Infertility, IVF, and the Role of Pelvic Floor PT
Infertility affects millions of individuals and couples, yet it’s still a topic that most people don't feel comfortable talking about. This month, we’re opening up the conversation—what it means to face fertility challenges, what treatments are available, and how pelvic floor physical therapy can support you through the process.
Understanding Natural Conception
Before diving into fertility treatments, it’s helpful to understand how conception naturally occurs. Day 1 of a menstrual cycle is the first day of menstruation. During the early part of the cycle, estrogen and progesterone begin to rise. As ovulation approaches, the brain releases a surge of follicle-stimulating hormone (FSH), prompting the ovary to release an egg.
Ovulation can occur anywhere from day 8 to day 25 depending on cycle length, though most apps estimate it around day 14. For those trying to conceive, the most fertile window spans the few days leading up to ovulation. Sperm can live in the uterus for up to 3 days, so having intercourse every other day in a 10-day window surrounding ovulation can optimize chances.
To track ovulation more accurately, many use:
Basal body temperature tracking (with a thermometer or wearable tech like the Oura Ring)
Ovulation sticks to detect LH/FSH surges
Menstrual tracking apps
When Conception Isn’t Happening
If you’ve been trying to conceive for over a year without success, it may be time to consult a reproductive endocrinologist. Infertility is defined as the inability to achieve pregnancy after 12 months of unprotected intercourse.
At your initial fertility consult, expect a thorough review of your health history and testing such as:
Hormone panels, thyroid testing, and AMH levels
Transvaginal ultrasound to check for fibroids, cysts, or uterine abnormalities
Saline sonogram for a clearer view of uterine structure
Semen analysis to assess sperm count and quality
Fertility Treatment Options
1. Timed Intercourse with Monitoring:
This is the least invasive option. Doctors monitor your cycle with bloodwork and ultrasounds. Once ovulation is confirmed or induced (with an injectable "trigger shot"), couples are instructed to have intercourse at optimal times. Medications like Letrozole may be used to boost egg production by increasing FSH.
2. Intrauterine Insemination (IUI):
When timed intercourse isn't successful, IUI may be the next step. Sperm is collected and inserted directly into the uterus around ovulation. This process often includes ovary-stimulating medications like Clomid or Letrozole and is timed using ultrasounds and bloodwork. Each IUI cycle offers about a 10–20% chance of pregnancy, and success rates increase with multiple cycles.
Note: Clomid may reduce cervical mucus, which typically helps guide sperm. But since IUI bypasses the cervix, this side effect is less concerning. Letrozole doesn’t dry up cervical mucus and is often preferred for timed intercourse.
3. In Vitro Fertilization (IVF):
If IUI is unsuccessful, IVF may be recommended. This involves stimulating the ovaries to produce multiple eggs, retrieving them, fertilizing them in a lab, and transferring one or more embryos back into the uterus.
A typical IVF cycle includes:
Ovarian stimulation(days 2/3 -day 10/12) with daily FSH/LH injections, examples are: Gonal-F, Follistim, Menopur
Ovulation suppression(day 5-6) to prevent premature release of eggs, examples are:Ganirelix, Cetrotide
Trigger shot(day 10-12) to mature eggs before retrieval, examples are: hcg or lupron
Egg retrieval(36 hours after trigger shot) under sedation, where they use a needle to aspirate the eggs.
Fertilization via natural method of putting sperm and eggs into a petri dish or ICSI (injecting a single sperm into an egg)
Embryo development wait to see if the embryos grow into a blastocyst by Day 5
Embryo transfer (fresh or frozen) meaning the embryo is inserted into the uterus or genetic testing (PGT-A/PGT-M) if desired
Genetic testing looks for any abnormalities or genetic defects of the embryos
Post-retrieval~14 days afterwards: Luteal phase support to make sure that embryo sticks in uterus- goal is to increase progesterone either by shot or vaginal suppository
Success rates vary based on age and embryo quality. For PGT-A tested embryos:
Under 35: ~65–75% chance of live birth per transfer
Age 38–40: ~55–65% chance of live birth per transfer
Age 41–42: ~50–60% chance of live birth per transfer
Over 43: ~40–50% chance of live birth per transfer
PGT-A testing isn't always covered by insurance and can be expensive. There is also a false positive risk or mosaic embryos that some fertility clinics may or may not consider using.
Infertility and Endometriosis
Endometriosis often plays a role in infertility. Here’s why:
Chronic inflammation may damage eggs, sperm, or embryos and impair implantation.
Anatomical changes like adhesions or cysts can block tubes or affect egg release.
Hormonal disruption can interfere with ovulation or implantation.
Lower egg quality has been observed in some cases.
For those with endometriosis going through IVF, consider:
Pre-treatment hormonal suppression (e.g., oral contraceptives or Lupron)
Lower-dose ovarian stimulation to minimize pain and bloating
Open discussions with your fertility team about embryo quality and transfer decisions
Where Does Pelvic Floor PT Fit In?
While pelvic floor PT isn't typically part of medical fertility treatments, it can play an important supportive role:
Before or during IVF stimulation, PT can help manage pelvic pain, bloating, and tension caused by medications or endometriosis.
Post-transfer, patients are usually on pelvic rest, so PT is paused during this time.
If vaginal progesterone suppositories are painful to insert, injections may be a more comfortable alternative—something your PT or fertility team can help you navigate.
Other tips that may make this process easier:
Find someone to help with your injections- either a partner, friend or even a nurse can help to make it easier.
Laying down to receive fertility medication injections is a great way to help muscles relax.
Menopur injections burn the most! do this injection first to get it out of the way.
Morning monitoring appointments can often be draining and exhausting, so find a way to treat yourself afterwards.
If you have a partner, and they are unable to be at morning monitor appointments, try to have them facetime or call in
Infertility and especially IVF, can be very expensive. Most fertility clinics have payment plans available so be sure to ask about that.
You’re Not Alone
Fertility challenges can feel overwhelming, but you're not navigating this journey alone. Whether you’re just starting to track ovulation or deep into the IVF process, your body—and your pelvic floor—deserves support. We're here to provide compassionate, evidence-based care every step of the way.