Vol. 19 Issue 10
Physical Therapy for Infertility
Manual therapy technique finds credibility in medical journals
Larry and Belinda Wurn began honing their unique infertility treatment nearly two decades ago.
The patent-protected Wurn Technique® implemented at their Clear Passage Therapies®(CPT) private practice clinics in four states, uses manual physical therapy instead of surgery to help break up the adhesions that can decrease fertility or block a woman's fallopian tubes.
Although Belinda Wurn, PT, CPT's national director of services, and Larry Wurn, CMT, CPT's CEO and director of clinical studies, have treated more than 150 clients with the system and seen "about 300 babies born to women diagnosed infertile," their findings were initially met with skepticism from physicians.
Now that's changed. Seven studies published in respected medical journals have lent credible scientific evidence to the claim that women can conceive after putting their infertility in the Wurns' hands.
"It's been exciting, but it has required a great deal of patience, introducing a new technique and profession to treat female infertility," Larry Wurn said. "It's almost like inventing a new field of medicine."
Crosslink by Crosslink
About 12 percent of women (7.3 million) in the United States aged 15 to 44 had difficulty becoming pregnant or carrying a baby to term in 2002, according to the National Center for Health Statistics of the Centers for Disease Control and Prevention (CDC). Many women turn to drugs or surgery to improve fertility and about two-thirds of these couples eventually conceive.
Originally, the Wurns studied myofascial release with John F. Barnes, PT, to help relieve the pelvic pain Belinda experienced after cervical cancer, surgery and radiation therapy. They also attended courses with J.P. Barral, DO, and several other American and French therapists and osteopaths.
Over time, an unintended but intriguing byproduct of the Wurns' work surfaced when women previously diagnosed as infertile by their gynecologists began to conceive naturally.
CPT focuses on decreasing pain and increasing mobility and function of the abdomino-pelvic and reproductive organs by addressing adhesions. Like a nylon rope composed of hundreds of individual strands, adhesions are made of tiny, but powerful, threads of collagen called crosslinks.
They surround and attach to injured tissue to isolate it and help it heal from inflammation, infection, surgery or trauma. Wherever they form, they act like strong glue, restricting normal movement. After tissues heal, the adhesions generally remain, where they can form curtain or rope-like bonds, decreasing function or causing pain.
"Adhesions are a big problem in gynecology because the female reproductive tract is so delicate and is subject to many inflammations and traumas during life," Belinda Wurn said. "For many women, the reproductive organs go through several healing events before menopause."
The Wurn Technique operates by peeling apart adhesions crosslink by crosslink. Over the course of 20 hours in five days, clients undergo a kind of deep massage designed to diminish the adhesions. It takes about 10 days for the body to recover after the treatment, and side effects are minimal.
"We can't break that adhesive rope, but we feel we can peel it apart strand by strand," Larry Wurn said. "Before long, it's half its size, a quarter of its size, and in many cases, it apparently dissipates totally."
When assessing patients, the therapists look for a history of infection, inflammation, surgery or trauma. The treatment has been effective in treating women infertile due to adhesions, endometriosis, blocked fallopian tubes and idiopathic, or unexplained, causes. The Wurns say their patients are happy to find a treatment shown to be effective in scientific studies and not reliant on surgery or drugs.
This past January, a study published in Alternative Therapies in Health and Medicine revealed that the Wurn Technique opened fallopian tubes in 61 percent of women with total occlusion, or blockage. Tubes were confirmed blocked before therapy by independent physicians; post-therapy patency (open tube) was confirmed by dye test or by natural pregnancy (which confirms open tubes). The study, as is all the research on the Wurn Technique, was based on the standard 20-hour treatment protocol.
Of the 28 women, "17 demonstrated post-treatment unilateral or bilateral patency, as measured by hysterosalpingography (radiologic dye test) or natural intrauterine pregnancy," according to the study. "The median interval between the last treatment date and patency confirmation was one month. Nine of the 17 (53 percent) patent patients reported a subsequent natural intrauterine pregnancy."
"This is a very significant study for several reasons," Belinda Wurn said. "Adhesions are considered the primary cause of fallopian tube occlusion. Before this study, the only known way to treat fallopian tube occlusion was by invasive surgery. Now, we know that we can open fallopian tubes non-surgically; which is remarkable in itself. But this also indicates that we can decrease or eliminate adhesions with manual therapy alone. The positive implications for this are huge in gynecologyand also in other areas such as bowel obstructions, post-surgical adhesions, adhesion-related pain and dysfunction."
