Polycystic Ovarian Syndrome (PCOS) is both a hormonal and mechanical condition. Like physicians, we find that by addressing the mechanical aspects of a woman’s reproductive organs, PCOS symptoms can decrease and natural fertility improves. However, our approaches to treating the mechanical aspects are far different from each other. To appreciate the goals and differences between our approaches, let us take a closer look at the mechanical aspects of PCOS.
In PCOS, the ovaries are stimulated to produce excessive amounts of androgen male hormone (hormonal aspect) and they become surrounded by a thick white covering (mechanical aspect). The egg follicles within are small and numerous; lack of ovulation (anovulation) is frequently present.
Like the skin of an orange surrounds the fruit’s interior, we believe that the covering acts as a barrier that prevents a maturing egg from escaping the ovary when it is time to ovulate. Bound within this wrapping, the egg has little chance of entering the fallopian tube to unite with sperm and create a baby.
Physicians may suggest one of two surgical approaches to treating PCOS:
- Ovarian wedging cuts a pie-shaped wedge out of the ovary;
- Ovarian drilling involves drilling holes in the ovary.
Both of these approaches attempt to free the surface of the ovary so that the eggs can escape and to help decrease the production of male androgen hormones. As surgical techniques mature, more physicians are avoiding the wedging technique due to the formation of post-surgical adhesions. Adhesions are internal scars that form as the body heals from surgery, infection, inflammation or trauma.
Recently, a manual physical therapy designed to deform and detach adhesions has shown effectiveness treating this condition without surgery. Published data notes significant increases in pregnancy rates among women diagnosed infertile with PCOS. We believe that the therapy “unwraps” portions of the ovary from its collagenous covering. In doing so, hormones appear to normalize and follicles allow eggs to mature and break through the covering – with previously infertile women becoming pregnant in a high percentage of cases.
Description of common procedures. As noted above, the intent of PCOS surgery is to create an opening in the covering of the ovary, allowing mature egg follicles to escape. This mechanical disruption also appears to help normalize hormonal function. Whether the surgeon performs ovarian wedging or drilling, the surgery is generally done laparoscopically.
In a laparoscopy, the physician puts the patient under general anesthesia, then cuts several holes (ports) in the body. One port is used to fill the abdominopelvic cavity with a gas to help separate the organs so the surgeon can visualize the ovaries. Using the other ports, the doctor will insert a light, generally a camera, and the surgical instrument(s) with which they can perform the surgery. You can observe an ovarian wedging surgery by clicking here and ovarian drilling surgery by clicking here.
When adhesions are extensive, the physician may elect to perform an open surgery called a laparotomy. In that surgery, the body is cut open with a scalpel and the sides generally separated with a metal retractor. Next, the physician enters with a scalpel, laser or other surgical instrument to cut or burn any adhesions s/he may find, en route to the ovaries. S/he will perform the wedging or drilling of the ovaries, repair or cauterize any bleeding that occurs, and will generally check the area for other problems before exiting the body and sending the patient to a room where staff can monitor their recovery.
Direct visualization. The surgeon can directly see the structures on which s/he is operating.
Observe nearby areas. In addition to treating the ovaries, the physician can visualize nearby structures and assess their health and condition, noting any other areas that may be of concern.
Operative report. The doctor will dictate a report describing what s/he observes and the procedures s/he performs during the surgery.
Anesthesia complications. Recent studies note concerns about neurotoxic effects on the brain and/or other areas of the body for patients who undergo one or more sessions of general anesthesia. (Perousanksy & Hemmings, 2009)
Inadvertent enterotomy. When a patient has significant adhesions, it can be difficult for the doctor to see the structures beneath them. Thus, a surgeon can unintentionally cut into a nearby healthy organ or other structure – called an inadvertent enterotomy (IE). An IE can cause serious problems or death. In a study from the Journal of the Society of Laparoscopic Surgeons, authors note that:
- “IE in laparoscopic abdominal surgery is underreported.”
- “Death from IE is not uncommon.”
- “IE was the most common laparoscopic complication at our hospital.” (Binenbaum & Goldfarb, 2006)
Hospitalization during recovery. Most patients must undergo a hospital stay after an invasive surgery to the abdomen or pelvis. Patients are monitored to ensure their recovery and that there are no immediate post-surgical complications or infections.
New adhesions generally form after surgery. A mammoth study of 50+ years of abdominopelvic surgeries shows that adhesions form in 55% to 100% of all such surgeries. Thus, adhesions can recur – sometimes worse than before the surgery to remove them.
