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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 16  |  Issue : 2  |  Page : 170-174

Ayurvedic management of infertility due to polycystic ovaries and tubal block: A case study


1 Department of Prasuti Tantra Evam Stri Roga, National Institute of Ayurveda, Deemed to be University, Jaipur, Rajasthan; Department of Prasuti Tantra Evam Stri Roga, TMV, Pune, Maharashtra, India
2 Department of Prasuti Tantra Evam Stri Roga, National Institute of Ayurveda, Deemed to be University, Jaipur, Rajasthan, India

Date of Submission26-Aug-2021
Date of Decision05-Mar-2022
Date of Acceptance23-Mar-2022
Date of Web Publication4-Jul-2022

Correspondence Address:
Pushpalatha Buduru
Associate Professor, National Institute of Ayurveda, Deemed to be University, Jaipur, Rajasthan, 302 002, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_276_21

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  Abstract 


Introduction: Various factors responsible for Vandhyatva (infertility) are explained by Acharya Charaka, such as yonidosha (gynecological disorders), Mansika-Abhitapa (mental stress), Shukra-Artavadosha (disorders of sperm and ovum), Ahara-Vihara Dosha (food- and lifestyle-related disorders), Akalyoga (inappropriate timing), Bala-Kshaya (decreased strength). Two major factors which are associated with fertility problems are anovulation and defect in tubal patency. In the present article, there is a case study of ayurvedic management of infertility due to bilateral polycystic ovaries along with the bilateral tubal block. Main Clinical Finding: A 29-year-old female patient reached the hospital with the complaint of wants issues for 2 years, she also had increased intermenstrual interval and weight gain for 2 years. Diagnosis: Her ultrasonography finding revealed bilateral polycystic ovaries, delayed ovulation in the follicular study, and hysterosalpingography findings showed bilateral fallopian tubal block. Interventions: Ayurveda treatment, including a combination of oral medications (Ashwagandha Ksheerapaka, Shatpushpa churna, Avipattikara churna, Pittantaka churna, tablet Leptaden, tablet Aloes compound, Phalasarpi, Pushpadhanva rasa, and Balabeej churna) at different stages of menstrual cycle and Sthanika Chikitsa by Yonipichu (Dhanvantaram taila) application, was planned for 3 months. Outcome: The patient missed her period after 2 months of treatment and urine pregnancy test was found positive. Conclusions: Timely ovulation and tubal patency are important factors for successful fertilization and conception. Hence, oral medications consisting of Aagneya and Vatanulomaka drugs along with Yonipichu with Dhanvantaram taila are effective in correcting both of these factors.

Keywords: Infertility, polycystic ovary syndrome, tubal block, vandhyatva, yonipichu


How to cite this article:
Buduru P, Kumaramangalam B, Sharma S. Ayurvedic management of infertility due to polycystic ovaries and tubal block: A case study. J Ayurveda 2022;16:170-4

How to cite this URL:
Buduru P, Kumaramangalam B, Sharma S. Ayurvedic management of infertility due to polycystic ovaries and tubal block: A case study. J Ayurveda [serial online] 2022 [cited 2022 Aug 10];16:170-4. Available from: http://www.journayu.in/text.asp?2022/16/2/170/349768




  Introduction Top


Infertility is defined as failure to achieve conception by a couple of mature age even after 1 year of regularly having normal coitus at the appropriate period of the menstrual cycle. The problem is increasing so widely that in developed countries, one out of every four couples had been found affected by infertility in some way (According to the World Health Organization).[1] Infertility directly and indirectly affects the physical, mental, emotional and social health of women. Ovulatory dysfunctions participate greatly for disturbing the hypothalamic–pituitary–ovarian axis and causing infertility-related problems (30%–40%)[2] On the other hand, different pathological conditions, such as pelvic inflammatory disease and genital tuberculosis result in the formation of fibrous tissue inside the fallopian tubes, causing its blockage, and hampering normal movement of female gamete and in turn fertilization. In ayurvedic classics, infertility is explained as Vandhyatva. Mainly, Vata Dosha function is getting disturbed here. Furthermore, there is vitiation of Rasa Dhatu, due to which there is a disturbance in the normal formation of Artava causing menstrual irregularities and abnormalities. Furthermore, due to blockage of tubes, there is occurring Vikriti (disease) of Kshetra which also causes infertility. Thus, in this article, an attempt has been made to assess the effect of ayurvedic treatment in case of infertility.


  Case Report Top


A married Hindu female patient of 29 years visited Prasuti Tantra and Stree Roga outpatient department on November 24, 2020, with the complaints of unable to conceive for the past 2 years, irregular menstruation with increased interval, and weight gain for the last 2 years. The patient had a married life of 3 years and tried to get conceived for the past 2 years. Her investigations were done previously, but she was not willing to take modern medication. Hence, she came to the Ayurveda hospital in a hope of getting cured.

