E-ISSN:2456-3110

Review Article

Enhancing Endometrium Health

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 5 May
Publisherwww.maharshicharaka.in

A game-changer in enhancing Endometrium Health - Uttara Basti as a promising alternative to PRP therapy & G-CSF instillation with superior impact on Thin Endometrium Cases

Bhavana G1*, Jana P2
DOI:10.21760/jaims.9.5.31

1* Bhavana G, Post Graduate Scholar, Department of Prasuti Tantra and Stree Roga, Sri Kalabyraveshwara Swamy Ayurveda Medical College and Research Centre, Bengaluru, Karnataka, India.

2 Papiya Jana, Professor, Department of Prasuti Tantra and Stree Roga, Sri Kalabyraveshwara Swamy Ayurveda Medical College and Research Centre, Bengaluru, Karnataka, India.

A healthy conception results due to the influence of Ritu, Kshetra Abu, Bija Samyoga, Garbha Sambhava Samagri as mentioned in Ayurvedic classics, any defect in the above component can lead to Vandyatwa. Kshetra is one of the most important factors that may have its impact on conception and growing fetus as well as it is considered as the site of implantation in the Garbhashaya which bears the fruit of conception and can be considered endometrium. Endometrium if unhealthy or thin can impact on maintaining the balance of Artavavaha Sroto function. Hence, we need to explore the function of endometrium and the pathogenesis related to it. In Ayurveda among the various Stanika procedures, Uttara Basti specifically stands out as a highlighted and well-practiced therapy for addressing infertility by promoting endometrial growth and enhance embryo implantation. The specific formulation mentioned in Ayurvedic classics contains drugs which are having Garbhasthapana actions and they also have Brumhaniya properties which have its action on correcting endometrium.

Keywords: Endometrium Health, Uttara Basti, Thin Endometrium, Garbhasthapana, Arthavavaha Srotas

Corresponding Author How to Cite this Article To Browse
Bhavana G, Post Graduate Scholar, Department of Prasuti Tantra and Stree Roga, Sri Kalabyraveshwara Swamy Ayurveda Medical College and Research Centre, Bengaluru, Karnataka, India.
Email: 		Bhavana G, Jana P, A game-changer in enhancing Endometrium Health - Uttara Basti as a promising alternative to PRP therapy & G-CSF instillation with superior impact on Thin Endometrium Cases. J Ayu Int Med Sci. 2024;9(5):186-193.
Available From
https://jaims.in/jaims/article/view/3222

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-03-11 2024-03-21 2024-03-31 2024-04-12 2024-04-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 23.54

© 2024by Bhavana G, Jana Pand 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].

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Introduction

Endometrial health issues are recently growing concern in the gynecology practice where most of the infertile couple seek consultation. The World Health Organization estimates that 60 - 80 million couples worldwide currently suffer from infertility. Infertility varies across the regions of the world and is estimated to affect 8% - 12% of couples worldwide.[3] According to the International Federation of Gynecology and Obstetrics manual (2015), the causes are peritoneal factors (35%), tubal factors (30%), ovulatory factor (20%), and uterine factor (15%). Among these uterine factors, as-endometrial abnormalities play an important role in the causation of infertility. The majority of times unexplained infertility is associated with endometrium morphology.

In the realm of reproductive health, two significant terms are "endometrium" and "thin endometrium." The endometrium refers to the tissue lining the innermost part of the uterus. On the other hand, a thin endometrium is characterized by this tissue being thinner than the usual thickness. While a normal endometrium is typical, a thin endometrium can pose challenges for fertility and pregnancy. Implantation is a crucial stage where the blastocyst attaches to the endometrium during the secretory phase of the menstrual cycle. The interaction between the developing embryo and maternal tissue is pivotal for the successful completion of the implantation process. For successful embryo implantation, an endometrium should normally have a thickness of 8 mm or more. A thin endometrium is one that has a thickness of less than 6 mm. This Endometrium can be understood as Kshetra where Arthava has its role.

Arthava is the Upadhatu of Rasa and its function depends directly based on Rasadhatavagni which is the important factor maintaining metabolism at the level of Upadhatu Artava. Hence the treatment aims at not only improving the endometrial health related to Arthava but also aims to maintain the function of Agni, Rasa and Rasa Dhatavagni.

