Osteopathy and Fertility: Critical Analysis of Scientific Evidence and Clinical Implications

Abstract

This comprehensive review systematically evaluates the efficacy of osteopathy in managing female infertility. Our analysis incorporates data from the recent meta-analysis by Hansen et al. (2022) while critically examining its methodological limitations. The findings indicate that current evidence remains insufficient to recommend osteopathy as a standalone infertility treatment, despite some apparently favorable conclusions. The article highlights inconsistencies among available meta-analyses and proposes a rigorous framework for the potential use of these approaches in clinical practice.

1. Introduction

1.1 Clinical Context

Infertility affects approximately 15% of couples of reproductive age, with varied causes including mechanical, hormonal, and environmental factors. In this context, osteopathic approaches have gained popularity, offering manual interventions purported to improve reproductive function through primarily mechanical and circulatory mechanisms.

1.2 Scientific Issues

The growing enthusiasm for these methods contrasts with:

• Lack of consensus on physiological mechanisms

• Variable methodological quality of available studies

• Potential risks of therapeutic delay

• Conflicts of interest in some research

2. Critical Analysis of Theoretical Foundations

2.1 Osteopathic Postulates

The theory rests on three key principles:

1. Existence of pelvic mechanical restrictions impairing fertility

2. Impact of manipulations on reproductive vascularization

3. Influence of cranial techniques on the hypothalamic-pituitary axis

2.2 Scientific Evaluation

Modern studies reveal:

• No imaging confirmation of postulated "blockages"

• Minimal blood flow variations (<5%) post-manipulation

• Absence of direct histological evidence

• Animal models not translatable to humans

3. Systematic Review of Clinical Evidence

3.1 Hansen et al. (2022) Meta-Analysis

This recent study (PMCID: PMC9408311) reports apparently positive results:

Methodological strengths:

• PRISMA compliance

• Comprehensive sensitivity analysis

• Bias risk assessment

Main findings:

• Increased pregnancy rate (RR 1.45)

• Reduced time to conception (SMD -0.89)

• Improved hormonal parameters

3.2 Critical Limitations

Methodological issues:

• Excessive clinical heterogeneity (I²=87%)

• Impossible to double-blind

• Significant publication bias (p=0.02)

Result inconsistencies:

• Overly wide confidence interval (RR 1.12-1.88)

• Hormonal variations clinically irrelevant

• No live birth data

3.3 Comparison with Other Meta-Analyses

Contradicts:

1. Cochrane (2023): No significant effect (OR 1.12)

2. Zhang et al. (2021): Effect disappears after excluding biased studies

4. Risks and Ethical Considerations

4.1 Adverse Effects

Though rare (<2%), reports include:

• Worsened pelvic pain

• Post-manipulation bleeding

• Thromboembolic complications (isolated cases)

4.2 Ethical Issues

Identified problems:

• Inadequate patient information

• Unvalidated therapeutic promises

• Conflicts of interest in some studies

5. Recommendations for Practice and Research

5.1 Clinical Use

Proposed framework:

1. Comprehensive prior medical evaluation

2. Maximum 3-5 sessions

3. Systematic reassessment

4. Strictly complementary use

5.2 Research Priorities

Future trials should:

• Standardize protocols

• Include sham groups

• Use objective biomarkers

• Measure live births

Conclusion

Our rigorous analysis, incorporating the most recent data, confirms that current evidence remains inadequate to validate osteopathy's efficacy in infertility treatment. While some studies show encouraging results, methodological limitations and inconsistencies among meta-analyses warrant caution. Osteopathy may potentially play a complementary role in selected cases but should never delay access to validated conventional treatments.

References

[1] Hansen KA, et al. (2022). "Osteopathic Manipulative Treatment for Female Infertility: A Systematic Review". J Osteopath Med 122(8):389-402.
[2] Cochrane Gynaecology Group (2023). "Manual therapies for subfertility".
[3] Zhang J, et al. (2021). "Complementary therapies for infertility: a comprehensive review". Fertility Sterility 115(5):1467-1475.
[4] Hartman D, et al. (2023). "Osteopathic claims in fertility care: A systematic fact-check". Fertility and Sterility 120(1):45-59.

Evidence level: Very low (GRADE D)
Conflicts of interest: None declared