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Still trying to have a baby? This might be the underlying problem.

Updated on January 15, 2016
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Pelvic adhesions affect fertility

One in eight couples struggles with the heart break of infertility. It turns out nearly half of all female infertility patients have adhesions or what is also referred to as scar tissue. Adhesions sometimes distort or block the fallopian tubes. Endometriosis, or infection (including Pelvic Inflammatory Disease or ruptured appendix) or surgery can create adhesions.

From RESOLVE, the national infertility association:

Any fall, cut, break, inflammation, surgery or infection, essentially any trauma or assault to the body can cause adhesions to form. While this is a natural response to healing, small, often microscopic adhesions can lead to pain or poor functioning, sometimes even decades after the initial trauma occurs.

Adhesions glue down the muscles or delicate organs and decrease their function. Once adhesions attach and grow they pull on nerves and sensitive structures in the body which can cause pain. Moreover, the body can't break down adhesions which means they remain a permanent part of the body's structure and lead to problems.

Surgery is the primary cause. Research indicates that about 80% of open abdominal and pelvic surgeries result in their formation. A 1999 British study published in the Lancet found that nearly a third of the patients who underwent open abdominal or pelvic surgery were readmitted to the hospital at least two more times for follow-up adhesion-related surgeries.


Adhesions and infertility: My story

I know how stressful it is when you want a baby, when nothing else matters but that one-single-goal. I lived, breathed, ate, slept, wanting to get pregnant.

But my infertility story is a little unusual.

In 1997 my husband and I knew well in advance of starting a family that I needed infertility intervention. When I was 19 I was diagnosed with a somewhat rare pituitary disorder (Empty Sella Syndrome). While ESS isn't serious, it does affect hormone levels and subsequently, reproduction.

As a result I was sort of emotionally prepared for infertility treatment. I'd already been on hormone replacement for 10 years and was very comfortable with my long time reproductive endocrinologist who when I wanted to get pregnant, became my fertility specialist.

Dr. Loy told me I needed to have a hysterosalpinogram (HSG), a dye test (I won't lie, it was a bitch, but with Valium and lots of Advil, quite tolerable). that detects tubal infertility in the fallopian tubes and uterine cavity.

I thought my pituitary hormone imbalance was my only challenge to get pregnant but the HSG dye test revealed some blockages in my left fallopian tube. I remember sobbing to my husband in the car on the way home. I already started with a less than stellar chance of making a baby and now this? (I thought my chances were iffy but Dr Loy insisted our odds were nearly as high as the average couple's. I still wonder if giving couple's confidence is part of his high success rate).

Dr. Loy told me because of the HSG results I needed a Laparascopy and a Hysteroscopy. When he went in he also found some mild endometriosis and an en utero (born with it) cyst on my right ovary. Essentially he "cleaned me out" and set the stage for a more successful attempt to get pregnant.

At the time I knew nothing about adhesions and infertility but it's very likely knowing what I know now, that because my left fallopian tube was adhered to my uterine wall, and because I had some endometriosis, I had adhesions that would have affected ovulation and/or implantation.

P.s. Did I get pregnant? Thankfully, yes.

Following my surgery, I did series of super ovulation hormone shots at home (carefully injected by my husband above my butt), an inter-uterine insemination with my husband's "cleaned up, sped up" or as he called it "super" sperm, and weeks later, I was pregnant. My daughter is nearly 18. And while we were told our chances to conceive a second time were good, we decided to stop at one child.

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How adhesions affect fertility

Where can adhesions form?

Pelvic adhesions can be found between any two tissue surfaces in the pelvic cavity. These include the uterus, fallopian tubes, ovaries, bowel, and bladder. Adhesions may also be found inside the fallopian tubes.

Endometriosis or tubal surgery may cause adhesions to form inside the fallopian tube, on the outer surface of the tube, or even on the ends of the fallopian tube called the “fimbria”. These fimbria, which act like fingers to sweep the egg into the tube, become stuck together and can’t move to get the egg into the tube when it is released during ovulation. Any tubal adhesions which block or distort the tube can lead to infertility or increase the chance of an ectopic pregnancy.

Can adhesions be removed?

Removal (also called ”lysis”) of adhesions can be accomplished using laparoscopy or laparotomy with traditional or microsurgical techniques. Studies have shown that removal of adhesions can reduce pain and can potentially improve the possibility of conceiving, versus no treatment at all. However adhesions may reform after they have been removed.

What types of surgeries can increase the risk of adhesion formation?

Adhesions form in the majority of women after gynecologic pelvic surgery. Studies have shown that adhesions formed in 55-100% of patients who had reproductive pelvic surgery, whether open or aparoscopic. For example, myomectomy (surgery to remove fibroids), tubal surgery (to remove an ectopic pregnancy), surgery on the ovary (to remove cysts) and surgery for endometriosis can cause adhesions.

