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Hands of Hope
Massage for Infertility

By Angie Best-Boss

Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.

Massage may help Debbie Harris do more than just relax. It could help her become pregnant. "My husband and I have been trying to conceive for about seven years now," she explains. Harris has tried fertility shots, three cycles of in vitro fertilization (IVF) and six artificial inseminations. Now she's trying massage. "It gets pretty hard on your body, so that's why I wanted to try something more natural."

Infertility affects nearly one in six couples. More than 6 million American couples will seek treatment for infertility this year alone. Almost half of infertility cases are due to hormone irregularities, such as polycystic ovary syndrome (PCOS) and anovulation. Another 40 percent of infertility cases are caused by mechanical failures, such as scarring, adhesions and blocked fallopian tubes. An estimated 2 million women are unable to get pregnant because of these complications. As the costs of assisted reproduction rise, more and more couples are looking toward natural approaches to enhance their chances of conception.


Stress and Fertility
Fertility requires a delicate balance of hormones to orchestrate the production, release, fertilization and implantation of an egg. This balance can be affected by many conditions within the body, including stress. "Stress, either low-level daily hassles or one-time big events, causes a release of hormones that can interfere with the delicate balance needed to create a new life," says occupational therapist Jennifer Bloome.

President of www.Your-birth.com and creator of a series of CDs designed to help women overcome infertility, Bloome says current research demonstrates that stress during an IVF procedure causes a decrease in the number of eggs developed, retrieved and transferred. Other research demonstrates that stress can cause changes in ovulation, changes in cycle length and tubal spasms.

"Not only does stress cause a physical reaction in the body, but also a mental reaction," says Bloome. "Stress can magnify the feelings of fear, worry, emptiness and anger. The combination of mental and physical reactions can lead to a downward spiral and an overall feeling of a loss of control. Techniques that help women work with and release stress can enhance feelings of control."

Massage-based techniques and movement therapies help to break the vicious cycle by encouraging relaxation. More specifically, they can help relax tense muscles and tight connective tissues that may have been constricting blood vessels, and thus enable blood to flow more freely. Soothing massage helps reduce emotional tension, induce relaxation, calm stress-related conditions and may help women with hormone-related difficulties.1


Soft-tissue Massage
About 12 years ago, massage therapist Larry Wurn and his wife Belinda, a physical therapist, came across an alternative treatment for female infertility related to mechanical problems. While treating an infertile woman for low-back and pelvic pain, the therapists discovered their client became pregnant, after seven years of infertility. What made it especially interesting was the client had been diagnosed with two blocked fallopian tubes and had been sexually active the entire time. Intrigued, the massage therapists tried the same technique on eight other infertile women. Half of them became pregnant following the massage therapy.

Wurn's treatment combines physical therapy with site-specific massage. They were encouraged by an early success rate of 50 percent treating female infertility with the process, according to Belinda Wurn. That rate has now climbed to more than 70 percent. "One of our latest cases was infertile for four years," says Wurn. "She came to us with two blocked fallopian tubes and one failed IVF. She had suffered two miscarriages, an ectopic (tubal) pregnancy and a failed attempt to open her tubes surgically, when she came for the therapy. She became pregnant after one week of therapy here and is due to deliver next week.

"Our patients usually have a history of either surgery, inflammation or trauma. The therapy addresses adhesions, spasm and mechanical factors that cause almost half of all female infertility. Patients often have a history of miscarriage, tubal blockage, difficulty with implantation, sperm or egg transport."

The patent-protected therapy, called the WURN TechniqueSM, has been used on women throughout the United States and abroad. In one study of 22 women who had completed the program, 16 are now pregnant or delivered following treatment. "That translates into a preliminary success rate of 73 percent," says Larry Wurn.

According to Marvin Heuer, M.D., president and research director of the medical research group Clin-Sci International, medical literature suggests 80 percent of abdominal and gynecologic surgeries cause adhesions. "Adhesions may form after an injury or inflammation, such as endometriosis, pelvic inflammatory disease, bladder or yeast infection," he says. "Patients seem to appreciate the more natural approach with this therapy. Without surgery or drugs, there is a significant decrease in complications. The main side effect appears to be decreased pain."

Gynecological researcher Richard King, M.D., helped design the present clinical trials. "If ongoing studies continue to produce results, there are positive implications for infertile women and patients with chronic pain or dysfunction due to adhesions," he says. Clinical studies are ongoing.

The therapy may be used as the sole treatment, or in combination with other techniques, such as acupuncture, or with assisted reproduction techniques like intrauterine inseminations and IVF. Therapy alone was the primary treatment in 13 of the infertility reversals, according to Wurn. In three other successes, women had the therapy prior to IVF, to increase uterine receptivity. In six separate cases, patients reported the therapy cleared at least one fallopian tube that had been blocked prior to therapy.


How it Works
The Wurn treatment seems to help women who have adhesions in their reproductive tract. Adhesions act like glue, disrupting the function of the affected organ. The treatment involves gentle, specific stretching to loosen tightened areas of soft tissue. The goal is to decrease adhesions in and around the organs, ligaments, muscles, joints, and support structures of the pelvis, abdomen, hips and low back. Wurn says most women become pregnant after the 20 to 23 hours of treatment, depending on how often patients are treated.

"We have developed our own specific treatment protocols after years of study, refinement and clinical experience," Wurn said. This work is a very sophisticated type of physical therapy, coupled with a very site-specific treatment of adhered tissues, and correction of faulty biomechanics. No one else performs our protocol for treatment of pain and female infertility. The highest age in our clinical trials for successful infertility reversal was 41 years old. The lowest successful number of treatments in our clinical trials was five hours, the highest was 23 hours of therapy. We feel 20 hours is a reasonable time for most women to succeed, or not," Wurn says.

