An article written by Heidi Armstrong with Suzanne Yates, for the FHT magazine, July 2014
Working with fertility
An introduction into how massage and reflexology can help with fertility issues
Massage and reflexology, and other complementary therapies, can offer many benefits for clients trying to conceive. In this article, Heidi Armstrong and Suzanne Yates explore some of the ways appropriately trained therapists can work, considering any relevant issues and treatment adaptations. While the focus is on women, as assisted reproductive technologies, miscarriage and pregnancy more directly impact them, the male client is equally important and many of the lifestyle factors are relevant to him.
The therapist’s role
Practitioners must have adequate training to be able to understand the main issues related to infertility. The therapist is potentially working in very early pregnancy and needs to be trained and confident in working with women in the first trimester. The therapist also needs to know how to work with the risk of miscarriage.
Therapists need to be sensitive to the client’s expectations, not give false hope and be realistic about what can be achieved. Forming part of the client’s support circle, the therapist needs to be clear what their role is and how to communicate with other healthcare professionals.
It is also important to know when to refer to GPs and primary care providers or other professionals, for example to a psychotherapist for clients who have suffered sexual abuse or trauma or a nutritionist for those who need additional nutritional support.
Factors reducing fertility
A quarter of couples planning a baby have trouble conceiving. It is not uncommon for a couple without fertility problems to take two to three years to conceive.
In each individual case the reasons affecting fertility will be different. There are a number of potential factors that may reduce fertility, including:
Poor nutrition: high caffeine intake potentially increases the risk of miscarriage; and yeast infections, allergies and high mucus-producing food (such as wheat, sugar and processed food) may affect fertility.1
Alcohol and drug use: drinking more than five units of alcohol per week can reduce fertility2 and drug abuse has been shown to affect the male reproductive hormones.3 Smoking: reduces both male and female fertility.4
Infections/environmental toxins: includes exposure to certain chemicals, pollutants, micro waves from microwave ovens and radiation from mobile phone masts, and so on.5
Age: female fertility starts to decline after 35 years and male fertility after 40.6
Weight: both obesity and anorexia affect hormonal balance.
Women: hormonal conditions such as polycystic ovary syndrome (PCOS), fibroids (non-cancerous tumours that grow in or around the womb), endometriosis (small pieces of the womb lining are found outside the womb).
Men: low sperm count, movement and form. Sperm counts have dropped by 50 per cent in the last ten years and men are showing an increasing number of sperm abnormalities.7
Adaptations to the consultation form
In addition to the standard questions on a consultation form, there are some important questions to ask fertility clients:
- How long they have been trying to conceive.
- Whether they have a history of miscarriage or termination.
- Type of contraception used before.
- Questions about menstrual cycle: length, duration, type of blood loss, how they feel, whether they know when they are ovulating.
- Whether they have had a medical diagnosis.
This information will indicate how to support the client physically or emotionally.
Most times a medical diagnosis will not be given until after 18 months of trying to conceive or more than three miscarriages.
Of those who seek medical help, 30 per cent are diagnosed with ‘unexplained infertility’ for which doctors can offer ‘no treatment’. For these clients, there is much we can do – from stress reduction and emotional support, to dietary or lifestyle advice and helping women to be more in tune with their cycle.
Relevant information needs to be gathered on any assisted reproduction procedures by speaking with the client and medical consultant, and your own research.
Potential benefits of massage and reflexology
Massage and reflexology treatments can help to:
- Reduce stress and anxiety, creating an optimum environment in the body for conceiving.
- Address postural issues such as pelvic alignment, hormonal balance and any menstruation issues, to help aid a trouble-free pregnancy.
- Strengthen the female reproductive system and help women to become more connected with their bodies and cycle.
- Improve energy levels through incorporating relevant traditional Chinese elements.
- Provide a non-judgemental space for clients to consider their lifestyle, relationship, support systems, stress levels and other potential issues, helping to create the best possible start for a natural conception.
