Infertility is defined as being unable to conceive despite having ongoing unprotected sex for a year or more. Factors such as hormone imbalances, age, underlying conditions, and lifestyle habits can contribute to infertility.
However, pelvic anatomical wellness and the mechanics of the reproductive system can also play a role.
What Is Infertility?
From the brain’s production of reproductive hormones to the release of healthy eggs, fertilization by healthy sperm, and implantation in the uterus – becoming pregnant is a physiological process involving certain steps. If one of these steps does not occur, pregnancy does not happen.
Infertility is described as difficulties getting pregnant despite having unprotected sex for a year or more. It can happen to anyone, at any age, and can be caused by issues relating to the male or female reproductive system.
For women under the age of 35, infertility is described as the inability to conceive after trying for one year. Over the age of 35, as the production of healthy eggs begins to decline, infertility is treated after six months of trying to conceive.
Symptoms of Infertility in Women
Approximately 13% of women are known to experience the challenges of infertility, which often include symptoms such as; anxiety, stress, depression, frustration, feeling isolated, and relationship problems.
Although many women don’t feel any physical symptoms associated with infertility, mechanical infertility can cause mild to severe pelvic pain, irregular menstruation, and sometimes, pain during sex.
What is Mechanical Infertility?
Mechanical infertility refers to an inability to conceive due to a physical blockage or obstruction that prevents an egg and sperm from meeting. This type of infertility is often linked to inflammation, the growth of abdominal or pelvic scar tissue after surgery, endometrial adhesions, or painful conditions that prevent women from engaging in sex.
Scar Tissue – Often ensuing from pelvic surgeries, injuries, or pelvic conditions like endometriosis; scar tissue can change the pelvic environment and make it more challenging for women to get pregnant.
Scar tissue can restrict the movement of connective tissues, cause inflammation, block the fallopian tubes, and prevent the reproductive organs from moving as they should. Restricted blood flow to and from the reproductive organs due to scar tissue further contributes to mechanical infertility.
Endometriosis – A condition that causes tissue similar to the uterine lining (endometrium) to grow outside the uterus. Transported by the blood and lymphatic system, endometrial-like tissue can result in lymphatic congestion, restricted blood flow to and from the reproductive organs, and painful menstruation.
When endometrial-like tissue attaches to other pelvic organs like the ovaries or fallopian tubes, it can form lesions, cysts, and adhesions that bleed during menstruation and often result in pelvic pain. (Adhesions are bands of tissue that bind two organs together which would otherwise remain separate.)
In addition to inflammation and pelvic pain, which often means sex is too painful to continue trying to conceive, endometrial lesions and adhesions can alter the geography of the reproductive organs making it more difficult for an egg and sperm to meet.
Polycystic Ovary Syndrome (PCOS) – Believed to be one of the most common causes of infertility, PCOS is a hormonal disorder that causes abnormal growth of cysts on the ovaries, insulin resistance, weight gain, fertility issues, as well as excess facial hair growth and acne due to high androgen levels.
Although hormone imbalances are the main cause of infertility in women with PCOS, cysts on the ovaries can also prevent eggs from being released and result in pelvic pain. This pain can cause the pelvic floor muscles to tighten, which often results in pain during sex (dyspareunia) and further contributes to infertility.
Dyspareunia – As the medical term for painful sex, dyspareunia is connected to several female conditions and is a frequent variable involved in mechanical infertility. Vaginismus, which causes the vaginal muscles to tighten due to the fear of pain during sex, is a common cause of dyspareunia. As is vulvodynia, which causes pain when the outer genitals are touched.
Pelvic surgery or injuries, previous childbirth, and underlying pelvic conditions or infections that result in tight or weak pelvic floor muscles are known causes of dyspareunia.
Pelvic Inflammatory Disease (PID) – Diagnosed as an infection of the female reproductive organs, namely the uterus, ovaries, or fallopian tubes, PID occurs when untreated sexually transmitted infections (STIs) such as chlamydia or gonorrhea spread to the reproductive organs.
Symptoms of PID include pelvic pain, an unusual vaginal discharge, dyspareunia, and if left untreated, irreversible infertility.
Treatment for Mechanical Infertility
While reducing stress, improving intimacy, and regulating hormones are first-line recommendations for infertility, they are often insufficient in treating the physical aspects associated with mechanical infertility.
