An Ayurvedic approach in the management of Female Infertility - A Case Study

T V Sreeni; Anju Elsa Roy

An Ayurvedic approach in the management of Female Infertility - A Case Study

V Sreeni T.¹, Elsa Roy A.^2*

DOI:

¹ T V Sreeni, Professor, Department of Rasashastra and Bhaishajya Kalpana, Govt. Ayurveda College, Thiruvananthapuram, Kerala, India.

^2* Anju Elsa Roy, Post Graduate Scholar, Department of Rasashastra and Bhaishajya Kalpana, Govt. Ayurveda College, Thiruvananthapuram, Kerala, India.

Infertility is a pathologic condition of both male and female, defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. In an Ayurvedic perspective, Susrutha Acharya described four important factors; Garbha Sambhava Samagri necessary for conception, Ritu, Khsetra, Ambu, and Beeja. Vata Dosha has a major role in infertility condition - Vandhyatva. In this particular patient aged 36 years who had complaint of inability to conceive despite ten years of unprotected sexual life. From detailed investigations abnormalities were detected in luteinizing hormone (LH), Estradiol (E2), Anti Mullarian Hormone (AMH) and multiple intra mural uterine fibroids were also found. For managing this patient, the treatment principles followed are Agnideepana (correcting the Agni-Digestive power), Mootavatanulomana (Correcting the deranged Vatha Dosha), Apanavatavaigunyahara, Kaphapithakara, Manovikara Samana, Garbhasthapana (support for conceiving). Ayurveda treatment was given for the lady for a duration of eight month and finally she got conceived.

Keywords: Infertility, Vandhyatva, Garbha Sambhava Samagri, Case Report

Corresponding Author	How to Cite this Article	To Browse
Anju Elsa Roy, Post Graduate Scholar, Department of Rasashastra and Bhaishajya Kalpana, Govt. Ayurveda College, Thiruvananthapuram, Kerala, India. Email:	T V Sreeni, Anju Elsa Roy, An Ayurvedic approach in the management of Female Infertility - A Case Study. J Ayu Int Med Sci. 2022;7(8):120-124. Available From https://www.jaims.in/jaims/article/view/1971

Introduction

Infertility is a disease of male or female, defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.^[1]

At reproductive age, millions of people are affected by infertility. Around 48 million couples and 186 million individuals were affected globally.^[2,3,4]

Infertility in females can be caused by problems with the ovary, uterus, fallopian tube, endocrine system, and others.

It is classified into two types: primary and secondary Primary infertility means the couple never conceived.

Secondary infertility means having previously experienced pregnancy, but failing to conceive later. Female infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology (ART). ART techniques include invitro fertilization (IVF), Intracytoplasmic sperm injection (ICSI), Gamete Intrafallopian Transfer (GIFT), Zygote Intrafallopian Transfer (ZIFT) and others.^[5]

In an Ayurvedic perspective, Susrutha Acharya described four important factors (Garbha Sambhava Samagri) necessary for conception, that is, Ritu, Khsetra, Ambu, and Beeja.^[6]

Rithu means time fertile for conception, Kshetra means healthy reproductive organs, Ambu means proper nutrition after conception, Beeja means healthy ovum and sperm. Any abnormality in the above mentioned factors, which leads to infertility or Vandhyatva. In Charaka Samhita, Acharya explained that the types of Vandya are Apraja (primary infertility) and Sapraja (secondary infertility).^[7]

Without Vata, the yoni never get vitiated, Vata is the main causative factor for Vandhyatva.^[8]

Charaka Acharya explained causes of infertility, which are Yoni Pradosha (diseases of reproductive system), Manasoka Abhitapa (psychological disturbances), Sukra Dusti (vitiated sperm), Sonita Dusti (vitiated ovum), Ahara Dosha (dietetic abnormality), Vihara dosha (abnormalities in activity), Akala Yoga ( period of age), Bala Kshaya (strength to become pregnant).^[9]

As per the Ayurvedic concept, Saumanasya (peaceful mind) is one of the important factors for conception.^[10]

Case Report

A 36-year-old married woman and her 40-year-old husband presented to the OPD department with a complaint of inability to conceive despite ten years of unprotected sexual life.

Investigations were done previously; semen parameters of the male were found to be within normal.

In female, prolactin, Thyroid Stimulating Hormone (TSH), found to be normal, whereas abnormalities were detected in luteinizing hormone (LH), Estradiol (E2), Anti Mullarian Hormone (AMH). Initially, Modern medicine managements were taken, but the patient was not conceived.

Lastly, gynaecologists advised doing invitro fertilization (IVF) - intracytoplasmic sperm injection (ICSI), invitro fertilization (IVF) with donor egg, but it was not successful. Before this IVF procedure she had done IUI several times. Then they came for ayurvedic treatment.

On interrogation, the lady had a regular menstrual cycle, with an interval of 30–33 days and a duration of 6 days. There was no family history, no abnormality in coital history, and she had not taken any contraceptive measures.