Menstrual history

Her menstrual history included age menarche – 15 years, of age, duration of bleeding – 3 days, interval – 40–45 days, LMP– November 15, 2020. She had irregular periods with mild pain, no clots, dark reddish, and flow was within the normal limits, i.e., 2–2 fully soaked pads in the first 2 days then 1 pad on 3rd day.

Obstetric history

Nil.

Contraceptive history

None.

Previous medical surgical and family history

Nonsignificant.

Personal history-diet

Vegetarian, appetite – normal, sleep – normal, bowel – one time in the morning, regular, satisfactory, micturition – normal (5–6 times per day), and allergy history – none.

Education

She is BAMS graduate working as ayurveda medical officer and her husband is MBBS graduate. There is no any history of addiction to alcohol, tobacco and other substances.

Physical examination

General condition – fair, blood pressure – 120/70 mmHg, pulse rate.– 76/min, height– 5'5'', weight– 72 kg (gained 6 kgs in the last 3 months), body mass index – 26.45, body built – overweight, and pallor– not present.

Dashavidha Parikshya Bhava

Prakriti–Pitta-Kaphaja, Vikriti– Vata-Kaphaja, Sara–Mansasara, Samhanana, Pramana, Satva, Ahara-Shakti, Vyayama-Shakti–Madhyama, Satmya–SarvarasaSatmya, and Vaya–Madhyamavastha

Investigations

The investigation was done on December 19, 2020).

Routine blood investigations results shown hemoglobin 13.2gm/dl, erythrocyte sedimentation rate – 24 mm, complete blood count, liver function, renal function test, random blood sugar, thyroidstimulating hormone, prolactin – all within the normal limit,and folliclestimulating hormone –5.74 mIU/ml, luteinizing hormone – 3.23 mIU/ml. Urine examination showed color pale yellow with ph 6.0, but absent protein and sugar.

Special investigations

Follicular study

The study was done on November 27, 2020, onward, starting from the 13th day of the cycle and continuing on every alternate day up to December 04, 2020 (19th day of cycle) when evidence of ovulation was seen (delayed ovulation).

Digital hysterosalpingogram (with dye) (done on December 24, 2020)–B/L distal end block of fallopian tube.

Ultrasound uterus and adnexa (done on December 26, 2020) – bilateral polycystic ovaries, uterus – anteverted, normal in size and shape, and endometrium – normal echoes, bilateral ovaries enlarged with hypertrophied stroma and multiple peripherally aligned small follicles [Figure 1].
Figure 1: Figures are regarding USG and HSG reports of patient

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Right ovary – 50.1 mm × 29.3 mm × 21.9 mm, volume – 16.80cc, right ovary – 38.2 mm × 23.3 mm × 35.4 mm, and volume– 16.53cc.

Male partner advised semen analysis but was not done.


  Discussion Top


In the present study, based on the condition of the patient and need of time, different combinations of medicines were used [Table 1][3],[4],[5],[6],[7],[8],[9].
Table 1: Treatment

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Ashwagandha Churna Ksheerapaka was given. Studies suggest that ashwagandha root reduces serum cortisol levels. Stress reduction normalizes leptin levels in the body which reduces food craving as a result of significant weight reduction in polycystic ovary syndrome (PCOS). apart from this stress is one of the important reasons in gonadal and sexual dysfunction.[10] Another study shows that ashwagandha stress-relieving effects may occur via moderating effect on the hypothalamus–pituitary–adrenal axis.[11] In short, it works on a genetic level for the breakdown of the pathogenesis of PCOS.

Shatapushpa Churna acts on vitiated Kapha and Vata Dosha, helps in the regulation of functions of Pitta Dosha. Hence, it is beneficial in improving intermenstrual interval, duration, and amount of bleeding. Its action on Kapha and Vata not only improves tubal functions but also works on ovulatory dysfunctions.[12]

The combination of Avipattikara and Pittantaka Churna helps in improving the formation and absorption of Ahara Rasa leading to proper Rasa Dhatu formation, which further leads to the formation of Artava Upadhatu. Avipatikarchurna possesses dipan, pachan, and sarakguna which normalizes vitiated pitta and eliminates extra pitta from the body with its laxative action.[13] Apana vayu (vital regulatory vata) gets normalizes as an outcome. Apana vayu by its artavniskraman action eliminates artav; as a result, there is the regularization of menstrual cycle in PCOS. A recent study compares the artavniskraman function of apanvayu with the sympathetic part of the autonomic nervous system which helps to decrease estrogen and progesterone due to the involution of corpus luteum.[14]

