Infertility and Alternative Care: A Case Report
Heather Yost, DC, DACCP
Abstract
Introduction:
The incidence of infertility has continued to rise over the last ten years and it is estimated that it now affects a minimum 11.8% of women of reproductive age. This number represents greater than 7.3 million couples in the United States alone. Couples have options ranging from being childless, adopting, taking various medications and infertility treatments. About 2 million couples seek infertility treatments each year [1]. Insurance companies provide very little financial support, if any. Infertility treatments can range in the thousands, with in-vitro costing ~15,000 each time. [http://infertility.about.com/od/ivf/f/ivf_cost.htm] Adoption can range anywhere from 5,000-40,000 dollars and parents are often waiting over a year for the adoption process. [http://costs.adoption.com/] Couples are now looking towards natural alternative health care [2,3] knowing that low risk alternatives are not only cost friendly (in comparison) but effective.
The focus of this case report is to present and discuss a case of a woman with infertility and the observed improvement in neurological function through surface EMG, thermography, improved range of motion as well as menstrual regularity and ability to conceive, documented subjectively and objectively during the course of her treatment.
Case Presentation:
A case study of a 28 year old female who presented to this office with failure to achieve menses without medication, anovulatory cycles, and chronic low back and hip pain with a diagnosis of infertility. Low back pain was chronic in nature and described as dull aching and tightness. The patient had some chronic low-grade discomfort, which slightly worsened with activity. The patient reported the following activities of daily living to be painful: sleep, static sitting, and static standing. Patient had previously conceived via infertility medication and carried pregnancy to term, delivering vaginally.
Methods:
The woman’s treatment plan consisted of full spine chiropractic adjustments and acupuncture along with dietary supplementation. Chiropractic adjustment techniques were Diversified and Thompson drop. Orthopedic, neurological exams were done along with range of motion, postural assessments, palpation and x-ray examination to determine need for care. Acupuncture was applied beginning at the 11th visit and then every few months as she went through fertility treatments. The points needled are as follows: GB 21, LV 3, SP 6, and SP 10.
Patient was adjusted in the cervical thoracic, lumbar, sacral, and pelvic regions with diversified and Thompson adjusting techniques. Omni adjusting table was used. Pelvic adjustments were followed by thoracic, lumbar, and then cervical adjustments last. After the adjustment, static and motion palpation was used to confirm the adjustment was successful. Painful lumbar range of motion/myositis was treated with supervised electric stimulation (Russian Stimulation): symmetrical sine wave, 30-50 pps, ramp time: 2 seconds, cycle: 4 seconds on and 12 seconds off, duty cycle: 50% with the intensity to medium contraction and duration 15 minutes each time. Russian stimulation was applied to the low back paraspinal muscles, lateral to L1 and L5/sacral region. Russian stimulation was performed for the first 12 visits. Chiropractic progress exams were performed every 12 visits to determine improvement and continued need for care. In progress exams, patient’s subjective complaints were improving and visual analog scale was reducing. The patient also stated that the low back pain had been reduced to the point that it did not affect her activities of daily living.
Results:
Improvements were seen in menses, cycle length, and her body’s response to medication (Provera and Femara). Patient received acupuncture on two different attempts to bring about her cycle and cycle was achieved the next day after the first treatment and 5 days after the 2nd treatment. Patient stated that she was a “slow responder” to medication and generally needed to continually increase the medication to achieve the desired response. After beginning her course of chiropractic care, she responded more favorably to medication, neurological function (improvements in static EMG and thermographic scans as well as improved range of motion and decreased pain) improved and pregnancy was achieved. These improvements were documented by the patient, her reproductive endocrinologist, and chiropractor over the course of four to six months. Patient miscarried at 7 weeks gestation. Chiropractic care continued and a second pregnancy was achieved 4.5 months later. This pregnancy also resulted in miscarriage. Subjective and objective improvements (as noted previously) were seen and patient was satisfied with care. Throughout the course of treatment, 2 pregnancies were achieved but not carried to term.
Discussion:
With case reports it is always difficult to determine if the patient may have had their desired response independent of care and that the care was coincidental or had a placebo effect. In this case the patient was seen because other care was not producing a desired result so the temporal relationship of the care rendered and patient’s response was compelling. It is always challenging with physical clinical applications to rule out a placebo effect however this patient was unresponsive to other care.
The care rendered appeared to demonstrate a relationship between low back pain and a difficulty to conceive. As the back pain resolved she was able to become pregnant. The rational for this response to care could be multifactorial and relate to: (1) balancing of the pelvis allowed the pelvic floor to better support the position of the uterus, fallopian tubes, and ovaries, (2) there might have been some somatovisceral component from the spine or pelvis which inhibited hormonal function to the uterus or ovaries, and/or (3) the stress of low back pain or just relaxing the low back allowed the patient to have sufficient stress reduction so that she was then able to conceive.
One issue of the Journal of Vertebral Subluxation Research focused on women and fertility issues and described 14 retrospective articles with diversity as follows: “all 15 subjects were female, ages 22-65; prior pregnancy history revealed 11 none, 2 successful unassisted, 1 assisted, 1 history of miscarriage. 9 had previous treatment for infertility, 4 were undergoing infertility treatment when starting chiropractic care [5].” As a means to describe the successful outcomes discussed in these 14 case reports it was suggested that “interference in physiological function, as viewed by the application of chiropractic principles, suggests a neurological etiology and is approached through the mechanism of detection of vertebral subluxations and subsequent appropriate and specific adjustments to promote potential and function. Parental health and wellness prior to conception influences reproductive success and sustainability, begging efficient, effective consideration and interpretation of overall state and any distortion [5].”
Conclusion:
Based on the patient’s response to care and the subsequent unresponsiveness to other care for her issues of menstrual cycle irregularity and infertility, chiropractic and acupuncture may have been contributory to her desired pregnancies. It is always difficult to determine if it was the care rendered solely that contributed to the patient’s positive response in single case uncontrolled studies. However due to the low risk and positive outcome further study is warranted to determine the role of chiropractic in helping women with infertility and how chiropractic and acupuncture may serve as a part of an early intervention team for women with reproductive challenges.
References:
- Infertility: (Data are for the U.S.). Centers for Disease Control and Prevention. [http://www.cdc.gov/nchs/fastats/fertile.htm] (Last accessed August 5, 2010).
- Factor-Litvak P, Cushman LF, Kronenberg F, Wade C, Kalmuss D. Use of complementary and alternative medicine among women in New York City: a pilot study. J Altern Complement Med. 2001 Dec;7(6):659-66.
- Smith JF, Eisenberg ML, Millstein SG, Nachtigall RD, Shindel AW, Wing H, Cedars M, Pasch L, Katz PP. Infertility Outcomes Program Project Group. Adler N, Showstack J, Croughan M, Gregorich S. The use of complementary and alternative fertility treatment in couples seeking fertility care: data from a prospective cohort in the United States. Fertil Steril. 2010 May 1;93(7):2169-74.
- Park JJ, Kang M, Shin S, Choi E, Kwon S, Wee H, Nam B, Kaptchuk TJ. Unexplained infertility treated with acupuncture and herbal medicine in Korea. J Altern Complement Med. 2010 Feb;16(2):193-8.
- Behrend TM. Insult, interference and infertility: an overview of chiropractic research. J Vert Sublux Res. May 2003; (2):1-8. [http://www.jvsr.com/abstracts/index.asp?id=161] (Last accessed August 5, 2010).