Hence the treatment modality what we adopt aims to improve the quality and quantity of endometrium. Uttara Basti plays a vital role in improving all the aspects related to Kshetra and correcting the vitiated Vata and improving the Sthanika Raja in terms of endometrial tissue.

Causes of thin Endometrium

1. Hormonal Imbalance: Fluctuations in hormone levels, particularly estrogen and progesterone, can affect the thickness of the endometrium. Low levels of estrogen, for example, can lead to inadequate growth of the endometrial lining.

2. Medical Conditions: Certain medical conditions such as polycystic ovary syndrome (PCOS), endometriosis, or thyroid disorders can impact the thickness of the endometrium.

3. Age: As women age, especially approaching menopause, hormonal changes can lead to a thinner endometrial lining.

4. Uterine Factors: Structural abnormalities of the uterus, such as scarring from previous surgeries or infections, can hinder the growth of the endometrium.

5. Medications and Treatments: Certain medications, such as those used for cancer treatment (chemotherapy or radiation therapy), can affect the thickness of the endometrium. Additionally, prolonged use of hormonal contraceptives may influence endometrial thickness.

6. Lifestyle Factors: Smoking, excessive alcohol consumption, poor nutrition, and extreme exercise can all impact hormone levels and consequently affect the thickness of the endometrium.

7. Reproductive Disorders: Conditions like Asherman's syndrome, characterized by intrauterine adhesions, can lead to a thin endometrium due to scar tissue formation.

8. Chronic Illness: Chronic conditions such as diabetes or autoimmune disorders can indirectly affect endometrial health by disrupting hormonal balance or compromising overall health9.

9. Infections: Infections of the reproductive system, such as pelvic inflammatory disease (PID), can cause inflammation and scarring, which may affect the endometrium.

10. Environmental Factors: Exposure to environmental toxins or pollutants may have an impact on reproductive health, potentially influencing endometrial thickness.

Idiopathic: cases suggest that thin endometrium may not always be linked to a specific


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disease process. It can be influenced by individual uterine architecture or intrinsic properties of the endometrium affecting its growth.

Miwa et al. (2009) demonstrated that thin endometrium is characterized by poor growth of glandular epithelium, high uterine blood flow impedance, reduced vascular endothelial growth factor (VEGF) expression, and inadequate vascular development. They proposed that elevated blood flow impedance in radial arteries acts as a trigger, impairing glandular epithelium growth, leading to decreased VEGF levels. The resulting low VEGF levels further hinder vascular development, creating a detrimental cycle that ultimately results in a thin endometrium.

Understanding these potential causes can help us diagnose and address thin endometrium, potentially improving fertility outcomes for affected individuals.

Samprapti Ghataka of thin Endometrium according to Ayurveda

Vataja Ahara Vihara

↓

Vata Kapha Dushti

↓

Dhatu Kshaya

↓

Affects Rasadhatavagni Vaishamya

↓

Upadhatu and Arthavavaha Srotho Dushti

↓

Kapha Avruta Vata and Alpa Arthava

↓

Stana Samshraya in Garbhashaya

↓

Yathochita Kala Arthava Adarshana

↓

Arthava Kshaya

↓

Vandyatwa

Samprapti Ghatakas

  • Dosha - Vata Kapha (Vata Pradhana)
  • Dushya - Rasa, Rakta and Artava
  • Agni - Jataragni, Dhatwagni
  • Agni Dushti - Jatargni Mandya, Dhatavagni Mandya
  • Srotas - Rasavaha, Raktavaha and Artavaha Srotas
  • Srothodushti - Sanga
  • Sanchara Staana - Rasavaha, Raktavaha and Artavaha Srotas
  • Udbhava Staana - Aamashaya
  • Vyakta Staana - Garbhashaya
  • Adhishtana - Garbhashaya
  • Vyadhi Marga - Abhyantara
  • Sadya Asadhyatwa - Sadhya

Pathology of Thin Endometrium leading to Infertility[6]

High blood flow impedance of Radial Arteries

↓

Poor epithelial growth

↓

Decreased Vascular Endothelial Growth Factor (VEGF) expression

↓

Poor vascular development

↓

Thin endometrium

↓

Reduced Endometrial receptivity

↓

Infertility

Understanding the Concept of Uttara Basti, G-CSF Instillation and PRP therapy

Uttara Basti

"Uttara Basti" is a combination of two words, namely 'Uttara' and 'Basti'.