Description of the procedure. The Clear Passage Approach® is a manual physical therapy; it uses no drugs or surgery. It has been cited in numerous studies and peer-reviewed medical journals for its ability to decrease adhesions. One large clinical study showed significant effectiveness improving pregnancy rates for women diagnosed infertile with PCOS. The same study noted unexpected improvements in pregnancy rates among women diagnosed infertile due to poor hormone levels.
The therapy is ‘all natural’ in that it is 100 percent ‘hands-on.’ While many patients describe it as feeling like a very deep massage, others note that the therapy can sometimes be much lighter, depending on the area and depth being treated. Our physical therapists use their hands to deform and detach the tiny strands that comprise adhesions – similar to pulling out the strands of a nylon rope or pulling out the run in a sweater. They describe it as “like pulling out salt-water taffy, in very slow motion.” We believe that these techniques tend to detach the covering from the ovary in women with PCOS. The therapists believe the therapy may improve hormonal function for women with PCOS in a similar manner as it has been shown to do in women with endometriosis and those with high FSH levels.
The therapy is site-specific; the therapists are experts at palpating and manipulating the soft tissues in the pelvis. They use data from the patient’s history, direct feedback from the patient during therapy, and a thorough training and understanding of therapy methods developed over 30 years. The work focuses on deforming and detaching the molecular/chemical bonds that are at the core of adhered ovaries and throughout the reproductive tract. The usual protocol, which is cited in the studies, consists of 20 hours of therapy, spaced over five or more days. You can view a short video of a Clear Passage therapy session by clicking below.
No hospitalization. Therapy is performed in a private treatment room, one-on-one with a therapist certified in the work. Patients are invited to bring a partner or family member along for company, if they like.
No anesthesia. The patient is awake and communicative during the procedure. Patient involvement is encouraged, with the patient invited to give feedback throughout the course of therapy. There is no concern of neurotoxic damage to tissues of the body or the brain from general anesthesia.
Decreased risk. Risk is minimal. There is no cutting or burning, no risk from anesthesia, and no risk of inadvertently cutting through a nearby organ or other structure.
No foreign bodies are introduced. No staples, stitches, films or meshes inserted into the body. No cameras, gas, lights or surgical instruments enter the body.
Side effects are mild and transient. The most common side effects reported with therapy are temporary tenderness, aching, fatigue and hip or back pain. When they occur, these symptoms pass within a few days.
Improvements in other areas of the body. Because therapy focuses on detaching adhesions throughout the body, patients regularly report significant increases in flexibility and range of motion after therapy. Many report decreased pain and/or increased function in areas near the site where they are being treated. Some report this in areas they had forgotten or had not realized they were having a problem, until therapy relieved the pain or tightness.
Therapists cannot visualize the adhesions. Initially, we deduce the likelihood of adhesions by conducting a thorough review of your history and symptoms. To gain further insights, we may require diagnostic tests or documentation from your physician.
During therapy, we thoroughly palpate the areas of your body around the ovaries, those related to symptoms, and any other area where we note tightness or increased temperature. Because our therapists have been doing this work for an average of over 25 years each, they are experts at palpating pelvic structures and adhesions.
Costs of therapy are generally a fraction of the cost of surgery; as with surgery, insurance reimbursement may vary based upon your insurer and your plan. Clear Passage is an out-of-network provider for your insurer.
Travel and time are a consideration. Therapy generally takes five days (e.g., Monday – Friday); it is only provided by trained, certified therapists in several cities in the U.S. and U.K. The 5-day program is designed for out-of-town and out-of-country patients.
Both surgery and therapy require that patients be screened for appropriateness and contraindications before treatment.
Screening before surgery. Before surgery, physicians consult patients to review the goals, risks and potential rewards they can expect from the procedure. They may order diagnostic tests to help rule out contraindications such as active infection and to help identify problem areas in the body for that should be assessed during surgery.
Screening before therapy. Before therapy, Clear Passage directors consult applicants to review goals, risks and potential benefits they can expect. We conduct a thorough review of the applicant’s history of healing events (prior surgery, trauma, infection, endometriosis, etc.) to determine if and where any other adhesions have likely formed and how they might be exacerbating the problem.
In short, we screen applicants for two reasons:
- to determine the likelihood that we can help an applicant to reach his/her goal;
- to rule out contraindications that could decrease effectiveness of therapy or cause problems.
To these ends, we may require additional tests or correspondence with your physician before we will accept you for therapy.