Fertility

Manuelle Medizin   30
96-98 (1992)

Study for the objectivation of the efficiency of the
method of L. Mojzisovà in some types of female infertility due to functional
disturbances of the pelvic region

H.Volejníková

Brno, CSFR (Rehabilitation
Department of the BRNO University Maternity Hospital).

Summary:

Of 166 women
suffering from some type of functional sterility 118 were followed up. They
were divided into 5 groups. Group A and (later) group E were treated and
trained according to the method of Mojzisovả. The method consists of
mobilisation techniques, post-isometric relaxation, and soft tissue techniques.
Treatment lasted for 6 months. The number of women successfully treated was
significantly higher in those who were treated by the method of Mojzisovả as
compared to the controls.

Keywords:

Female sterility
- Functional disturbances of lumbar spine and pelvic ring – Mobilisation
techniques – Post-isometric relaxation.

The success rate
of the method of treatment of Mojzisovà for female sterility due to functional
pelvic disturbance was tested at the rehabilitation unit of the University
birth clinic of Brno.

The study period
lasted from June 1987 to June 1989. Following a project by Dr. E. Frankovà
Ph.D, the treatment was performed by a female Physiotherapist who has been
trained by L Mojzisovà.

Material and
Method

The study
population consisted of a group of 166 women who had been referred for medical
rehabilitation of sterility which was previously managed unsuccessfully for an
average of 4 years. Selection was performed by a questionnaire filled in by a
gynaecologist. The following criteria were applied:

q  Age
between 22 and 30 years

q  Normal
quality and quantity of sperm of partner

q  Patency
of fallopian tubes

The women were
randomly allocated to groups A, B or C. Furthermore groups D and E were made
up, details of which will be considered in a later section. Treatment was
scheduled on a monthly basis for 10 women at a time from groups A, B and C. The
same was repeated for the following months.

2

At the
rehabilitation unit the women were:

q  informed
about the effect of the methods of rehabilitation,

q  given
further information regarding the treatment routine (temperature measurements,
fluid intake, necessity to perform exercises twice daily, etc.);

q  examined
by the female physiotherapist for: posture, pelvic distortion, leg length,
pressure sensitivity of vertebrae and costosternal joints, rib fixations and
muscle tightness, signs of hypertonicity of the pelvic floor musculature,
etc.);

q  gynaecologically
examined by Dr. J. Navratilovà.

The success of
treatment (pregnancy) was determined as described below:

q  Number
of women treated successfully in group A following the treatment and exercises
of Mojzisovà.

q  Number
of women treated successfully by a different therapeutic regime and different
exercises (group B).

q  Number
of untreated women in group C who also did not follow an exercise regimen.

Group A (n=50)

In this group
women were treated by the method of Mojzisovà, which specifically included
treatment of the lumbar spine and pelvis. Both areas have a close association
with reproductive organs.

Method
of treatment  1-4

1. Stretching and
relaxation of lumbar and pelvic musculature, post-isometric relaxation (PIR)
buttock and pelvic floor muscles as well as strengthening of muscles of the
chest. Exercises were explained to the women on their initial visit and
instructions were given to perform these at home twice daily for the following
4-6 weeks.

2. In the first
half of the menstrual cycle the female physiotherapist also:

q  relaxed
pelvic floor muscles: after initial warm-up PIR, internal rectal massage and
coccygeal treatment were performed.

q  Following
this, mobilisation of hypomobile areas in the sacroiliac joints, lumbar spine,
and ribs was performed.

q  The
home exercise program was checked and corrected. Furthermore additional
exercise with the purpose of strengthening pelvic floor, buttock and abdominal
muscles were prescribed.

During the course
of the next menstrual cycle the last two points were repeated. Relaxation of
pelvic floor musculature was only performed if clear indication of
hypertonicity existed.

3

If, for whatever
reason (illness, holidays), one of the women missed a treatment this
appointment was delayed to the next menstrual cycle.

The course of a
treatment ended after 6 visits and was considered successful if a pregnancy
occurred in this study period.

Group B (n=50)

For this group a
different set of active and passive exercises was performed than that of group
A (designated ‘non-genuine’ exercises in the following text). Care was taken so
that these exercises did not affect the areas involved in Mojzisová’s method.
The women were blinded to the fact that the exercises were non-effective.

This group also
differed from group A with respect to the organisation of
check-up examinations at the rehabilitation department. During the two year
study period Mojzisovà’s method was already well known even among laymen. Due
to technical difficulties it was impossible to completely seperate the two groups
in waiting rooms and corridors so that it was possible for the women to
discover differences between prescribed exercises and treatments. Therefore
monthly check-ups of group B were organised in small groups in advance. This
allowed the creation of an isolated group. The goal of this group was to
prevent information about treatment in group A to become known to other
subjects.