Pelvic health physical therapy, on the other hand, has been proven to improve pregnancy rates in women experiencing infertility, even in women with endometriosis, dyspareunia, and PCOS, as well as those undergoing IVF.
Indeed, studies have reflected the success of pelvic physical therapy for mechanical infertility. One study, in particular, concluded that out of 10 mechanically infertile women treated with 1-6 sessions of manual therapy, six conceived within three months of their PT sessions, and all six delivered healthy babies at full term.
Another 10-year study into the efficacy of pelvic physical therapy for mechanical infertility showed an average increase of 50% in pregnancy rates. Participants in the study included women with blocked fallopian tubes (56% increase), endometriosis (43% increase), and PCOS (53% increase). 56% of the women who underwent IVF after PT treatment for mechanical infertility also conceived.
How Does Pelvic Physical Therapy Treat Female Infertility?
Scar tissue, inflammation, lymphatic congestion, lack of blood flow, tight pelvic muscles, and fascial constraints are often underlying contributors to female infertility. And the manual manipulation of pelvic tissues through physical therapy can improve all of the above.
Trigger Point Therapy
Trigger points are small dime-sized nodules or irritation that are felt as a painful muscle knot. They are believed to develop due to a lack of blood flow after a muscle injury or overly tight muscles that remain contracted. When touched, pressed, or irritated, trigger point pain can worsen. PTs are trained to locate trigger points and apply the correct amount of pressure to encourage blood flow to the area and allow the muscles to relax.
Myofascial Pain Relief
Fascia is the tissue supporting the body’s musculoskeletal system - essentially connecting the bones, muscles, skin, and organs, and protecting them from injury. When fascia is soft and fluid it functions correctly, however, if it becomes tight or stiff it causes pain. Relieving myofascial pain with the correct type of massage can improve the chances of healthy eggs meeting sperm for pregnancy.
Improved Muscle Function
Regular pelvic physical therapy sessions are known to reduce the pelvic pain linked to PCOS, endometriosis, and PID by improving muscle function. Pelvic floor muscle dysfunction is often a contributing factor for infertility, however, physical therapy can help improve the flexibility and coordination of these muscles to increase the chances of pregnancy with incurable conditions such as POCS, endometriosis, and PID.
Tissue Mobilization
Mobilizing the tissue around the ovaries, fallopian tubes, and uterus with manual physical therapy improves blood flow to the reproductive system. Better lymphatic drainage can also be achieved with physical therapy to increase the chance of pregnancy.
Scar Tissue Massage
Pelvic physical therapists can reduce the organ restrictions caused by endometrial adhesions and lesions, as well as the adverse effects of scar tissue, through manual myofascial mobilizations.
Pain & Stress Relief
Often the stress of experiencing infertility can adversely affect the hormone balance required for conceiving. Pelvic PT can help lower stress and improve hormone balance levels by relieving pain and teaching patients to breathe diaphragmatically.
Dyspareunia Relief
Lastly, PT is also one of the best ways to relieve dyspareunia. Typically caused by a tightening or weakening of the pelvic floor muscles in response to injuries, trauma, pain, or fear, physical therapists can teach patients how to strengthen weak pelvic floor muscles and relax tight pelvic floor muscles for more enjoyable sex and an improved chance at pregnancy.
How to Treat Mechanical Infertility at Home
While pelvic health physical therapy for mechanical infertility will begin in the PT’s clinic, home therapy also plays a role in improving the chances of getting pregnant. Depending on the injury or condition causing mechanical infertility, physical therapists may recommend helpful pelvic tools such as vaginal dilators or Kegel weights to continue treatment at home.
Vaginal Dilators
Vaginal dilators are tube-shaped medical devices ranging from the size and diameter of a woman’s pinkie finger to an erect penis. Commonly prescribed by OG/GYNs and physical therapists to relax tight pelvic floor and vaginal muscles, dilators can help relieve pain during sex and vaginismus, as well as alleviate the symptoms of endometriosis.
Although originally made from glass and then plastic, the most advanced versions of modern dilators are made from body-safe medical-grade silicone and sold in incrementally increasing sizes for long-term results.
Kegel Weights
Also known as vaginal weights, Kegel weights are recommended to strengthen and re-train the pelvic floor muscles when they have been weakened.