- Provide lifestyle and nutrition advice to support conception, where appropriately qualified
- Offer physical and emotional support during assisted reproduction.
- Support the loss and grief of women in sensitive cases of miscarriage and accepting motherhood is not to be and provide information on other sources of support.
There have been several studies on reflexology and fertility but unfortunately none have provided any conclusive information. There are some studies on acupuncture but funding is an issue for large randomised control trials (RCTs) and such trials are not always relevant for touch-based therapies. Complementary therapy offers treatment individualised to the client and it is hard to isolate only one specific input. Qualitative research is more relevant but is sadly not widely recognised by the medical profession. There is however evidence that bodywork can reduce cortisol levels indicating stress reduction and improved psychological well-being, aid anxiety, and help with hormonal balancing.8-9
Contraindications to treatment
- Deep vein thrombosis;
- Vomiting and diarrhoea; and
- Unexplained abdominal pain and vaginal bleeding.
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- Supporting natural fertility
In order for successful conception to occur:
- Hormone levels must be correct so that the egg develops normally.
- The woman must be ovulating* so that an egg is released. Some menstrual cycles are anovulatory, that is to say that no egg is released. This is often due to factors such as hormonal levels.
- The woman must have sex at the right time in her cycle.
- The partner must have good sperm count and healthy sperm.
- The egg has to be captured in the fallopian tube and fertilised.
- The fertilised egg needs to implant on the wall of the uterus.
- The right level of hormones are needed during pregnancy to support foetal and placental development.
* Ovulation usually in the middle of the menstrual cycle (around 10 to 16 days before the start of the next period). If a menstrual cycle is 28 days long, this would be around days 13 to 19. (http://www.nhs.uk/chq/Pages/829.aspx?CategoryID=54).
For successful conception, sex must be in the window of the first few days after ovulation. As many women are not in tune with their cycle and don’t know when they are ovulating, they might be having sex at the wrong time.
The stress of trouble conceiving can cause hormonal imbalance, which further affects chances of conception. Other issues that affect hormone balance include being overweight or underweight.
Massage and reflexology have been shown to help with hormonal balancing and to reduce stress. Treatments provide a space for the client to be heard, become more attuned to their cycle, and consider lifestyle factors causing weight issues.
Intimacy and sexuality issues can also cause a strain on the sexual relationship – helping the woman to connect more with her body may help. Clients who have experienced sexual abuse or trauma may require additional psychotherapeutic approaches, but can respond well to massage or reflexology.
Abdominal work can help a woman to connect with her cycle and with her uterus. Many therapists are wary of working this area when the client is knowingly trying to conceive but some simple holding techniques combined with breathing and relaxation exercises can introduce the work.
Working the gluteals, piriformis and sacrum can relieve any congestion caused by muscle tension, which can affect lymph and blood flow and digestion. Releasing any constriction in the pelvis will help the body to function optimally.
Energy techniques can help regulate hormones, including CV and GV pathways (midline body starting from perineum and running front and back to mouth), chakras and some hormonal-regulating points on the hand such as HP6 and TH5, L7 and SI3.
Energy work to the midline and spine can lower adrenalin and cortisol levels to help the endocrine system function. Deep relaxation will mitigate and balance stress levels. General foot massage is helpful for grounding people emotionally and physically.
Working through the endocrine system and linking to the reproductive reflexes can support hormonal regulation, particularly in ovulation issues. Incorporating acupressure points such as kidney 1 ,3,6, and spleen 3,4 6 will strengthen and support the endocrine and reproduction systems.
Working the adrenal and pituitary axis gently may help reduce adrenalin and cortisol levels, which can interfere with the endocrine system, helping to reduce stress.
The solar plexus and diaphragm are also useful points for calming and releasing stress.
Working with different phases of the cycle
It is important to adapt treatment depending on where the woman is in her cycle.
