E-ISSN:2456-3110

Case Report

Tubal Blockage

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 5 May
Publisherwww.maharshicharaka.in

Ayurvedic management of Tubal Blockage: A Case Study

Lavanya S.1*, Anupama V.2
DOI: http://dx.doi.org/10.21760/jaims.8.5.39

1* S Lavanya, Post Graduate Scholar, Department of Prasuti Tantra Evam Stree Roga, Sri Kalabyraweshwara Swamy Ayurvedic Medical College, Hospital and Research Centre, Bangalore, Karnataka, India.

2 V Anupama, HOD and professor, Department of Prasuti Tantra Evam Stree Roga, Sri Kalabyraweshwara Swamy Ayurvedic Medical College, Hospital and Research Centre, Bangalore, Karnataka, India.

Infertility a multifactorial disorder is a major contributor to emotional disturbances and reduced quality of life. Out of the many factors, tubal factors causing infertility account for about 25-30 % of all cases of infertility.[1] Infections, abdominal surgery, and diseases such as endometriosis can cause scarring at the inner linings of fallopian tubes. STDS, past ectopic pregnancy and any previous abdominal surgeries may cause tubal blockage.[2] The fallopian tube is the Kshetra for Garbhadhan, as it carries the gamete before and zygote after fertilization. Going through various signs and symptoms we can understand that it is a Vata dominated Tridoshaja Vyadhi, where Kapha Dosha also contributes to the formation of block. Uttara Basti is emerging as a boon in treating blocked fallopian tubes. The drugs having Vata Kapha Shamaka, Tridoshagna properties, and drugs with Sukshma, Sara, Katu, Ushna, and Pramathi properties helps to remove the blockage and restore tubal functions. In the present case study, both Shodhana and Samana Chikitsa were adopted. The combination of Mahanarayana Taila, Kshara Taila and Phala Gritha having Lekhaniya and Vata Kapha Shamaka property is proven beneficial in treating tubal blockage.

Keywords: Artava Vaha Srotas, Tubal Blockage, Utharavasthi

Corresponding Author How to Cite this Article To Browse
S Lavanya, Post Graduate Scholar, Department of Prasuti Tantra Evam Stree Roga, Sri Kalabyraweshwara Swamy Ayurvedic Medical College, Hospital and Research Centre, Bangalore, Karnataka, India.
Email: 		S Lavanya, V Anupama, Ayurvedic management of Tubal Blockage: A Case Study. J Ayu Int Med Sci. 2023;8(5):232-236.
Available From
https://jaims.in/jaims/article/view/2389

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-03-22 2023-03-24 2023-03-31 2023-04-07 2023-04-14
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2023by S Lavanya, V Anupamaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

Journal of Ayurveda and Integrated Medical Sciences 2023;8(5)232
Lavanya S et al: Ayurvedic management of Tubal Blockage A Case Study

Introduction

Fallopian tubes are having a function of transport of the gametes and to facilitate fertilization and survival of zygote through its secretion. If it fails to do than leads to the one of the factors for infertility. Infertility is defined as failure to conceive within one or more years of regular unprotected coitus. Tubal blockage is one of the most common causative factors for female infertility. The prevalence of fallopian tubal obstruction was 19.1% in the fertility age group. Tubal blockages can be correlated to Sanga Sroto Dushti of Artavavaha Srotasa in Ayurveda, involving Vata and Kapha Doshas. Normalizing the vitiated Vata–Kapha Dosha leads to restoration of tubal function and easy conception. The case report presented here highlights the role of Ayurvedic medicines and therapies in successfully managing tubal blockage.

Case Presentation

Case History: Patient aged 36 years old with the obstetrical history of P2L2A0D0 underwent tubectomy after the 2nd delivery. After 2nd marriage 7yrs back, she underwent recanalization of fallopian tube. She was anxious to conceive since her recanalization but failed to do so, even after having unprotected coitus. Patient had regular menstrual cycles and complained of scanty menstrual bleeding of one pad completely soaked on day one and only half pad of bleeding on day 2, since 2 and half years. For the same, patient visited a gynaecologist and with all the investigations it was noted that bilateral tubal block was present and suggested for IVF. As the patient did not want to undergo IVF, she visited our OPD of SKAMCH&RC, Bengaluru.