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Analyzing the components, the prefix 'ut' in 'Uttara' conveys a sense of superiority, indicating an elevated status for Uttara Basti. The suffix 'Tara' is employed to signify a comparatively superior or improved state. Administering Uttara Basti during the Rutu Kala, akin to the menstrual proliferative phase, is considered ideal. During this period, blood vessel stumps break, and new arterioles grow, facilitating easy absorption of administered drugs. The broken glands further enhance absorption possibilities. Utilizing oil-based solutions ensures slow absorption. Uttara Basti exhibits various actions, including effects on blood vessels, haemostasis, and coagulation. It also stimulates the uterus and shows systemic actions like anti-estrogenic effects. In simpler terms, giving Uttara Basti during Rutu Kala allows for effective absorption and beneficial actions in the body.

Granulocyte Colony-Stimulating Factor

G-CSF, or granulocyte colony-stimulating factor, is a glycoprotein produced by various cells such as bone marrow cells, stromal cells, mononuclear cells, fibroblasts, natural killer (NK) cells, and endometrial cells. Its primary function involves stimulating the growth and differentiation of neutrophils within the bone marrow and regulating their release into the bloodstream. The discovery and purification of G-CSF in mice date back to 1983, and its human form was subsequently cloned three years later in 1986.

G-CSF appears to modulate certain neutrophil functions as well as the distribution of neutro- phils and progenitor cells within the body. G-CSF possesses unique and interesting characteristics among the family of hematopoietic growth factors. [1]

Platelet rich plasma (PRP)

Platelet rich plasma (PRP) has gained a lot of acceptance, being a non-operative treatment for multiple medical disorders. In orthopaedics along with sports medicine it is being used routinely for pain relief via the promotion of natural healing in musculoskeletal et al diseases like arthritis, tendonitis, ligamentous strains and tears. Especially PRP injections have been used for athletic injuries, resulting in exceptional healing with rapid return to routine activities with complete pain relief.[2]

Autologous PRP is derived from an individual’s whole blood, then centrifuged to remove red blood cells. The remaining plasma has

a 5-10 times greater concentration of growth factors as compared to whole blood.

PRP Composition & Activation

PRP, or platelet-rich plasma, is composed of platelets rich in cytokines and growth factors stored within α-granules. These growth factors include Platelet-derived growth factor (PDGF), insulin-like growth factors (IGF), vascular endothelial growth factors (VEGF), platelet-derived angiogenic factor, epidermal growth factors (EGF), connective tissue growth factor (CTGF), transforming growth factor-beta (TGF-β), fibroblast growth factors (FGF), and interleukin-8. Additionally, platelets contain substances like fibronectin, vitronectin, and sphingosine-1-phosphate that initiate the wound healing process.[3,4]

The activation of platelets induces the release of growth factors through various stimuli or substances such as thrombin, calcium chloride, and collagen. Each activation method influences both the physical composition of PRP and the quantity of released growth factors, including the kinetics of their release. Currently, there is no established evidence regarding the ideal concentrations of activators required to achieve optimum growth factor release during the PRP activation process. Consequently, varying concentrations may yield diverse results.

Indications of Uttara Basti /G-CSF instillation and PRP therapy in Infertility

Uttara BastiG-CSF InstillationPRP
1.  Anartava
2.  Rajo Dosha
3.  Yoni Dosha
4.  Vandhyatwa
5.  Vataja Yoni Vyapad
6.  Kapha Vataja Yoni Vyapad
7.  Putraghni
8.  Arthava Dushti		1.  Recurrent Implantation Failure (RIF)
2.  Thin Endometrium
3.  Recurrent Pregnancy Loss (RPL)		Its application in reproductive medicine, specifically for treating infertility, is an area of ongoing research.
There is limited scientific evidence supporting the use of PRP in the context of infertility, and its efficacy and safety for such purposes are not well-established.

Management of Thin Endometrium in infertility and a Review on Mode of Action of Uttara Basti and analysing the effect of G-CSF and PRP therapies.