On USG investigation, multiple intra mural uterine fibroids were also found. From history it was known she was suffering from anxiety to conceive and psychological stress.

Personal history

She was a moderately built patient, with good nutrition
No known H/O diabetes mellites, hypertension, dyslipidaemia
Diet: Mixed
Appetite: Reduced
Bladder: Normal frequency
Bowel: Regular
Sleep: Disturbed

Findings

Date	Findings
Investigations 02/02/2018	LH - 5.0 mlU/ml, Anti Mullarian Hormone (AMH) - 0.1 ng/ml, Estradiol - 39.72 Pg/ml, Vitamin D - 15.6 ng/ml, TSH - 2.38 ulu/ml, Prolactin - 10.72 ng/ml
23/05/2018	FSH - 9.23 mlU/ml, LH - 3.53 mlU/ml, Anti Mullarian Hormone (AMH) - 0.32 ng/ml
USG 18/03/2020	Multiple small intra mural uterine fibroids
USG 05/01/2021	Single intrauterine gestation with CRL 0.27 corresponds to 6 week 0 days with good cardiac activity, yolk sac present

Treatments given

Date	Medicines	Dose	Time
25/01/2020	Sukumaram Kashaya [11]	60 ml-0-0	½ hr before food morning
25/01/2020	Kalyanakam Kashaya[12]	0- 0- 60 ml	½ hr before food evening
25/01/2020	Cap. Ayush Estro	0-1-1	After food
25/01/2020	Kalyanaka Ghrita[12]	10g-0-10g	Along with Kashaya morning and evening
17/2/2020	Dadimadi Ghrita[13]	10g-0-0	½ hr before food morning
17/2/2020	Kalyanaka Ghrita	0-0-10g	½ hr before food evening
17/2/2020	Cap. Profert F	0-1-1	After food
17/2/2020	Lakshmanaristam[14]	0-0-20ml	20ml +10 ml water at bed time
17/2/2020	Rajanikhand Powder	5g-0-5g	With Ghrita at morning and evening
5/03/2020	Phala Sarpis[15]	10g-0-0	½ hr before food morning
5/03/2020	Kalyanaka Ghrita	0-0-10g	½ hr before food evening
5/03/2020	Cap. Optova	0-1-1	After food
5/03/2020	T.A Tablet	0-1-1	After food
14/06/2020	Dadimadi Ghrita	10g-0-0	½ hr before food morning
14/06/2020	Kalyanaka Ghrita	0-0-10g	½ hr before food evening
14/06/2020	Cap. Profert F	0-0-1	At bed time
14/06/2020	Cap. Menatone	0-1-1-0	At 11 am & 3 pm
22/08/2020	Kalyanaka Ghrita	10g-0-0	½ hr before food morning
22/08/2020	Menatone cap	0-0-2	½ hr before food evening
22/08/2020	Cap optova	0-1-1	After food
22/08/2020	Lakshmanarista	0-0-20ml	20ml + 10 ml water at bed time
20/9/2020	Brahmi Ghrita [16]	10g-0-0	½ hr before food morning
20/9/2020	Menatone cap	0-0-2	½ hr before food evening
20/9/2020	Cap optova	0-1-1	After food
20/9/2020	Lakshmanarista	0-0-20ml	20 ml + 10 ml water at bed time

After the course of treatment, she got conceived.

Discussion

Infertility is an increasing problem, which affects the mental and physical health of woman. Here the couple was suffering from infertility and related psychosocial problems since 10 years.

During the investigations, found the male partner was no significant pathology, whereas female partner had hormonal abnormality in luteinizing hormone (LH), Estradiol (E2), Anti Mullarian Hormone (AMH) and uterine fibroids. Treatment principle is Agni Dipana, Mootavatanulomana, Vatahara, Apanavata Vaigunyahara. Kaphapithakara, Garbhasthapana.

Acharya Charaka^[16] described Agroushada for Garbhadhana is Saumanasyam (peaceful mind). This couple was suffering from psychological stress, that should be also treated. Initially Sukumaram Kashaya and Kalyanaka Kashaya were given morning and evening respectively. Sukumaram Kashaya exhibit the properties like Dipana, Anulomana, Tridosha Samana and indicated in Yoni Roga, Ksheena Rajas, Apraja, Udavartha and others. Kalyanaka Kashaya possess activities in Aretasi, Apraja, Apasmara etc, it shows Balya, Mangalya. Ayushya and Medhya property, and have an action in psychological conditions also. Cap. Ayush Estro is a patent medicine which contain seven powerful plant nutrients beneficial to treat uterine fibroids, menstrual problems and others. Kalyanaka Ghrita have same properties that of kashaya. Dadimadi Ghrita exhibit properties like Dipana, Mootavatanulomana and directly indicated for Vandhya, Dhukha Prasava etc so it was given in the second stage of treatment. Profert F is an Ayurvedic patent medicine directly indicated for infertility, by encourages timely ovulation, increase the chance of conception, and create a fertile intra uterine environment. In Bhaishajya Ratnavali explained intake of Lakshmanarista for 1 month cure all Stree Rogas. During the treatment she had got some allergic problems, modified Haridra Khanda- Rajanikhand powder was given. Phalasarpis indicated for Yoni, Sukra Dosha, Pustikara, Medhya, good for Pumsavana and Garbhini. It improves the quality of ovum and regulates the ovulation. Optova capsule directly given for impotency and infertility. T.A tablets given to the patient for the purpose of improving haemoglobin count. Menatone (Capsule of Mahanarayana Thaila) is an Ayurvedic traditional Medicine indicated for, Sukra Kshaya, Vandhyatva. Brahmi Ghrita has a special property Vandhyasoota Pradam. Brahmi Ghrita, Phalasarpis, Kalyanaka Ghrita have a role to overcome the psychological problems. The lady got conceived within the nine (9) months of treatment.

