Fertility: the other F word.
The older I get the more I realize there’s another F word out there…fertility.
As a cis female in my 30s it’s become apparent that fertility is a scary word no matter what side of the coin you fall on. Fertility can ignite fear of pregnancy someone isn’t ready for, or a constant reminder of pregnancy that one desperately hopes for. Whether or not your career, financial stability, relationship status, lifestyle choices, or pregnancy plans meet the mark, it can feel like there’s a ticking bomb on your ovaries and time is the detonator. Maybe that’s my own projection, but that’s some serious pressure.
As someone who works with women in pelvic health, I get asked questions about fertility and work with clients who experience miscarriages and other fertility issues. To be transparent, I’m no expert in the field of fertility, however, I decided to do some digging and share what I have found.
If you think about the process of reproduction—and I’m not even talking about the fun stuff—I mean the physiological process where the sperm and egg meet and settle in the uterus, a LOT needs to happen!
Hormones are key to this incredibly complex process.
Male dominant hormone testosterone produces sperm, and only 10% of these guys make it past the cervix. It then has to meet up with an egg in the fallopian tubes. But if the female isn’t ovulating (releasing an egg), the whole trip was for nothing.
In females, ovulation occurs when several hormones (estrogen, FSH, LH) tell the ovaries to release an egg. An imbalance in any of these hormones can cause a woman not to ovulate, which is a common cause of infertility. If the sperm meets up with the egg during ovulation, then fertilization occurs. The hormone progesterone plays a big role in making the uterus a happy home to an embryo. If there’s an imbalance in progesterone or issues with the uterine lining, the environment of the uterus may not allow the embryo to grow and develop.
Then when pregnant another hormone Human Chorionic Gonadotropin (HcG) is produced that tells the body it’s pregnant and to keep producing the necessary hormones. If at some point the body believes it is no longer pregnant, it will halt the production of HcG. This is a common cause of miscarriage.
Infertility Stats
According to the Center of Disease Control & Prevention (CDC), 6% of married women in the United States are unable to get pregnant. About 12% of women, regardless of marital status, have difficulty getting pregnant or carrying a pregnancy to term.
Both men and women contribute to infertility. In about 35% of couples with infertility, a male factor is identified along with a female factor.
Male Infertility
In males, infertility is caused by
Disruption of testicular or ejaculatory function
Hormonal disorders
Genetic disorders
Risk factors that effect infertility include excessive alcohol use, smoking, obesity, exposure to testosterone, certain medications, exposure to radiation or environmental toxins such as lead, pesticides, or mercury, or frequent exposure to testes in high temperatures (frequent sauna or hot tub use, or a man confined to a wheelchair). Interestingly, age also plays a role. While advanced age is typically associated with infertility in women, couples in which the male partner is 40 years old or older are more likely to report difficulty conceiving.
Female Infertility
In females, fertility requires the functioning of ovaries, fallopian tubes, and uterus.
Ovarian Disruption (absence of ovulation) can be caused by a number of factors. A woman with irregular periods is likely not ovulating, or anovulation. Potential causes of anovulation include the following:
Polycystic ovary syndrome (PCOS) is the most common cause of female infertility and affects an estimated 8% to 20% of women worldwide
Diminished ovary reserve: fewer eggs remaining than normal
Functional hypothalamic amenorrhea (FHA) is caused by excessive exercise, low body weight, or stress. Sometimes associated with eating disorders such as anorexia
Improper function of the hypothalamus and pituitary glands
Premature ovary insufficiency (POI) or premature menopause
Menopause
Fallopian tube disruption (tubes can be open, blocked, or swollen). Blocked fallopian tubes, estimated as the primary cause of 25% to 35% of female infertility. Risk factors for blocked fallopian tubes include
History of pelvic infections
History of ruptured appendicitis
History of gonorrhea or chlamydia
Endometriosis
Abdominal surgery
Abnormal Characteristics of Uterus
Fibroids
Other anatomical abnormalities
Female fertility declines with age and habits such as excessive alcohol, smoking, extreme weight or loss, excessive physical or emotional stress.
Getting the Docs Involved & Fertility Treatment
There’s a LONG list of contributing factors, so at what point should someone reach out to a professional in the medical community?
According to the CDC, at least 1 year with women under 35. In couples with a woman over 35, a provider should get involved after 6 months without success.
Some health conditions increase the risk of infertility, and a specialist is recommended to be involved from the start. These conditions include
Very painful periods
Endometriosis
Irregular periods or no menstrual periods
Pelvic Inflammatory disease
More than one miscarriage
Suspected male factor (trauma to testes, chemotherapy, hernia surgery, or infertility with another partner)
Doctors treat infertility with medicines, surgery, intrauterine insemination, or assisted reproductive technology (example: IVF). Treating female infertility may include surgeries or medications to address underlying causes. Medications may be taken to regulate hormones or promote ovulation. Surgical solutions such as removing endometrial tissue obstructing fallopian tubes. IVF usually involves the following steps: Ovulation Induction, Egg Retrieval and Embryo Transfer. A study in 2015 reported that 1.6% of all infants are born from assisted reproductive technology.
Many couples are choosing integrate other forms of treatment in addition to their medical treatment or forgoing standard medical intervention all together. These may be…
Acupunture
Visceral manipulation
Change of diet, exercise, and other habits
Apps such as Clue, Flo, Glow to track ovulation and optimal times
The Relationship Between Pelvic Floor Therapy and Fertility
Having pelvic pain or pelvic floor dysfunction (PFD) does not mean that a person will have difficulty conceiving.
According to a 2015 study manual therapy demonstrated to have positive outcomes in reversing female infertility attributed to occluded fallopian tubes, endometriosis, hormonal dysregulation, and unexplained infertility, as well as to increase successful in-vitro cycles. Manual therapy was described in the study as “various site-specific pressures across the restrictive bands of adhered tissues and structures, working progressively deeper from the most superficial tissues, to restore mobility via myofascial release. Adhesions within and between organs and interstitial spaces within the viscera were addressed using the Wurn technique; decreased organ motility was then addressed using visceral manipulation.”
Specific findings included:
Treatment with manual therapy had a 60.85% success rate overall for opening 1 or both tubes in women with total tubal occlusion.
42.8% pregnancy success rate in using manual therapy as a treatment for women experiencing infertility associated with endometriosis. This is equivalent to pregnancy rates after surgical interventions.
Manual therapy shown in the current study to affect hormonal regulation positively in women with POF, PCOS, and elevated FSH with success rates of 20%, 53.6%, and 49.2%.
The rate of pregnancy in PCOS patients treated with manual therapy, when directly compared with surgical or medication interventions, was demonstrated to be equivalent or superior to those standard interventions.
Manual therapy was also demonstrated to be beneficial to those patients who underwent IVF after treatment, with pregnancy rates 1.5 times higher than that for IVF alone.
Based on research and my clinical experience, there is a really unique role in pelvic floor therapy in fertility. By combining strategies to regulate the central nervous system, habits & routine analysis, and the assortment of manual therapeutic techniques, pelvic floor therapists can offer women increased pregnancy success rate and the opportunity to take a more active role in the fertility process.
Fertility is a daunting subject, and this post in no way covers scratches the surface. If you have questions or concerns, please reach out to your provider. Hopefully this article shed some light on a topic that is typically not talked about. If you are someone who struggles with fertility or has experienced a miscarriage, know that you are not alone.
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