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pathology perspectives BY RUTH WERNER BODYWORK FOR FEMALE INFERTILITY Female infertility is a situation fraught with physical, mental, emotional, and even spiritual challenges. At some level, most humans experience the instinct to procreate, although obviously not all of us choose to follow that urge. In some cultures, even in a developed country like the United States, a woman's sense of value and self-worth may be deeply and surprisingly connected to her ability to bear young. A woman who does not conceive or successfully give birth to a longed-for child may go through periods when she questions her significance, her identity, her very reason for existence. If the chance for a sperm cell to encounter her ovum is somehow impaired, it isn't a distant leap for a woman to feel responsible, even guilty, for that defect. Infertility is defined in the United States as the inability to conceive a child after a full year of unprotected sexual intercourse. Infertility is not synonymous with sterility. Infertility is a condition in which it is difficult to conceive; sterility describes a situation where conception is impossible. Statistics on infertility in the United States are difficult to gather, because not all affected people seek help. Some cases resolve spontaneously with a successful pregnancy; other couples give up. Some sources suggest that approximately 15 percent of couples are infertile and that physiological problems with the women in those couples are the obstacles to conception in about 70 percent of those cases.1 million women seek treatment for infertility each year.2 About 7 Recent developments in fertility assistance technology include hormone injections, in vitro fertilization, and other invasive techniques. They have improved the outlook for women who wish to carry a child, but even the most advanced interventions have a relatively low success rate, depending on the age and general health of the patient. Further invasive interventions carry many risks to both mothers and children.3 Alternatives to conventional fertility treatments exist, and couples seek them out increasingly in their quest for a healthy biological child. Massage therapists and bodywork practitioners are finding a place in this community of caregivers. This trust carries an astonishing level of responsibility. CAUSES OF FEMALE INFERTILITY Causes of female infertility can be loosely grouped into four different categories: adhesion disorders, hormonal imbalances, structural anomalies, and environmental and behavioral factors. These are not always mutually exclusive. ADHESION DISORDERS Adhesion disorders include conditions and events that lead to the accumulation of excessive collagenous scar tissue in the pelvis. These adhesions can range from microscopic to obvious. They can interfere with fertility by limiting mobility of pelvic organs, creating pain with intercourse, impeding local blood and lymph flow, interrupting nerve function where neurons are bound up in fascial restrictions, and mechanically obstructing the surface of the ovaries and exterior and interior of the uterine tubes.4 connect with your colleagues on massageprofessionals.com 109