No significant past medical history (Not a known case of DM, HTN, Thyroid Dysfunction, Asthma, Epilepsy, Tuberculosis) was seen. But it was observed that Patient is an event manager and complaints of stress in her work.

Menstrual History

  • Nature: Regular
  • Bleeding duration: 2 days
  • Interval: 28-30 days

D1 – 1 pad, fully soaked

D2 – 1 pad, half soaked

  • Clots: Absent
  • Dysmenorrhea: Absent
  • Foul smell: Absent
  • Itching: Absent

Surgical History

  • LSCS with B/L Tubectomy - 16years ago
  • Recanalization of fallopian tubes - 7years ago

Vyavaya Vruttanta

  • Frequency - 3 to 4 times/week
  • No Dyspareunia
  • No History of any

Partner’s Details

  • Name - XYZ
  • Age - 39 years / Male
  • Occupation - Business
  • N/K/C/O DM, HTN
  • Habit - Coffee twice a day
  • Semen analysis - Normal study

Obstetric History

P2L2A0D0

  • P1L1 - 18 years, Male FTND, uneventful
  • P2L2 - 16years, Male LSCS (Transverse lie)

General Examination

  • Height - 155 cm
  • Weight - 70 kg
  • BMI - 1 kg/m²
  • Pulse Rate - 76 beats/minute
  • BP - 130/80 mm Hg
  • Respiratory Rate - 22 cycles/minute
  • Temperature - 98℉
  • Tongue - pink, clear

Gynaecological Examination

Examination of vulva

Inspection

Pubic Hair - Normal

Clitoris - Normal

Labia - Normal

Redness - Absent

Swelling - Absent


Journal of Ayurveda and Integrated Medical Sciences 2023;8(5)233
Lavanya S et al: Ayurvedic management of Tubal Blockage A Case Study

Palpation: No palpable mass observed

Vagina

  • Redness - Absent
  • Tenderness - Absent
  • Local lesion - Absent
  • Discharge - Present (mild)
  • Color of Discharge - white color
  • Consistency of Discharge - Thin, mucoid
  • Smell of discharge - Absent
  • Amount of Discharge - Mild

Cervix (per speculum examination)

  • Inflammation - Absent
  • Size - Normal
  • Redness - Absent
  • External OS - Multiparous os
  • Cervix lip - Nabothian cyst present

Cervix (per vaginal examination)

  • Texture - Soft
  • Mobility - Mobile
  • Movement - no pain
  • Bleed on touch - Absent

Fornices

  • Lateral- Free, no tenderness
  • Posterior – Free, no tenderness

Uterus (Bimanual Examination)

  • Position - Anteverted
  • Direction - Anteflexed
  • Size - Normal
  • Consistency - Firm
  • Mobility - Mobile
  • Tenderness - Absent

Nidana

Ahara - Akala Bojana, Pishta Ahara (junk food regularly), Madhura Ahara

Viharaja - Stressful work, Anidra, Shastra Karma (Tubectomy and tubal recanalization)

Roopa - infertility


Samprapti Ghataka

  • Dosha - Vata Kapha Pradhana Tridosha
  • Dushya - Rasa, Rakta, Artava
  • Agni - Jataragni, Dathvagni
  • Agnidushti - Jataragni Mandya and Dathvagni Mandya
  • Srotas - Rasavaha, Raktavaha and Artavaha Srotas
  • Srotodushti - Sangha
  • Udbhava Sthana - Amashaya
  • Sanchara Sthana - Garbhashaya
  • Vyaktha Sthana - Garbhashaya (Fallopian Tube)
  • Adhisthana - Garbhashaya
  • Vyadhimarga - Abhyantara
  • Sadyasadhyata - Sadhya

Samprapti

Nidana

↓

Jataragni Mandya

↓

Vata Kapha Pradhana Tridosha Dusti

↓

Sanga and Vrana Vastu formation

↓

Sthana Samshraya in Garbhashaya and Artavaha Srotas (USG shows bilateral prominent pelvic veins)

↓

Artava Kshaya

↓

Vandyatwa

Investigations

AMH - 1.31 mg/dl

FBS - 85mg/dl

TSH - 1.520mIU /ml

HBA1C - 5.5

WBC - 5500 /ml


Journal of Ayurveda and Integrated Medical Sciences 2023;8(5)234
Lavanya S et al: Ayurvedic management of Tubal Blockage A Case Study

ESR - 18 mm/hr

HSG Report - Bilateral Tubal Block

TORCH test

  • Rubella IgG - 4 IU/ML reactive
  • Cytomegalo virus > 500 IUI /ml reactive
  • Herpes simplex virus IgG - 64 IU/ml

Follicular study shows bilateral prominent pelvic veins.

