|Year : 2021 | Volume
| Issue : 1 | Page : 40-43
An ayurvedic approach to a case of primary infertility
Asha Hosur1, Swarda Ravindra Uppin2
1 Department of Prasuti Tantra and Stree Roga, Govt Ayurvedic Medical College and Teaching Hospital, Shimoga, India
2 Department of Kayachikitsa - Rasayana Vajeekarana, KAHER's Shri BMK Ayurveda Mahavidyalaya Post Graduate Studies and Research Centre, Belagavi, Karnataka, India
|Date of Submission||10-Feb-2021|
|Date of Decision||28-Feb-2021|
|Date of Acceptance||02-Mar-2021|
|Date of Web Publication||17-Apr-2021|
Swarda Ravindra Uppin
Assistant Professor, Dept of Kayachikitsa - Rasayana Vajeekarana, KAHER's Shri BM Kankanawadi Ayurveda Mahavidyalaya, Post Graduate Studies and Research Centre, Shahapur, Belagavi, Karnataka
Source of Support: None, Conflict of Interest: None
Infertility is a multifactorial condition affecting both partners, of which the female contributes about 40% cases of infertile couples. Of all the various factors, the most frequently contributing factors are those of ovarian and uterine. Polycystic ovarian disease is the most common cause of an ovulatory infertility, being found in 75% of cases. It now proves to be a significant factor in female infertility with the prevalence of 0.6%–3.4% in infertile couples. While uterine or endometrial polyps are one among those that can affect the shape and functioning of the uterus, thereby leading to infertility. On an average, the prevalence of endometrial polyps can vary from 7.8% to 34.9%. The contemporary medical science extends hormonal and surgical intervention as the prime line of the management. Ayurvedic treatment modalities can bypass the surgical management to avoid the related burden and provide a fruitful outcome in such conditions. Here, we present a case of primary infertility with a known polycystic ovarian disease and sonologically diagnosed endometrial polyp. The case was successfully treated with Ayurvedic treatment modalities such as virechana karma, uttara basti, nasya karma, and shaman aushadi. The treatment course resulted in the regression of the polyp, re-established ovulation, and a successful conception with full-term normal labor.
Keywords: An-ovulation, endometrial polyp, infertility, Nasya karma, polycystic ovarian disease, Shaman Aushadi, Uttara Basti
|How to cite this article:|
Hosur A, Uppin SR. An ayurvedic approach to a case of primary infertility. Indian J Ayurveda lntegr Med 2021;2:40-3
| Introduction|| |
Infertility can be defined as a disease of the reproductive system characterized by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. It is estimated that about 10%–15% of the couples of reproductive age face fertility issues. Fertility is a relative aspect affecting both the partners, the male factor affecting 30%–35%, the female 40%, both contributing about 10%–15% and unexplained 10%–15% of the total infertile couples. The various and frequently contributing factors to female infertility are ovarian and ovulation factor, tubal factor, uterine factor, and cervical factor.
Among these, polycystic ovarian disease is the most common cause of an-ovulatory infertility, being found in 75% of cases. Polycystic ovarian disease (PCOD) now proves to be a significant factor in female infertility with the prevalence of 0.6%–3.4% in infertile couples. While uterine or endometrial polyps are one among those that can affect the shape and functioning of the uterus, thereby leading to infertility. On an average, the prevalence of endometrial polyps can vary from 7.8% to 34.9%. However, the actual incidence till date is unknown due to its asymptomatic nature.
Ayurveda, elaborates the four important factors responsible for conception, i.e., rutu, kshetra, ambu, and beeja. Here, kshetra is the garbhashaya, also termed as ”Yoni,” where fertilization and implantation occurs and any abnormality in the yonipradesha will lead in failure to conceive.
Here, we put forward a known case of PCOD and asymptomatic presentation of endometrial polyp which was diagnosed through sonological findings during an evaluation for primary infertility. The condition was successfully treated with Ayurvedic protocol.
| Presenting Concerns|| |
A 30-year-old female patient, with a known case of PCOD and complaints of no issues since 5 years, approached the outpatient department of Prasuti Tantra and StreeRoga (Obstetrics and Gynaecology), at KLE Ayurved Hospital, Belagavi, Karnataka, India.
The apparently healthy patient, approached with a marital life of 5 years with a satisfactory sexual life and no H/O contraception or consanguineous marriage. Initially, she had regular menstrual cycles. About a year after marriage, she experienced amenorrhea for 2 months, but urine pregnancy test (UPT) showed negative result. She further consulted a gynecologist and was prescribed oral medication to regularize the cycle. Within the duration of 1 month, she gained about 4–5 kg of weight and also failed to conceive for a period of more than 1 year. She was thus advised ultrasonography (USG) which revealed PCOD and was put on external hormonal therapy to induce ovulation. During this course, the menstrual cycles were regularized and she underwent intra-uterine insemination 4 times with no fruitful outcome. USG was then repeated which revealed the presence of endometrial polyp measuring about 2 mm × 3 mm. The patient refused the routine surgical intervention for polyp, and as no positive outcome was achieved with the on-going treatment, she approached KLE Ayurved Hospital on August 04, 2016 with the above stated complaints.
| Clinical Findings|| |
- Last menstrual period : August 01, 2016
- Menstrual history: 4–5 days/28–35 days; regular, no h/o clots, dysmenorrhea, abnormal discharge
- Married life: 5 years
- Trying period: 5 years
- Sexual life: Satisfactory.
