Chapter contents
Introduction99
Causes100
Conventional management of infertility103
General relaxation reflexology to support infertile couples105
Precautions when treating infertile couples108
Reflex zone therapy for specific indications related to infertility110
Research evidence111
References112
Further reading113
Useful resources113
ABSTRACT
This chapter explores the growing issue of infertility and the ways in which reflexology may help couples who are having difficulty in conceiving. The causes and conventional medical methods of treating couples with infertility are considered. Precautions to reflexology are discussed and the use of reflexology, both for general relaxation to reduce stress levels, which can so often be a contributing factor, and as a treatment modality for specific causes, are also explored.
Introduction
Infertility – or more correctly, subfertility – is a problem for which couples increasingly seek complementary therapy treatment, with reflexology appearing to be amongst the most popular choices. Certainly, the relaxation response from reflexology may help to restore and maintain homeostasis in some women, facilitating the body to normalise its functions and thus enabling them to become pregnant, and there is some interesting work being carried out in some centres in which reflexology is offered to women seeking specialist infertility treatment.
Subfertility is an extremely complex situation which, in some cases, cannot be remedied, and if the cause lies not with the woman but with her partner, treating the woman alone will not achieve pregnancy. However, many women seem convinced that reflexology is the answer to their difficulties and the media does nothing to dispel these convictions. It would, of course, be entirely unprofessional for practitioners of reflexology to claim to ‘treat’ infertility or to guarantee to facilitate conception. This may give false hope to couples, some of whom may never be able to have a baby naturally. The women, in particular, are desperate to conceive and may have been trying to become pregnant for many years. They are particularly vulnerable and – like some cancer patients – will try ‘anything’ for which there is a suggestion that it might be successful. Unfortunately, there are numerous online accounts in which therapists purport to have treated women who subsequently become pregnant, but this is not evidence that the reflexology treatment is effective in ‘curing’ the physiopathological cause of the infertility. Furthermore, some reflexologists who ‘specialise’ in treating women/couples for infertility have an extremely poor knowledge and understanding of the aetiology and predisposing factors of the condition, and of the conventional medical management, and it is imperative that the professional clinical reflexologist has addressed this before attempting to do more than simple relaxation treatments.
Causes
Couples are classified as subfertile after one year of having regular, unprotected sexual intercourse, with about one couple in six seeking professional help. The aetiology of infertility is a complex combination of physical, psychological and social factors and it is important to be aware of these.
The psychosocial reasons for an increase in infertility in recent years include high-pressure jobs, financial pressures, career women actively choosing to delay having children until their late thirties and divorces leading to second marriages at a later age. When a couple starts considering a family and the woman fails to become pregnant for some time despite having regular sex, there will be anxiety that there is a medical problem, compounded by feelings of guilt about their lifestyle and their delay in entering the pregnancy arena. Whilst a man continues to produce spermatozoa until much later in life, the number of eggs left in a woman in her thirties or even her forties is constantly declining with each subsequent menstrual cycle, and those that remain may not be accessible to the sperm for a variety of reasons. The reflexologist can be especially supportive in these cases, and a course of treatment may, for some couples, be all that is required to facilitate a reduction in stress hormones and a consequent rise in the hormones required for conception and pregnancy.
Some couples fail to conceive due to sexual difficulties. They may be having intercourse infrequently or not at the most appropriate stage of the woman’s menstrual cycle, around ovulation. (This is fourteen days before the next menstrual period; women who have a long or overly short menstrual cycle have a variable length in the first – follicular – ‘half’ of the cycle, before ovulation occurs, but the second – luteal – phase is always fourteen days.) These difficulties may be due to social, domestic or occupational stressors, or sometimes lack of knowledge. For example, very occasionally, the relationship may not have been consummated, the couple either indulging in non-penetrative physical contact or inadvertent penetration of the anal sphincter or urethra, rather than the vaginal opening, usually through poor knowledge or embarrassment and inhibition. Psychological factors can also cause vaginismus in the woman, excessive muscular contraction due to fear, which prevents penile penetration. These women/couples need specialist psychosexual counselling; it is not within the remit of the reflexologist to attempt to treat them and the couple should be encouraged to return to their general practitioner for referral for appropriate treatment.