"Our successes tend to receive 20 hours of therapy. Therapy may be performed in as few as five days, or stretched out over several months. We have no evidence that frequency of treatment determines success. A few patients opted for 25 hours of therapy, and became pregnant. When a patient becomes pregnant, therapy stops and she returns to her physician."


Theoretical Framework
When we are injured or have had an infection or surgery, we may later experience pain, dysfunction or increased tissue tension in our body. Symptoms may appear in muscles, joints, connective tissues, organs or throughout the body. Initially, problems can occur in the body due to the adhesions formed following the original trauma. Pain and dysfunction can also occur months or years later, due to the body's compensations in response to the injury, surgery or infection.

Adhesion formation occurs after trauma to the tissues, as a response to the tissue damage. After an injury, infection or surgery, tiny but strong collagen fibers form as part of the body's response to the trauma. These collagen fibers form adhesions by laying down "crosslinks" in random patterns. These crosslinked adhesions are the building blocks of scar tissue. Adhesions can be tough and wiry, or filmy and thin. They may be large enough to be seen by diagnostic tests, or so small that they are microscopic. Either way, they can exert tremendous tensile forces on the tissues where they form.

Adhesions and crosslinks remain in our bodies long after the original inflammation or trauma has healed. They may adhere the injured tissues to nerves (causing pain) or to neighboring structures (causing dysfunction). As the body's tissues heal and adhesions are formed, the tissues begin to shrink somewhat, resulting in decreased movement in the injured area. Thus, the healing process can actually create more mechanical irritation and more crosslinking of collagen fibers, perpetuating the cycle of adhesion formation.1

"We use our hands to apply a gentle, specific stretch for a sustained period of time to tightened areas in the body's connective (soft) tissues until the tension releases," explains Wurn. "This release of tension suggests a breakdown of the crosslinks that have been adhering structures. The release allows those structures to move more freely, generally with decreased pain. The result is improved mobility of the soft tissues, which the patient notices as decreased pain and increased function."

The primary goal of massage therapy is to increase mobility and decrease pain. Gentle, specific stretches are applied for a sustained period of time to tightened areas in the body's connective tissues until the tension is released. The release of tension suggests a breakdown of the crosslinks that have been adhering structures. The release allows the structures to move more freely and with less pain, resulting at the end of therapy with improved mobility, decreased pain and increased function. As pain decreases, patients notice an improved quality of life.2


Creating a Network of Infertility Clinics
Practically speaking, in a managed healthcare environment, the Wurns have found an effective way to avoid insurance battles. While many practitioners complain of having to see more patients in less time, the Wurns spend an hour or two with each patient at every visit. "For $175 in cash an hour, it's a good deal for us and the patient," says Wurn. "Plus, we're happy, and the patient is thrilled to have infertility treatment without drugs or surgery, and to be paying less than most infertility treatments." In fact, the Wurns' biggest problem is how to treat all of the women who request it. With patients flying in from across the country and around the globe, it isn't unusual for their roster of clients to include a woman from Michigan, Panama and Hong Kong in the same afternoon.

Wurn is in the process of developing an extensive therapist training manual to instruct other therapists in performing his patented procedure. "We plan to start building a network of physical therapists, and perhaps some very appropriate massage therapists who work in medical offices under direct physician supervision," he says. "One reason we are moving ahead so cautiously is that the work often includes internal (vaginal) treatment. We feel we have to be very conservative in teaching this new work, at this time. While physical therapists have been treating internally (mainly for incontinence and pelvic pain) since 1975, we believe that we must be extremely conservative with massage therapists as we move forward, due to restrictions by most massage licensing boards. Some states don't even have licensing boards. Actually, once massage therapists understand that the therapy includes internal treatment, most of them say that they don't really feel comfortable."

Internal treatment does raise some concerns for potential therapists. Wurn continues: "We have a conversation about comfort right at the very beginning to try to address as many concerns as we need. I always say, 'we want you to be comfortable. We are going to explain what we are doing before we do it, and during the process we need to have good communication.' We work within their tolerance level. Whenever I am treating internally, I always have a female staff member in the room, and patients are encouraged to bring a support person with them as well."

The Wurns are beginning to offer clinical internships this summer that will include clinical training, modesty training, sensitivity issues, how to have conversations about internal treatment, basic infertility information, a complete administrative package and extensive marketing and media relations guidelines. "We can train 30 to 50 therapists a year, and we are looking for physical therapists with manual soft tissue skills," says Wurn.


Conclusion
Clearly, the breakdown of adhesions through such noninvasive, less-expensive means has its benefits, including restoration of fertility, decrease in pain and an overall improvement in the quality of life.

Stacey Virtue tried for five years to get pregnant. "I had so much trouble that we kind of decided it wasn't going to happen." After 12 massage treatments, she's shopping for baby clothes for her soon-to-be-born son. "It's so amazing. I can't begin to tell you how excited we are to be having a baby."

Angie Best-Boss is a freelance women's health writer and author of four books, including Living with PCOS: Polycystic Ovary Syndrome and Babies in Waiting: Choices and Challenges in Egg and Embryo Adoption.

References
1. "Pathogenesis of adhesion formation." British Journal of Surgery 1995;82:3-5. Thompson, JN, Whawell, SA.
2. Clear Passage Therapies, www.clearpassage.com.




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