy from some of these procedures as well as fertility drugs may produce multiple fetuses, some being selectively reduced and others born with lifelong medical challenges.5
Considering the high cost of technical procedures and the overwhelming possibility of failure, pursuing assisted conception may best be described as a long ride on an emotional and financial roller coaster. If the Wurns' soft tissue technique is proven scientifically to aid in the reversal of infertility, it could open up a new, less costly and safer option for childless couples. Patients are charged $130 per session for this conservative approach and avoid the complicated side effects of drugs and surgery.
Wurn is quick to point out, however, that the priority at his clinics is not fertility treatment. "Freeing adhesions in the abdomen and pelvis, whether from surgery, endometriosis, infection or trauma, is a much bigger picture and will prove to be a much larger field of medicine than infertility treatment. Infertility treatment is just a side effect of treating adhesions."
Adhesions which can cause fallopian tube obstruction are common following abdominal surgery, affecting from 67 percent to 93 percent of patients. The odds are equally high for gynecological surgery. In addition, tubal scarring and obstruction may result from endometriosis, inflammatory disease or a variety of abdominal and reproductive organ problems. Trauma to the tissue causes a build-up of collagen fibers, which cross-link to form scar tissue. The excess cross-links cause pain and limited movement, and in the case of fallopian tubes, obstruction. Scarring may also prevent the finger-like extensions of the fimbria at the end of the tube from grasping the egg, further obstructing conception.6
The Wurn TechniqueSM is a site-specific, manual soft tissue therapy designed to break down the excess collagenous cross-links, thus freeing movement and relieving pain. The therapist locates tightened areas of the connective tissues, the cross-link sites, which are considered the core of the adhesion. By gently stretching these tightened areas for a sustained period until the tension is released, the therapist brings about a permanent elongation of the tissues and a resultant improvement in mobility.
The Wurns initially began their practice in the field of physical therapy, operating five rehabilitation clinics in the north Florida area. As their interest in work with adhesions grew, they traveled throughout the United States and to France, studying with prominent experts in areas of myofascial release and muscle, joint, organ and connective tissue treatment. The Wurns' approach is an amalgamation of techniques learned through their continued studies of pelvic and reproductive tract adhesions. Their investigations led to the development of Clear Passage Therapies. Initially catering to women, they expanded their clinics to encompass treatment of both men and women suffering from pain or dysfunction secondary to surgery, trauma, radiation therapy or inflammation. As their practice has grown, so have their successes.
As a treatment for adhesions and tubal obstruction, the non-invasive approach of the Wurn TechniqueSM is considered a safe and cost effective therapy. However, Wurn advised, women with a history of tubal adhesions and obstruction are still at risk of a tubal pregnancy, which can be life-threatening. Patients at Clear Passage Therapies are instructed to notify their physician immediately in case of pregnancy so that any possible complications may be dealt with early. Additionally, conditions that would preclude treatment by this method are active cancer, HIV, hemophilia, abnormal cysts and active infections. The Pilot Study
The stated objective of the pilot study is "to assess the effectiveness of a specific soft tissue therapy protocol in reducing adhesions and improving function by measuring any infertility reversal in eight infertile women with histories indicating adhesions or scarring." The retrospective portion of the study included the first four women the Wurns had treated who had become pregnant. A second prospective group included four women with bilateral tube occlusion as documented by hysterosalpingogram (HSG) or laparoscopy with chromotubation.
Laparoscopy with chromotubation is a dye test considered to be the most valid method of determining patency in the fallopian tubes. Hysterosalpingography, a less invasive X-ray procedure involving the injection of dye under pressure into the uterus, has also been shown to be highly effective in determining occlusion. It is referred to in the study report as "the gold standard" in diagnosing tubal obstruction. (There is report of a newer test being developed that utilizes ultrasound rather than irradiation or X ray.)7
All eight women in the study group had been medically diagnosed as infertile, by definition as not having conceived for a period of more than one year while having unprotected intercourse. The women ranged in age from 28 to 42, with durations of infertility from 2 to 12 years, well beyond the medical criteria.
The cases were limited to three causes of infertility: fallopian tube occlusion, pelvic adhesions and idiopathic, with a history indicative of adhesions. Seven of the women had been referred on the basis of the infertility diagnosis and one with a diagnosis of musculoskeletal trauma, thus inadvertently receiving treatment for her infertility.
Manual physical and massage therapy was provided by a co-therapy team. Treatments were 40 minutes in duration, with the total number of treatments for each case ranging from seven to 31. The treatment involved myofascial and visceral manipulation to address biochemical dysfunction, adhesions and micro-adhesions.
In the retrospective study group (PS#1), documentation of pre-treatment condition was obtained from clinical observation, patient reports and gynecological records. Post-treatment patency of the fallopian tubes was assumed from the resultant viable births. In the prospective group (PS#2), however, there was opportunity to use HSG and laparoscopy procedures to scientifically document results.
The outcome of the study was, as previously stated, that four of the eight women had become pregnant and two others "demonstrated unilateral patency following therapy." Two women evidenced no change in obstruction of their tubes.
According to the study report, all eight women had a history of "some abdominal or pelvic surgery as well as moderate to severe musculoskeletal trauma." In addition, all but one had discontinued any other fertility treatment prior to entering manual therapy. Six had tried an array of unsuccessful approaches, perhaps implying that manual therapy was a last resort. These observations, along with the histories of unsuccessful pregnancy attempts, suggest minimal influence from previous infertility care. As stated in the study, this observation "does not imply that the residual effects of prior infertility care may not have contributed to the physical therapy's outcome, or that manual therapy did or did not facilitate previous infertility treatment. Nor can we conclude that the positive results are attributable primarily or exclusively to the manual physical therapy procedure. However, the chain of evidence and positive endpoint/outcome patterns are suggestive enough of the possibility to warrant further research based on this observation as a hypothesis."
While the results of the pilot studies are impressive, they do not qualify as proven scientific fact. To meet that qualification, the Wurns will have to proceed with a randomized study, carefully controlling for variables and narrowing the study group to only those women with tubal obstruction. At the moment, they do not have a sufficient number of subjects to meet the criteria for a random study, but are continuing to gather data on their current patients. Their original study group of eight women has been expanded to 12. Of those, there are five documented pregnancies and two more cases of fallopian tube patency confirmed by HSG. These figures put their success rate well above those of medical and surgical procedures for infertility reversal.
Whether or not these numbers will be maintained or improved upon with continued research remains to be seen. But for some of the 2 million American women currently facing the prospect of infertility due to fallopian tube obstruction, it is a candle of hope.
Information about Clear Passage Therapies is available on their website at www.clearpassage.com
. Larry and Belinda Wurn may be contacted at 352/336-1433 in Gainesville, Fla.Shirley Vanderbilt is a staff writer for Massage & Bodywork magazine. References