Conclusion

A couple is generally considered as Infertile when she has not conceived after one year of regular unprotected sexual activity. Infertility affects both male and female partners, especially physical, mental, emotional, and social health of women. From the above case study, it was cleared the Ayurvedic treatment for infertility was effective and leading to successful conception. But one more thing kept in mind was, before start treatment cause of infertility clearly identified and that should be addressed.

Ayurvedic concept of treatment is based on Asthasthana Pareeksha and Dasavidha Pareeksha. So, each patient and the conditions are different; according to the condition formulate a line of treatment for that particular patient.

Reference

1. World health organization(WHO), International classification of diseases, 11th Revision(ICD-11) Geneva: WHO 2018

2. Mascarenhas MN, Flaxman SR, Boerma T, et al. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med 2012;9(12):e1001356. doi: 10.1371/journal.pmed.1001356 [published Online First: 2012/12/29]

3. Boivin J, Bunting L, Collins JA, et al. international estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Human reproduction (Oxford, England) 2007;22(6):1506-12. doi: 10.1093/humrep/dem046 [published Online First: 2007/03/23]

4. Rutstein SO, Shah IH. Infecundity infertility and childlessness in developing countries. Geneva: World Health Organization 2004.

5. Radhey Shyam Sarma, Richa Sexena, Infertility & assisted reproduction; Ahistorical & modern scientific perspective, Indian J Med Res; 2018 Dec; 148

6. Srikandamurthy Susrutha Samhita Volume II Sarira Sthana reprint edition, Varanasi, chaukamba Krishnadas Academy 2010, Pp 26

7. Sharma, Bhagwandash, Charaka samhitha, Volume II, Sarira sthana, English translation based on Chakrapanidatta's Ayurveda Dipika, Reprint Edition, Varanasi, Choukhamba Sanskrit series, 2011, Pp 352

8. Srikandamurthy, Vagbhata's Ashtanga Hridaya, Volume III, Uthara Sthana, 7 th Edition, Varanasi, Chaumkhamba Krishnadas Academy, 2010, Pp 320

9. Sharma, Bhagwandash, Charaka samhitha, Volume II, Sarira sthana, English translation based on Chakrapanidatta's Ayurveda Dipika, Reprint Edition, Varanasi, Choukhamba Sanskrit series, 2011, Pp 352

10. Sharma, Bhagwandash, Charaka samhitha, Volume I, Sutra sthana, English translation based on Chakrapanidatta's Ayurveda Dipika, Reprint Edition, Varanasi, Choukhamba Sanskrit series, 2011, Pp 426

11. Srikandamurthy, Vagbhata's Ashtanga Hridaya, Volume II, Chikitsa Sthana, 7 th Edition, Varanasi, Chaumkhamba Krishnadas Academy, 2010, Pp 398

12. Srikandamurthy, Vagbhata's Ashtanga Hridaya, Volume III, Uthara Sthana, 7 th Edition, Varanasi, Chaumkhamba Krishnadas Academy, 2010, Pp 61

13. Srikandamurthy, Vagbhata's Ashtanga Hridaya, Volume II, Chikitsa Sthana, 7 th Edition, Varanasi, Chaumkhamba Krishnadas Academy, 2010, Pp 447

14. GovidaDasji, Bhaishajya Ratnavali, volume III, reprint edition, chaukambha Sanskrit sansthan, Varanasi, 2014, Pp 358

15. Srikandamurthy, Vagbhata's Ashtanga Hridaya, Volume III, Uthara Sthana, 7 th Edition, Varanasi, Chaumkhamba Krishnadas Academy, 2010, Pp 326

16. Srikandamurthy, Vagbhata's Ashtanga Hridaya, Volume III, Uthara Sthana, 7 th Edition, Varanasi, Chaumkhamba Krishnadas Academy, 2010, Pp 60

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-07-25	2022-07-26	2022-08-02	2022-08-09	2022-08-16
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	17%

Case Report

Female Infertility

Journal of Ayurveda and Integrated Medical Sciences