Physiotherapy Theory and Practice, 27(2):155–159, 2011 Copyright & Informa Healthcare USA, Inc. ISSN: 0959-3985 print/1532-5040 online DOI: 10.3109/09593981003777356 CASE REPORT Effects of physiotherapeutic TENS in a woman with unexplained infertility Nasser Salsabili, PhD, 1 Noureddin Nakhostin Ansari, PhD, PT, 1 Katayoon Berjis, MD, Ob/Gyn, 2 Asefeh Sedighi, MSc, PT, 3 and Hoda Salsabili, MSc, PT 4 1 Associate Professor, Faculty of Rehabilitation, Tehran University of Medical Sciences, Iran 2 Infertility Fellowship, Mirzakouchak Khan Hospital, Tehran University of Medical Sciences, Iran 3 Faculty of Rehabilitation, Tehran University of Medical Sciences, Iran 4 Faculty of Medical Sciences, Tarbiat Modarres University, Iran ABSTRACT Unexplained infertility (UI) is a difficult diagnosis in the field of obstetrics and gynaecology. This report describes TENS treatment as an adjunct therapy for a 30-year-old woman with long-standing UI who was scheduled to undergo ovarian stimulation for in vitro fertilization (IVF) and embryo transfer. She had three unsuccessful intrauterine insemination treatments. Her last IVF treatment also failed. The treatment consisted of burst-TENS for seven sessions, which was applied daily from the second day of induction of ovulation (IO) to hCG adminis- tration. The transvaginal ultrasonography with pulsed Doppler curves was performed to measure the uterine artery impedance indices of Pulsatility Index (PI) and Resistance Index (RI). Before TENS application, on the first day of IO, the PI and RI for right side uterine artery were 3.96 and 0.96, respectively. For left uterine artery, the PI and RI were 6.92 and 1, respectively. After treatment with TENS, on the day of hCG administration, the PI and RI for right side uterine artery were 3.39 and 0.90, respectively. On the left side, they were PI52.62 and RI50.86. IVF was performed and on the day of oocytes collection, 22 oocytes were collected and inseminated. Fertilization was confirmed 16 hours after insemination by visualization of 2 pronuclei. A singleton pregnancy was achieved by the presence of a fetal sac during an ultrasound examination. It is concluded that the addition of TENS resulted in remarkable reduction of uterine artery PI and RI and a successful pregnancy after IVF for this woman with UI. INTRODUCTION Infertility is one of the specialty domains in the field of obstetrics and gynaecology. Unexplained infertility (UI) is a difficult diagnosis, because it indicates that standard infertility testing has not found a cause for the failure to conceive (Sutter, 2006). Approximately 15% of couples with infertility do not have a clearly identifiable cause for infertility (Ryley et al, 2005). Because the diagnosis of UI should include only couples with undetected abnormalities, the condition has been defined by using a duration of involuntary infertility of 2–3 years (Aboulghar et al, 2001). Therefore, UI is a challenge for both biological and clinical research (Collins and Crosignani, 1992). However, not identifying a cause for infertility does not necessarily mean that the couple is normal or has no cause (Lashen, 2007). Investigators suggest that abnormal uterine perfusion (Isaksson, Tiitinen, Reinikainen, and Cacciatore, 2003) and increased resistance to uterine blood flow may be important contributing factors to UI (Steer, Tan, Mason, and Campbell, 1994). On the basis of differences in female age and the infertility duration, the cumulative pregnancy rates without treatment in couples with UI are between 30% and 80% (Hull et al, 1985). The principal treatments for UI include expectant observation with Address correspondence to Dr. Nasser Salsabili, PhD, Faculty of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave, Pitch-e-shemiran11498 Tehran, Iran. E-mail: nsalsabili56@yahoo.com Accepted for publication 10 March 2010. 155 Physiother Theory Pract Downloaded from informahealthcare.com by Miss Sally Howells on 06/27/11 For personal use only.