In the very early days after menstruation, treatments should aim to support the woman’s energy. As she builds up her strength, stronger work can be incorporated to shift congestion.
- Lymphatic drainage techniques in congested areas.
- Stretches and mobilisations; especially in the pelvic area.
- Gentle work around the pelvis: psoas release, colon work, piriformis and glutes.
- Lymph work to release congestion.
- Working through the reproductive system, the fallopian tubes and the pelvic area to release congestion
- Incorporate endocrine system to encourage engagement in this part of the cycle, release congestion and promote blood flow
Conception may have occurred so it is important to work in a similar way to the first trimester.
- Holding techniques generally, can include energy work along conception and governing vessel (midline energies).
- Scalp and some slight sinus work.
- Neck and some shoulder release.
- Gentler work around the pelvis.
- Gentle holding abdominal work may be included if the mother is happy with this.
- Include energy holds linking the uterus and kidney reflexes.
- Care should be taken not to over-stimulate the endocrine or reproductive system.
- Gentle work to reduce stress.
If the woman knows that she is not pregnant, then immediately before the period can be another good time to support detoxification and letting go.
This will be more like work in the early phase after menstruation.
Of course the abdomen may be sensitive but very gentle hormonal balancing, abdominal or stress reduction techniques may support the cleansing and detoxification aspects of the period.
Visualisations can be included to help women connect with different phases of their cycle, support energy levels and reduce stress. It is helpful to work these out with each individual client, but some examples are:
- Imagining the egg cell maturing.
- Visualising fertilisation.
- Preparing to receive a baby; inviting the spirit of the child to come to the body is a key part of preparing to conceive in many primitive cultures (The sexual life of savages by Bronislaw Malinowski).
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- Supporting physical issues
Poor posture can increase stress levels and tension in the pelvis can potentially lead to issues with menstruation and fertility. A basic postural check can help address issues, particularly around the pelvis.
Treatments can help reduce physical tension and improve posture, encouraging the body to function more optimally.
If a client is receiving medical attention for specific physical issues such as cysts, fibroids, endometriosis, massage and reflexology can aid post-operative recovery and improve circulation in the pelvis.
Appropriate exercise suggestions can support the sessions.
- Address specific postural imbalances.
- Muscle release work in relevant areas.
- Include abdominal and pelvic work, where appropriate.
- In cases of mucus-blocked fallopian tubes, working the fallopian reflexes, lymphatic flushing and acupressure points spleen 6 and liver 3 are useful.
- Tension spinal reflexes and zone five can also encourage a positive somatic response.
- Supporting medical treatment
Assisted reproduction may be offered when specific factors impede conception, such as blocked or scarred fallopian tubes; issues with egg production or sperm; hormonal issues that cannot be resolved; a history of repeated miscarriage; or when there is no obvious reason. These treatments are constantly changing and vary from area to area and in private or NHS care. However they involve two main aspects:
- The mother is given fertility-enhancing drugs to artificially regulate her menstrual cycle and stimulate ovulation. This enables the release of the egg to be controlled for insemination inside the womb or so that they can be harvested for fertilisation outside the womb. Side effects may include tiredness, sickness and menopausal symptoms such as hot flushes.
- Procedures involving insemination inside or outside the womb. There are various possible combinations including using mother’s egg or father’s sperm or using a donor egg or sperm.
Massage and reflexology will not inhibit the effects of assisted reproduction, but can support the body in accepting the treatment and relieve side effects, such as exhaustion.
Massage and reflexology can be helpful as mother is usually under a lot of stress; consultants sometimes recommend massage to combat stress. Treatments can also help the woman to connect with her body during the different procedures.
While treatments are safe after implantation, how soon depends on the client. Therapists should be aware that if an assisted reproduction treatment fails, clients may potentially be looking to pass blame (albeit wrongly) out of frustration. While some therapists give a window between the medical treatment and therapy treatment to reduce this risk, if a therapist has been working with the client pre-conception there should be trust in place.