Based on the Aushadi Taila/Kashaya/Ghritha, Mostly we select Vatahara Dravys as Yonivyapad and Vandyatwa arises due to Vataja Dushti.


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For Example: Phalaghritha is indicated in Vandyatwa where the woman presents with thin endometrium and low receptivity.

As Phalaghritha contains, Ref. Ashtanga Hrudaya Uttarasthana 34/63-67

ManjishtaRubia cordifoliaGuru, Ruksha, Kapha Pitta Shamaka
KushtaSaussurea lappaLaghu, Ruksha, Tikshnakapha Vata Shamaka
TagaraValerina wallichiLaghu, Snigdha, Kapha Vata Shamaka
HaritakiTerminalia chebulaLaghu, Ruksha, Tridosha Shamaka
VibhitakiTerminalia bellericaRukhsha, Laghu Balances Kapha and Pitta
AmalakiPhyllanthus belliricaGuru, Sheeta, Tridosha Hara
VachaAcorus calamusLaghu Tikshna, Khapha Vata Shamaka
HaridraTurmericRuksha, Laghu Kapha Vata Shamaka
DaruharidraBerberis aristataTikta, Kahaya, Kapha Pitta Shamaka
MadhukaGlycyrrhizaGuru, Snigdha, Vata Pitta Shamaka
MedaPolygonatum cirrhifoliumGuru, Vata Pitta Shamaka, Kapha Vardhaka
DipyakaTrachyspermum roxburghianumLaghu, Ruksha, Tikshna, Kapha Vata Hara
KaturohiniTrachyspermum roxburghianumRuksha, Laghu, Kapha Pitta Shamaka
PayasyaIpomea Mauritian
KakoliRoscoea proceraGuru Snigdha, Kapha Kara, Vatapitta Shamaka
VajigandhaWithania somnifera
ShatavariAsparagus racemosusGuru, Snigdha, Vata Pitta Shamaka
HinguAsafoetida
SharkaraSugar
GhrithaGhee
KsheeraMilk

Chemical Composition of Ghritha contains plant and animal protein which function locally and builds tissue, corrects cellular functions and target endometrial tissue which helps in developing the endometrial lining.

Other drugs and combinations which can be used in Uttara Basti are as follows

Bhrami Gritha

Kalyanaka Ghritha

Shatavari Ghritha

Dhatri Ghrita

Panchagavya Ghritha

Kasisadi Taila

Ksharataila

Ksheera Bala Taila

Balaashwagandhadi Taila

Mode of action of Uttara Basti in Ayurveda on thin Endometrium

The mode of action of Uttara Basti in thin endometrium cases involves several key principles from Ayurvedic philosophy and therapeutics:

1. Pacification of Vata Dosha: According to Ayurveda, imbalances in the Vata Dosha, one of the three fundamental dosha governing the body, can lead to Rookshata, Dhatu Kshaya thus leading to thinning of tissues, including the endometrium. Uttara Basti is believed to have Vatahara property and provides Balya and Bruhmana effects to the endometrial tissue. The Dravyas, Ghritha and Taila preparations used in Uttara Basti are specifically selected to counteract vitiation of Vata Dosha and promote the restoration of healthy tissue function.

2. Strengthening and Nourishing the Endometrium: The Ayurvedic formulations used in Uttara Basti are Balya and Brihmana in nature thus nourish the endometrial tissue. These formulations typically contain Dravyas with properties that support tissue regeneration, enhance blood circulation to the pelvic organs, and promote hormonal balance. By providing essential nutrients and important constituents directly to the endometrium, thus helps in improve the endometrial thickness and overall health.

3. Enhancing Uterine Blood Flow: Uttara Basti therapy is thought to enhance blood circulation to the uterus and pelvic region. Improved blood flow delivers vital nutrients, oxygen, and bioactive compounds to the endometrium, facilitating its growth and repair. Increased blood circulation also aids in the removal of metabolic wastes and toxins, promoting a healthier uterine environment conducive to optimal endometrial thickening.

4. Balancing Hormonal Function: Ayurveda herbs and drugs used in Uttara Basti formulations possess hormonal modulating properties, helping to balance hormonal function in the body. Hormonal imbalances can contribute to thin endometrium by disrupting the normal menstrual cycle and impairing


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endometrial growth. Uttara Basti aims to restore hormonal equilibrium, supporting the natural processes of endometrial thickening and regeneration.