****Even surgery to remove adhesions can lead to new adhesions. Laparoscopic surgery (surgery done through several small incisions using a camera) causes less adhesion formation than laparotomy (surgery through one larger incision without use of a camera). Microsurgery (surgery using a microscope or magnifying glass, and special surgical technique) leads to less tissue damage and has a lower incidence of adhesion development than the traditional approach. Diagnostic procedures, which only involve a visual inspection of the organ(s), such as a diagnostic hysteroscopy or diagnostic laparoscopy, rarely lead to adhesions.

How can the risk of developing adhesions be reduced?

There are techniques which can be used at the time of surgery to reduce the risk of developing adhesions. In addition to using microsurgery or laparoscopic techniques, prevention of infection is essential. During surgery, various products are used to inhibit adhesion formation, known as adhesion barriers. These include gauze-like materials placed over the tissue which dissolve to become a gelatinous layer to reduce the incidence of post-operative adhesions. This material is eventually absorbed by the body.


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The Wurn Technique to improve fertility

In 1984, when physical therapist Belinda Wurn underwent treatment for cervical cancer, the radiation therapy designed to save her life left her with scarring, adhesions and chronic pain.

Belinda and her husband Larry, a massage therapist, searched for years for relief. When a string of conventional approaches failed, the couple decided to take a series of post-graduate courses in manual (hands-on) physical therapy.

Over time what they learned drastically relieved Belinda's chronic pain. As a result, after researching numerous methods and studying with respected osteopathic and physical therapy clinicians across the country, the Wurns refined what they learned to create their own palpitation method to treat restricted areas in the body. Most “unexplained” pain in patients, they found, was caused by these all too common yet under-diagnosed adhesions.

Belinda and Larry Wurn developed The Wurn Technique® where practitioners trained in this therapy manually palpatate blockages caused by adhesions in the body. This technique offers a drug and surgery-free treatment for infertility, chronic pain and a long list of pelvic conditions.

Is this quackery or does it work? Data is very promising.

I can't personally vouch for The Wurn Technique® I can however, look at the *data. According to the Wurn's website:

"We are thrilled to announce that in a study of 1,392 infertile women treated at Clear Passage during a period of 10 years, our therapy was found to be equivalent to or exceed standard medical treatments for common causes of female infertility, including both hormonal and mechanical conditions (e.g. blocked fallopian tubes).

*The multi-site study, which will be published in the peer-reviewed journal Alternative Therapies in Health and Medicine(May/June, 2015), is now housed in the U.S. Library of Medicine, and available here.

Wurn Pregnancy Rates

  • Blocked Fallopian Tubes – 57% pregnancy rate for women whose tubes have opened (vs. 22% – 34% for surgery)
  • Endometriosis – 43% pregnancy rate
  • PCOS – 54% pregnancy rate
  • High FSH – 39% pregnancy rate
  • Pre-IVF – 56% with Clear Passage before transfer (vs. 37% without Clear

Adhesions in the body

How the Wurn Technique works

The Wurn Technique® involves a hands-on therapy based on massage and physical therapy principles and has been successful with the following:

  • Pre-In vitro fertilization (IVF) therapy
  • Blocked fallopian tubes
  • Pelvic and endometriosis pain
  • Hormone levels
  • Sexual function and intercourse pain
  • Tailbone pain

Therapy feels much like a slow, deep massage and often includes some internal (vaginal) treatment, although patients can always decline internal treatment. Internal treatment has been used by physical therapists, write the Wurns in their material, to treat incontinence since 1975 and is still endorsed by the APTA today.

Patient awareness and tapping intuition increases healing

Trained therapists engage in a step-by-step process with patients that includes reviewing their history, setting goals, doing a palpatory evaluation, and finally, manual treatment. Therapists work closely with patients to bring awareness to past and current events that may have led to their symptoms.

Not entirely mainstream but extremely empowering for patients, Wurn therapists encourage their clients to actively participate in their own healing process, suggesting they tap into their own intuition, or “inner wisdom” to find answers.

“We realize that this attitude is not scientific and is controversial itself,” write the Wurns in their book, Miracle Moms, Better Sex, Less Pain (Med-Art Press, 2009). “ Yet over time, we have noticed that patients who make decisions based on a combination of medical advice and their own intuition have been more successful and reached their goals faster than those who lived by empirical scientific advice alone.”

The Wurns claim a 71% natural pregnancy success rate with patients within one year of receiving therapy, backing their findings with clinical research. They disclaim on their website however that “Ongoing success rates with natural fertility reversal can be difficult to determine due to follow-up, 12 and 24 months after therapy. Judging from success rates we can easily measure (e.g. opening blocked fallopian tubes, IVF pregnancies after therapy) we believe our natural fertility success rate is between 60% and 65%.”

There are numerous conventional and alternative approaches available for women and men who face infertility, chronic pain, sexual dysfunction and related conditions. The Wurn Technique® however, addresses one of the most common yet under-diagnosed underlying causes of these medical issues, adhesions that can block the body’s natural ability to function effectively on its own.

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