In addition to becoming fertile, many of the Wurns' patients experience decreased pain and increased satisfaction during sexual intercourse.
Under the guidance of Richard King, MD, former chief of staff of North Florida Regional Medical Center, the Wurns conducted a study of 14 patients with endometriosis who reported decreased sexual function. The participants received a series of the Wurns' manual pelvic physical therapy sessions designed to address restricted soft-tissue mobility. Each patient acted as her own control in pre- versus post-therapy testing using the validated Female Sexual Function Index (FSFI). They tested the full scale of sexual function and its six domains measurable by science: desire, arousal, lubrication, orgasm, satisfaction and pain.
Results via the Wilcoxon Sign-Rank Test (two-sided) showed a statistically significant improvement in all areas: Full scale: (P =<0.001); Desire (P = 0.011); Arousal (P = 0.004); Lubrication (P = 0.001); Orgasm (P = 0.004); Satisfaction (P = 0.005) and Pain (P <0.001). The study was published in Fertility and Sterility and presented along with two other CPT studies at the 2006 Annual Meeting of the American Society for Reproductive Medicine (ASRM).
"Our patients generally don't want surgery; they prefer something natural," Belinda Wurn said. "Whether or not they become pregnant right away, they know their chances are improved and that their bodies will function better. Except for some temporary soreness and spotting, the major side-effects are better orgasms and decreased pelvic or intercourse pain."
A First Resort?
Physicians are apparently taking more notice of the wonders of the Wurn Technique.
"We've seen some good changes over the past five or six years," Larry Wurn said. "Now only a quarter of physicians say 'that can't possibly work.' About half say, 'Well, try it if you think it'll help,' and about a quarter actively encourage their patients to undergo the therapy."
The Wurns have trained about a dozen other physical therapists in their work, though they've received interest from about 2,000. And while they've yet to hold formal training courses for eager professionals, the published research has given them enough substantiation that they may consider it for the future.
"Now that we've published seven studies in peer-reviewed medical journals, we're starting to feel a good foundation under us," Belinda Wurn said.
The Wurns hope that the more their technique becomes accepted in the medical field, the more clients will come to them as a first, not a last, resort.
"Eventually, this will likely be a treatment that people try first," Belinda Wurn said. "Choosing treatment options conservatively is a well-accepted principle in medicine. Patients and physicians should start with physical therapy and then proceed to drugs, and finally surgery, if more conservative approaches haven't worked. Presently, it seems to not work that way."
Lauren Fritsky is assistant editor at ADVANCE. She can be reached at firstname.lastname@example.org
Fallopian tube damage or blockage: Fallopian tube damage usually results from inflammation of the fallopian tube (salpingitis). The sexually transmitted disease chlamydia is the most frequent cause. Tubal damage is the major risk factor of a pregnancy in which the fertilized egg is unable to make its way through the fallopian tube to implant in the uterus (ectopic pregnancy). One episode of tubal infection may cause fertility difficulties.
Pelvic adhesions: Pelvic adhesions are bands of scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery. This scar tissue formation may impair fertility.
Endometriosis: Endometriosis occurs when the uterine tissue implants and grows outside of the uterus, often affecting the function of the ovaries, uterus and fallopian tubes. These implants respond to the hormonal cycle and grow, shed and bleed in sync with the lining of the uterus each month, which can lead to scarring and inflammation.
Ovulation disorders: Disruption in the part of the brain that regulates ovulation can cause low levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Even slight irregularities in the hormone system can affect ovulation. Specific causes of hypothalamic-pituitary disorders include injury, tumors, excessive exercise and starvation.
Elevated prolactin (hyperprolactinemia): The hormone prolactin stimulates breast milk production. High levels in women who aren't pregnant or nursing may affect ovulation.
Polycystic ovary syndrome (PCOS): In PCOS, your body produces too much androgen hormone, which affects ovulation. PCOS is associated with insulin resistance and obesity.
Early menopause (premature ovarian failure): Early menopause is the absence of menstruation and the early depletion of ovarian follicles before age 35. Although the cause is often unknown, certain conditions are associated with early menopause, including immune system diseases, radiation or chemotherapy treatment and smoking.
Benign uterine fibroids: Fibroids are benign tumors in the wall of the uterus and are common in women in their 30s. Occasionally, they may cause infertility by blocking the fallopian tubes.