Made from smooth medical-grade silicone that feels comfortable inside the body, these Kegel weights are designed to fit in the vagina like a weighted tampon. Once inside, the pelvic floor muscles are toned and strengthened by repetitively contracting and releasing while holding the weight in place.
Other Causes of Infertility
Only 33% of infertility cases are due to factors affecting females, another 33% affect both men and women, and the remaining cases are statistically defined as unexplained infertility. Factors that affect fertility in both men and women include their overall health, sexual function, lifestyle, and age, in addition to excessive alcohol consumption, smoking, or poor diet. Chronic disorders, undergoing radiation treatment, undereating, or over-exercising can also contribute to infertility.
The Most Common Causes of Infertility in Women
Female infertility can be difficult to diagnose, but according to the CDC, the most common causes of infertility in women are physiological issues with the ovaries, fallopian tubes, or uterus.
The ovaries, which are responsible for producing healthy eggs can be affected by several disorders which cause the ovaries to produce eggs infrequently, irregularly, or not at all. These include:
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Diminished Ovarian Reserve (DOR)
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Impaired function of the hypothalamus and pituitary glands
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Polycystic Ovary Syndrome (PCOS)
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Primary ovarian insufficiency (POI)
Once the ovaries release an egg, it enters the fallopian tube where it meets sperm and becomes fertilized to form an embryo. The muscles in the fallopian tubes then transport the embryo to the uterus for implantation. Damaged or congested fallopian tubes can cause infertility. The following conditions and surgeries are known to contribute to injured or blocked fallopian tubes:
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Abdominal Surgery
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Chlamydia
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Endometriosis
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Gonorrhea
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Repeated pelvic infections
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Ruptured appendix
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Pelvic surgery
The uterus is where a fertilized egg is implanted and grows throughout pregnancy. When implantation does not occur, the uterus lining is shed during menstruation. Conditions that impair uterine function and contribute to infertility include:
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Adenomyosis
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Congenital uterine irregularities
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Endometrial adhesions
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Uterine fibroids
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Uterine polyps
Infertility caused by physiological issues affecting the ovaries, uterus, or fallopian tubes is typically treated with hormone therapy, medication, and lifestyle changes. Although these physiological issues are known as the most common causes of infertility, physical issues, also known as mechanical infertility, can simultaneously occur.
Conclusion
Every woman’s journey to having children is unique, therefore no universal cure for infertility exists. Hormone imbalances and physiological issues with the reproductive system are the most common causes of infertility. However, mechanical infertility is also common and diagnosed when a physical blockage prevents an egg and sperm from coming together for fertilization.
Linked to the growth of scar tissue after injuries or surgeries, the formation of lesions with endometriosis, and reduced muscle function in the pelvic floor due to pain, mechanical infertility is best treated with pelvic health physical therapy. Continued therapy is recommended at home with pelvic massage relax tight tissues, relieve painful pelvic trigger points, and improve muscle function.
References
Cleveland Clinic – Female Reproductive System - https://my.clevelandclinic.org/health/articles/9118-female-reproductive-system
Centers for Disease Control Infertility: Frequently Asked Questions - https://www.cdc.gov/reproductive-health/infertility-faq/index.html
Endometriosis Foundation - Everything You Need to Know About Pelvic Floor Physical Therapy (PFPT) for Endometriosis - https://www.endofound.org/everything-you-need-to-know-about-pelvic-floor-physical-therapy-pfpt-for-endometriosis
Womens Health - Polycystic ovary syndrome - https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome
National Library of Medicine - Deep Dyspareunia, Superficial Dyspareunia, and Infertility Concerns Among Women With Endometriosis: A Cross-Sectional Study - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261667/
National Library of Medicine - Combined manual therapy techniques for the treatment of women with infertility: a case series - https://pubmed.ncbi.nlm.nih.gov/23055467/
National Library of Medicine - Ten-year Retrospective Study on the Efficacy of a Manual Physical Therapy to Treat Female Infertility - https://pubmed.ncbi.nlm.nih.gov/25691329/
National Library of Medicine - Low Dose, High-Frequency Movement Based Dilator Therapy for Dyspareunia: Retrospective Analysis of 26 Cases - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240346/
National Library of Medicine - Safety and effectiveness of an internal pelvic myofascial trigger point wand for urologic chronic pelvic pain syndrome - https://pubmed.ncbi.nlm.nih.gov/21613956/