Treament Given: Udwarthana followed by Vamana is given, after Vamana the next consecutive cycle the patient improved with her menstrual flow (from 2 days to 4 days. And no. of pads 1-2 pads per day.

Yoni Prakshala with Pachavalkala Kashaya, Yoni Poorana with Mahanarayana Taila, and Matra Basti was given with Phala Ghrita. Ovulation was noted on the 16th day of menstrual cycle.

Yoga Basti and Uttara Basti is given with the Kshara Taila and Phala Ghritha for 1 cycle and planned for hysteroscopy for tubal potency.

Orally,

1. Cap. Viscovas 1-0-1 A/F

2. Cap. Panchavalkala 1-1-1 after food

3. Gandharvahastadi Taila 20ml HS with 1 glass of milk

4. Cap. Torchnil 1-1-1 (A/F)

5. Cap. Sujath 1-0-1 (A/F)

6. Streevyadhihararasa 1-0-1 (A/F)

Hysteroscopy for tubal patency was done - Both the tubes were patent.

Treatment Outcome

  • Bleeding during menstruation is increased from 1-2 days to 4-5 days with the 2-3 pads per
  • Tubal block is cleared and both the tubes are patent.
  • Patient was advised to try for natural conception.

Discussion

Tubal blockage is one of the leading causes in female infertility.

In Ayurveda, it can be better correlated with Artava-bijavaha Srotorodha (obstruction in fallopian tube). Vata-Kapha Doshas are the causative factor in tubal blockage. Sankocha produced by vitiated Vata Dosa due to its Ruksha, Khara and Darana Guna.[3] Sthira, Mantha property of vitiated Kapha Dosa results in Sanga-Srotodushiti of Arthava Vaha Srotas. This ultimately leads to Vandhyatwa. Hence, the treatment principle should be to pacify Vata - Kapha Dosa, Vata Anulomana, Deepana Pachana line of management. Udwartana which is Vatahara as well as Kapha Medovilayana, thereby helps to clear the Srotorodha to some extent.

Further Vamana also helps in the Kapha Vilayana and causes Srotoshodhana and the same is mentioned by Acharyas in the Chikitsa Sutra of Artavakshyaya.

Basti has multidimensional effect, as it has Lekhana, Rasayana, Sroto Sanganasaka, Vata Anulomana which leads to purification of body. Hence Yogavasthi and Uttaravasti were selected.

Kshara Taila having Ksharana property also has Vata and Kaphahara property which can be seen in this case and this probably helps to clear the block in the tubes.

Phala Ghritha is indicated directly in Yoni and Shukra Dosha which also it helps in increasing the fertility rate.

Conclusion

Though there are no direct references for Tubal blockage one can understand the Dosha, Dushya and Srotho Dushti Lakshana and the right type of treatment protocol can be advised.

In contemporary medicine, management includes hormonal correction, ovulation induction and ART (Artificial Reproductive Techniques). Most of the patients with infertility due to tubal blockage end up with IVF (Invitro Fertilization) management.

The aim is to enhance the proper functioning of reproductive system by providing natural and effective medicines. Srothorodha in the Artava Vaha Srotas were eliminated by proper Shaman and Sodhana therapy which results in the clearance of the tubal block is seen in the patient just after treatment as in this case.



Journal of Ayurveda and Integrated Medical Sciences 2023;8(5)235
Lavanya S et al: Ayurvedic management of Tubal Blockage A Case Study

Reference

1. World Health Organization. infertility definitions and technology. accessible at http://www.who.int/reproductivehealth/topics/infertility/definitions/en/Accessed November 16, 2018

2. Dawn C.S. Text book Gynaecology and Contraception 11th Edn. Dawn books Calcutta.

3. Srikanta Murthy K.R. Trans. Illustrated Sushrut Samhita, vol1, edition 2004, Chaukhamba Orientalia Varanasi, Sharirsthana, Chapter 9, verse 154. p.149.


Journal of Ayurveda and Integrated Medical Sciences 2023;8(5)236