The physiopathological reasons for the condition may lie with either the female or the male partner, or a combination of both, but the nature of the problem often means that couples feel embarrassed to discuss it, since it is a very personal issue and because, due to societal expectations, people feel they have ‘failed’. In women, the reasons for difficulty in conceiving can loosely be classified as failure to produce or release eggs, structural anatomical problems or pathological medical conditions. In men, the causes are almost always related to abnormalities of sperm production and/or release.
Problems with ovulation (release of an egg) may be due to hormonal imbalances in the hypothalamus, pituitary gland or ovaries and can be triggered by stress and lifestyle factors such as smoking, alcohol abuse, a history of sexually transmitted infections, excessive exercise, under- or overweight. Stress hormones, such as cortisol, adrenaline (epinephrine) and noradrenaline (norepinephrine) from the adrenal glands, are known to have adverse effects on the production of hormones necessary to conception, pregnancy and breast feeding, such as oxytocin (Uvnas-Moberg & Petersson 2005). Women need at least 17% of their body weight to be adipose tissue (fat), as oestrogens are stored in the fat; therefore, women who are severely anorexic almost always cease menstruating and ovulating. Conversely, obese women with a body mass index of 30 or above are more at risk of conditions such as severe diabetes mellitus, hypertension and other cardiovascular problems (Kelly-Weeder & O’Connor 2006), which in themselves can contribute to reduced fertility.
Other causes include polycystic ovary syndrome or excessive prolactin production from the pituitary gland. Polycystic ovary syndrome is the most common cause of failure to ovulate, and is due to multiple small cysts on the surface of the ovaries, together with a hormonal imbalance, leading to absent or irregular periods; characteristically women so affected may be of stocky, slightly masculine build and be considerably more hirsute than most women, although this is not universal. High circulating prolactin levels from conditions such as a benign pituitary tumour will suppress the oestrogen and progesterone required for development of the Graafian follicle and, therefore, ovulation is suppressed.
Some women are found to have blocked fallopian tubes, usually occurring as a result of previous infection (salpingitis), sometimes sexually acquired, as in the case of chlamydia. The incidence of this infection has become such a significant problem that all young people between the ages of 15 and 25 are now offered free chlamydia testing. Infection caused by this or other organisms can also affect the cervical mucus, thickening it so that the passage of sperm at intercourse becomes much more difficult; in addition some women develop anti-sperm antibodies, exacerbating the problem.
Uterine factors include fibroids, polyps and tumours, which are usually benign, or an abnormally shaped or positioned uterus. Growths on the wall of the uterus interfere with the endometrial lining which is shed during menstruation, and sometimes causes scarring; if conception does occur, this prevents implantation of the fertilised ovum. Endometriosis is another very common cause of infertility, in which tissue normally located within the uterus develops abnormally in other areas of the pelvis, such as the fallopian tubes, on the ovarian surface and in the pelvic cavity. It causes intense pain and discomfort during menstruation, while the development of scar tissue and adhesions in and around organs in the pelvic cavity will further compromise the chances of conception.
Occasionally, a genetic condition, such as Turner’s syndrome, may mean that secondary sexual characteristics fail to appear and there is no ovarian activity. In mild cases the condition may not be diagnosed until the woman fails to conceive, although more commonly absence of the menarche (onset of menstruation at puberty) will have revealed it earlier. A few women with normal ovarian function may experience premature menopause, or the ovaries may be affected by disease, including cancer and the effects of treatments such as radio- or chemotherapy.
Immunological factors may also play a part and can contribute to unexplained infertility, repeated early miscarriages or failure of in vitro fertilisation. There is a chemical ‘mismatch’ between the mother’s system and the embryo – which contains ‘foreign’ cells from the father – and the embryo fails to embed in the uterine lining or separates (miscarriage). Occasionally, this is seen as an ‘allergy’ to the partner which can cause pregnancy failure or complications (in some women, pre-eclampsia can also be caused by these immunological issues). If the woman changes her partner, for example, through divorce or separation, attempts at conception may be more – or less – successful with the new partner.
Male infertility is most commonly related to sperm abnormalities. Good-quality semen requires an adequate concentration of spermatozoa which are both normal in structure and sufficiently mobile to make the long arduous journey from the vagina, following ejaculation, to join with the ovum which has been released from the woman’s ovary, usually somewhere within the fallopian tube. Spermatozoa consist of a head, body and tail, but in the normal 3ml of ejaculate, with an average of 200–300 million sperms present, 30% may be abnormal, having either an absence or a duplication of one or more sections of the sperm.