Aloes compound stimulates ovulation and improves the quality and quantity of cervical mucus [Table 2]. Aloes compound is found very effective in menstrual disorders as well as infertility in various studies.[15] Main ingredient of aloes compound is Aloe indica which is known as Kumari in Ayurvedic Texts. The major action of Kumari is rajapravartak due to its Katurasa, Ushnaveerya, Sara, Tikshnaguna, Pittavardhak, and Srotosodhakguna. It will improve sthanikartavagni and upadhatuartava.[16] Kumari is also liver stimulant thus it regularizes the metabolism process.[17]
Table 2: Ultrasonography for fetal well-being

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Tablet Leptaden was earlier given to support the progesterone phase of the cycle and later on, it was continued throughout the pregnancy to support the fetal outcome. Jivanti and Kamboji are equal in quantity. Study shows that it prevents the biosynthesis of prostaglandins, hence, it prevents abortion and premature labor.[18] Jivanti and kamboji are having garbhasayasodhan , garbhasthapan and sothagna property. These properties promote normal environment for reproduction, activate neuroglandular system and helps in the nidation of zygote.[19]

Phalasarpi is helpful in correcting blocked fallopian tubes. It improves the quality of the ovum and regulates ovulation by correcting vitiated Vata, Pitta and Kapha.[20] Pushpadhanva Rasa pacifies Vata and Pitta Dosha, helps to improve female infertility by regulating ovulation.[21]

Dahanvantaram Taila helps in the regulation of functions of Vata Dosha. Thus, it is helpful in removing tubal blocks and improves ciliary motility inside the tubes. Snehana Karma done by Taila helps in movements and normal functions of the ovum inside the tubes. She was also advised for Yonipichu (tampoon) to ensure proper drug delivery to the target site. Bala is having Grahi Guna and Vatanulomaka properties,[22] which are mentioned by Acharya Charaka in the treatment of Avritta Apana Vayu.[23] Bala seeds are mentioned in preconceptional care making the internal environment hostile for fetus. As AcharyaSushruta indicated it in GarbhaSrava–Paatahara Chikitsa, thus, indicating its importance in preventing fetal loss after conception.[24]

From the above study, it could be concluded that the treatment modalities should be set depending on the cause which is responsible for infertility. Different combinations of medicines and different formulations, along with the local application of DhanvantaramTaila Yoni Pichu are beneficial in reversing tubal patency as well as in improving ovulation, leading to successful conception.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
  References Top

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Choudhary D, Bhattacharyya S, Joshi K. Body weight management in adults under chronic stress through treatment with ashwagandha root extract: A double-blind, randomized, placebo-controlled trial. J Evid Based Complementary Altern Med 2017;22:96-106.  Back to cited text no. 10
    
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Moharana P, Rawat N, Roushan R. A critical review of Apana Vayu in modern perspective, international journal of basic and applied research, ISSN 2249-3352 (P) 2278-0505 (E) 2018;8:897-903.  Back to cited text no. 14
    
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Priyanka RG, Medikeri S, Doddamani MS. Review on Rajahpravartini Vati – A herbo- mineral formulation. International AyurvedicMedical Journal 2017;1:650-4.  Back to cited text no. 16
    
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Sannd R, Lnu B, Otta SP, Kumari SI, Vyas N. Clinical efficacy of ayurvedic formulations Rajahpravartini Vati, Varunadi Kashaya and Kanchanar Guggulu in the management of polycystic ovary syndrome: A prospective, open-label, multicenter study. J Res Ayurvedic Sci 2017;1:90-8.  Back to cited text no. 17
    
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Mohanty SK, Swamy MK, Sinniah UR, Anuradha M. Leptadenia reticulata (Retz.) Wight & Arn. (Jivanti): Botanical, agronomical, phytochemical, pharmacological, and biotechnological aspects. Molecules 2017;22:E1019.  Back to cited text no. 18
    
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Wadia N, Hospital M. Study of the composition of breast milk and the effect of selection of patients. In: Dosage: Method of Expression. 1977. Available from: https://www.techplusmedia.com/health/2017/08/09/wadia-hospital-creates-awareness-on-benefits-of-mothers-milk/ [Last accessed on 2022 May 13].  Back to cited text no. 19
    
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Pandya SH, Gujarathi JR, Vyas JM. Effect of shatpushpa in female infertility W.S.R to anovulatory factor: A review study. J Ayurveda Holistic Med 2017;5:53.  Back to cited text no. 20
    
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22.
Pushpadhanwa Rasa Medicine Details – Bimbima Pushpadhanwa Rasa Medicine Details – Bimbima 20 Charaka Samhita, Sutra Sthana, Yajjapurushiya Adhyaya, 25/40. Available from: https://niimh.nic.in/ebooks/ecaraka/?mod=read. [Last accessed on 2021 Apr 07].  Back to cited text no. 22
    
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