The patient was afebrile with pulse rate 74/min and blood pressure 110/70 mmHg. She was moderately built weighing about 50 kg.
The findings of the central nervous system, cardiovascular system, respiratory system, and per abdomen were within the normal limits. No any contributing abnormality was noted in the external genitalia. On per speculum examination, normal vagina and healthy cervix were observed. On bimanual examination, the findings exhibit normal sized retroverted uterus, fornices free with no palpable mass, absence of tenderness, and freely movable uterus.
| Diagnostic Focus and Assessment|| |
- Hematological tests: Normal
- Biochemistry tests: Normal
- Serological tests: Normal
- Thyroid function test: Normal
- Urine analysis: Normal
- USG: (July 22, 2016) Bilateral PCOD with Endometrial Polyp measuring 2 mm × 3 mm with endometrial thickness 6.8 mm
- Partner profile: Normal.
K/C/O PCOD and sonologically diagnosed endometrial polyp leading to primary infertility.
| Therapeutic Focus and Assessment|| |
[Table 1] showing the details of visits, follow ups and treatment.
| Follow-up and Outcomes|| |
- USG: (July 22, 2016) bilateral PCOD with endometrial polyp measuring 2 mm × 3 mm with endometrial thickness 6.8 mm
- Follicular report: (Post to Virechana karma and Basti).
[Table 2] showing the follicular report before treatment.
- USG: (November 09, 16) No significant abnormality (suggesting the absence of endometrial polyp)
- Follicular report: (Posttwo cycles of Nasya karma).
[Table 3] showing the follicular report after treatment.
After the third cycle of nasya karma, the couple was advised to have unprotected intercourse, after which she missed her next cycle. UPT on 16/02/17 showed positive result.
| Discussion|| |
Infertility is a condition wherein multifactorial involvement is observed. The case presented above had a history of PCOD and recently diagnosed endometrial polyp which was an interfering factor for conception. The condition of PCOD involves the vitiation of vata kapha dosha, thereby affecting the course of arthava, which can be regarded as an initial pathology. PCOD in itself is a variable disease and is marked by amenorrhoea, obesity and occasionally hirsutism, being one of the most common causes of an-ovulatory infertility. The dushita arthava, further can vitiate rakta and mamsa producing an umbrella-shaped muscular sprout in the yoni pradesh (uterus), thereby affecting the normal functioning of uterus. This endometrial polyp can be correlated to yonyarsha, and may be asymptomatic, and to some extent contribute for infertility. Theorized mechanisms by which polyps could adversely affect reproductive performance include: Irregular intraendometrial bleeding; inflammatory endometrial response similar to an intrauterine device; an obstructive defect inhibiting sperm transport; a physical surface area effect preventing exposure of the embryo to the endometrium. The contemporary science elaborates the involvement of the estrogen as the polyps are sensitive to this hormone.
Antagonizing the properties of pathological body elements is the basic principle of dosha dhatu viruddha chikitsa. Thus, for the purpose of obtaining Deha-shuddhi, virechana karma was opted. Further, for obtaining Kshetra-shuddhi, Uttarbasti with Varunadi Ghrita was advised which has lekhaniya property and must have helped in resolving the endometrial polyp. Although the patient had been treated for PCOD, the latest follicular study report showed an-ovulatory cycle which can be correlated to the improper development of beeja. For this Nasya karma with Shatavari ghrita was administered. Shatavari is proved to contain phyto-constituents known as phyto-estrogens which help to maintain endogenous harmony, and supports to regulate hormonal secretions. Furthermore, nasyakarma acts on the hypothalamus to regularize the hormonal imbalance. This must have resulted in the appearance of dominant follicle and ovulation, i.e., Prakrutbeeja.
Shamana Aushdi such as Nityanda rasa, Kanchanar guggulu, Chirbilavadi Kashya, and Abhayarista are kapha medo hara dravya possessing lekhaniya property. They act as granthihara and are proved effective in treating various conditions of kshetra from PCOD to endometrial polyp. Phalaghrita is proved to have Garbhasthapaka property.
Thus, the treatment protocol adopted in this case successfully served in establishing a healthy conception by normalizing the underlying hormonal imbalance.
| Conclusion|| |
Infertility is a condition which involves impairment in the reproductive hormones which in turn give rise to conditions such as anovulatory cycles and PCOD, and endometrial polyps, as seen in the case presented above. The contemporary medical science extends standard hormonal replacement therapy and surgical management. This can be bypassed by Ayurvedic interventions which are effective in achieving deha and kshetra shuddhi and normalizing hormones to establish a healthy pregnancy. Thus, the Ayurvedic line of treatment can be considered as an effective modality in treating the multiple factors that lead to infertility.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]