- Relaxation is more important than strong physical release techniques.
- This is less a time to correct poor posture.
- Couples can be encouraged to support each other, perhaps with simple at-home massage techniques.
- Focusing on energy holds linking the uterus and kidney reflexes and heart uterus reflexes, which works with these meridian channels to support the woman’s energy of reproduction and address the emotional stress and fear.
- The emphasis here is on a supportive, non-invasive treatment.
Some clients find it helpful to visualise the egg (fertilised inside or outside the womb), connect with their future baby.
Working with miscarriage
One in four women miscarry. Some experience repeated miscarriage – as often as 10 times.
Miscarriage is a natural process: either the woman’s body is unable to accept the pregnancy; or there are issues with how the embryo (or even the cells) are developing. Massage and reflexology cannot cause a woman to miscarry but naturally sensitivity is key when working with a woman who has a history of miscarriage, as she may have issues trusting her body. It is the client’s choice whether she wants massage or reflexology to support her during her miscarriage or how soon after.
The therapist also needs to be trained in identifying potential emergency referrals, such as an ectopic pregnancy.
Case study: client undergoing assisted reproduction, by Suzanne Yates
I provided massage and shiatsu to this client prior to assisted reproduction to stabilise energy. Once her drug treatments to stimulate the ovaries started, treatments were to calm her. I saw the client and her partner for a double session just before she was going to have her eggs harvested and could feel the energy of her ovaries, especially through some of the kidney points in the feet. I supported the CV and GV pathways and included some gentle relaxing back work and shoulder release. For her partner, we worked on stress reduction with strong results as he was understandably nervous about giving his sperm in the hospital and didn’t like the clinical environment. Visualisations of the fertilised eggs and staying connected with their growing babies while they were outside the mother’s body proved helpful. After successful treatment, I saw the mother regularly during her pregnancy and did some work in early labour.
Glenville M Natural solutions to infertility by. Piatkus Publishing.
Dooley, M. Fit for fertility.
1. Wilcox A et al (1988). Caffeinated beverages and decreased fertility, The Lancet 2: 1453-5.
- Jensen TK (1998). Does Moderate alcohol consumption affect fertility? Follow up study among couples planning first pregnancy, British Medical Journal 317: 505-10.
- Smith CG and Gilbean PM (1985). Drug abuse effects on reproductive hormones, Endocrine Toxicology. Raven Press; New York.
- Campbell JM and Harrison (1979). Smoking and infertility, Medical Journal of Australia 1: 342-3.
- Foresight Preconception (www.foresight-preconception.org.uk).
- Utting D and Bewley S (2011). Family planning and age-related reproductive risk Reproductive Ageing. London: Royal College of Obstetricians and Gynaecologists
- Andersen AG et al (2000). High frequency of sub-optimal semen quality in an unselected population of young men, Human Reproduction 15: 366–372.
- Stringer J, Swindell R and Dennis M (2008). Massage in patients undergoing intensive chemotherapy reduces serum cortisol and prolactin, Psycho-oncology 17(10): 1024-31.
- Garner B et al (2008). Pilot study evaluating the effect of massage therapy on stress, anxiety and aggression in a young adult psychiatric inpatient unit, The Australian and New Zealand Journal of Psychiatry 42(5): 414-22.
Suzanne Yates is a massage and shiatsu therapist and founder of Well Mother, which supports parents and babies with massage and bodywork. She runs various courses for health professionals, including massage therapists and midwives internationally. She is the author of several books including Pregnancy and childbirth: an holistic approach to massage and bodywork. www.wellmother.uk
Heidi Armstrong is a reflexologist who has 11 years’ experience working with pregnancy and birth. She teaches pregnancy course for reflexologist, shiatsu practitioners and therapists, incorporating TCM. Heidi runs the complementary therapy college in Bath www.complementarycollege.co.uk