These conditions lead to other unforseeable
differences:

q  Missed
appointments could not be re-scheduled and were missed completely

q  Due
to monthly group meetings the women were able to develop relationships, talk
about their experiences with the treatment and some women only attended to
announce their pregnancy.

The above
conditions put group B into an advantageous position as compared to women in
the other groups who attended check-ups individually.

In accordance
with group A the treatment of group B consisted of the following:

q  Active
‘non-genuine’ home exercises (4 weeks)

q  monthly
group meetings not taking into account timing of menstrual cycle. Firstly home
exercises were repeated and secondly ‘non-genuine’ passive exercises were
performed individually.

These meetings
took place six times and were deemed successful if pregnancy occurred in that
period.

4

Group C (n=50)

This group did
not exercise although the initial talk and gynaecological examination were the
same as for the other groups. Date and time of the

next appointment
were negotiated so that the women knew that treatment was merely delayed by six
months.

The purpose of
this group was to exclude the possibility of a psychological effect on the
number of pregnancies due to expectation of treatment.

The observation
period was also six months and positive outcomes were pregnancies which
occurred between the initial examination and before commencement of treatment.

Group D (n=16)

Due to timing
difficulties it was impossible to integrate this group into group B.

Treatment
consisted of active home exercises which were not checked regularly by the
medical rehabilitation unit. Also passive exercises (‘non-genuine’, group D)
were not performed.

Although
treatment period was only three months results are of interest and will
therefore be discussed. Pregnancy within three months of commencing exercises
was designated as success.

Group E (n=76)

Women in this
group were those who did not become pregnant after performing either ‘wrong’
exercises (groups B and D) and those who did not exercise at all (group C).
Treatment lasted six months and followed Mojzisovà’s protocol (group A).

These women
therefore were not disadvantaged but treatment and possible following pregnancy
were merely delayed by six months. This is in agreement with medical ethics.

Again treatment
was concluded after 6 check-ups and success was described as pregnancy during
treatment period.

Results

Results are shown
in table 1. It can be clearly seen that the success rate was significantly
higher in those women treated with Mrs. Mojzisovà’s method (groups A and E) as
compared to who were not (groups B and D).

In the light of
these results it would be interesting to compare effectiveness of this method
with other reflex therapeutic protocols (mobilisation techniques, accupuncture,
reflexology massage).

Statistical
analysis was performed by Dr. V. Novàk and RN Dr. H. Koukalovà.

5

Statistical
results

The x²-test
was used for statistical analysis taking into account the number of pregnancies
in individual groups. Firstly an overview table will be shown (table 1).

In table 1 x²
=13,543 which correlates with p<0,01. The number of pregnancies is therefore
in statistically significant relation to treatment in individual groups. Since
results of groups B, C and D are similar success rates of these three groups
were established in the same way.

X²=0,012
which correlates with p>0,975 i.e. the groups are almost identical. For this
reason these groups were summarised into one group, which was compared to
groups A and E (table 2).

In table two x²=12,179
correlating with p<0,0005, and in table three x²=9,262
correlating with p<0,005.

There is a highly
statistically significant relationship between pregnancies and treatment method
insofar as groups A and E showed higher numbers pregnancies than groups B, C,
and D.

Comparison of
groups A and E showed x²=0,503 (p>0,45). This signifies that
treatment in these two groups did not differ statistically.

Conclusion

Statistical
analysis using the x²-test showed a statistically significant higher
proportion of pregnancies in groups A and E, which were treated and exercised
following Mojzisovà’s protocol as compared to (control) groups B, C and D.
There was no significant difference between the number of pregnancies when
comparing groups A and E.

Table
1 – Trial results

6

Table
2 – Overview of statistical results A

Table
3 – Overview of statistical results E

The Publishers

P.S. Translation
from the German text in MANUELLE MEDIZIN¹ by Timo Kaschel, Intern at the Anglo -European
College of Chiropractic, Bournemouth, England for Michael Davidson DC FCC,
Chiropractor, Gillets Farmhouse, Woodville, Stour Provost, Gillingham, Dorset,
SP8 5LX, tel/fax. 01747-838553, e-mail msdchiro@aol.com

The original article
in German is available from MSD or the publishers.  The original reference to this article was
from the text “Manipulative therapy in Rehabilitation of the Locomotor
System” Reed Educational and Professional Publishing Ltd, 1985, by
neurologist Professor Karel Lewit, Senior Leader in the field of Eastern
European Manual Medicine, Czech Republic. MSD hopes to obtain further
information from the author as soon as the problems of language can be
overcome, specifically regarding any data on symptoms related to spinal/pelvic
dysfunction in participating subjects.

¹ Published by the SPRINGER
Publishing Group.