Testicular problems may result in deficient production (i.e. number) of sperm; the causes may be associated with previous infections, stress, excessive alcohol consumption, smoking, recreational drug use or treatments for medical conditions, including pharmaceutical prescriptions or radiotherapy, but in many cases the cause is unknown. Certain occupations can contribute to reduced fertility, notably those involving chemicals, electricity or nuclear power. Occasionally, the reason may be hormonal, whilst any situation in which the local temperature around the testes is raised, for example a varicocele (dilated blood vessels) or simply wearing tight underpants, will also impede sperm production. Constantly using a mobile telephone, especially if it is kept in the trouser pocket between calls, has also been blamed for reduced sperm production, possibly because of the heat they generate or due to the electromagnetic radiation they emit (Agarwal et al. 2008).
If there is an obstruction in the vas deferens, or very occasionally an anatomical absence of the tube, semen production may be normal but there will be no sperm in the ejaculate; this condition can follow infections such as tuberculosis, or severe trauma to the testicles. In men who have undergone reversal of a vasectomy, anti-sperm antibodies may be produced which attack the sperm and inhibit their motility, so although the tubes are patent again, the chemistry remains alien to conception (Firth & Hurst 2005:606).
Conventional management of infertility
When a couple eventually seeks medical help they may have been unsuccessfully trying to conceive for some considerable time and it will not have been an easy step to consult their doctor. The general practitioner may undertake some investigations but, if no treatable cause is readily found, usually refers couples who meet specific criteria for more specialist help. Women over the age of 35, with six to twelve months of infertility, or younger women who have been unsuccessful after a year of trying, will normally be referred to a specialist gynaecologist, particularly if hormone tests indicate ovarian failure, or there has been no response to drugs which aim to stimulate ovulation. If there have been negative results to some of the initial tests, such as semen analysis or a post-coital test, or if there is the possibility of disease in the pelvis or fallopian tubes, these couples will also be referred to the consultant.
A full medical history is taken from both partners and a general examination of the woman is performed. General lifestyle advice is given – diet, weight management, smoking, alcohol consumption, drug use (prescribed medication and recreational use) and dealing with stress. Blood is taken to test for rubella immunity and various hormone levels, and a pelvic ultrasound scan is performed to assess for structural abnormalities in the pelvis. The man is asked to produce a semen sample which is tested for the volume of semen, number and concentration of sperm, motility and normality of individual sperm and the white cell count, which may reveal infection.
These tests are fairly basic but if the cause is still not found, the couple undergoes more intrusive investigations, including a post-coital test, although the usefulness of this is now being questioned. The woman is asked to go to the clinic within six to eight hours of having intercourse (without washing), usually in the preovulatory phase of her menstrual cycle, and a sample of mucus is taken from the cervical canal and transferred to a slide to assess how the sperm reacts to the mucus. She may be required to have a hysterosalpingogram – an X-ray during which a dye is passed through the cervix, uterus and fallopian tubes to test for patency of the reproductive tract, especially the tubes. If no abnormality has yet been detected she may also need a laparoscopy under anaesthetic to view the pelvic organs directly and to detect problems such as tubal patency, endometriosis or pelvic adhesions from previous surgery, all of which may affect the woman’s ability to conceive.
Unfortunately, the difficulties for couples attempting to conceive may be compounded by multiple factors, for example, the woman may have endometriosis and the partner may have a low sperm count. In themselves, these conditions do not always result in infertility, but when combined they seriously impair the chances of successful conception. The most common ‘cause’ of all is ‘unexplained infertility’ and these are, from a conventional medical perspective, the most difficult situations to remedy. An additional group of female patients includes those who manage to conceive yet who are unable to continue with the pregnancy, suffering multiple miscarriages. The causes of repeated pregnancy loss in the first trimester (three months) tend to be the same or similar to those for subfertility, but, of course, these women will be possibly even more psychologically and emotionally distressed, which does nothing to help the problem. Again, whilst it is the responsibility of the reflexologist not to overstep the boundaries of their practice by attempting to treat or ‘cure’ the situation, gentle empathetic support and relaxation reflexology can go a long way towards helping these couples to come to terms with their situation.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