5. Promoting Relaxation and Stress Reduction: Stress and emotional factors can influence hormonal balance and uterine function, potentially affecting endometrial health. Uttara Basti therapy incorporates principles of relaxation and stress reduction through its gentle and nurturing approach. The therapeutic process of Uttara Basti, including the warm medicated oils and supportive environment, promotes relaxation of the pelvic muscles and nervous system, which may indirectly benefit endometrial thickness and receptivity.

B. Mode of action of G-CSF Instillation on thin Endometrium

The mode of action of G-CSF in this context involves several mechanisms

1. Endometrial Regeneration: G-CSF has been shown to promote the proliferation and regeneration of endometrial tissue. By stimulating the growth and repair of the endometrium, G-CSF can help increase its thickness and improve its receptivity to embryo implantation.

2. Angiogenesis: G-CSF has angiogenic properties, meaning it can stimulate the formation of new blood vessels (angiogenesis) within the endometrial tissue. This enhanced blood flow can improve the delivery of oxygen and nutrients to the endometrium, fostering its growth and development.

3. Immune Modulation: G-CSF exerts immuno-modulatory effects within the endometrium, regulating the activity of immune cells and promoting a favourable immune environment for embryo implantation. By modulating immune responses, G-CSF may help prevent rejection of the embryo and support its successful implantation.

4. Enhanced Secretory Function: G-CSF has been reported to enhance the secretory function of the endometrium, leading to the production of factors that support embryo implantation and early pregnancy maintenance. This includes factors such as cytokines, growth factors, and adhesion

molecules that facilitate embryo-endometrial interactions.

5. Reduced Apoptosis: G-CSF may exert anti-apoptotic (anti-cell death) effects on endometrial cells, helping to prevent premature cell death and maintain the integrity of the endometrial lining. By reducing apoptosis, G-CSF can contribute to the preservation and thickening of the endometrium.

C. Mode of action Of PRP Instillation On thin Endometrium

In recent years, PRP therapy has gained attention as a potential treatment for thin endometrium, with emerging evidence suggesting its efficacy in improving endometrial thickness and receptivity. The mode of action of PRP in thin endometrium cases involves several key mechanisms:

1. Growth Factor Stimulation: PRP is rich in various growth factors, including platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), vascular endothelial growth factor (VEGF), and insulin-like growth factor (IGF). These growth factors play crucial roles in tissue regeneration, angiogenesis, and cellular proliferation. When PRP is instilled into the endometrial cavity, these growth factors stimulate the proliferation and regeneration of endometrial cells, leading to an increase in endometrial thickness.

2. Angiogenesis Promotion: PRP contains factors such as VEGF that promote angiogenesis, the formation of new blood vessels. By enhancing blood flow to the endometrium, PRP facilitates the delivery of oxygen and nutrients to the endometrial tissue, promoting its growth and development. Improved vascularity also contributes to the establishment of a more receptive environment for embryo implantation.

3. Stem Cell Recruitment and Differentiation: PRP contains bioactive molecules that can recruit and activate stem cells within the endometrium. These stem cells have the potential to differentiate into various cell types, including endometrial cells. By recruiting endogenous stem cells and promoting their differentiation into endometrial cells, PRP helps in the regeneration and thickening of the endometrial lining.


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4. Anti-inflammatory Effects: PRP exhibits anti-inflammatory properties, which can help mitigate inflammation within the endometrium. Chronic inflammation is associated with thin endometrium and impaired endometrial receptivity. By reducing inflammation, PRP creates a more favourable microenvironment for endometrial growth and embryo implantation.

5. Extracellular Matrix Remodelling: PRP contains components that contribute to extracellular matrix remodelling, such as fibrin and fibronectin. This remodelling process is essential for tissue repair and regeneration. By enhancing extracellular matrix remodelling, PRP promotes the restructuring of the endometrial tissue, leading to increased thickness and improved receptivity.

PRP facilitates the regeneration and thickening of the endometrial lining, ultimately enhancing endometrial receptivity and improving pregnancy outcomes.

Discussion

This article sheds light on the significance of various Ayurvedic principles and treatments in addressing infertility, particularly focusing on thin endometrium, a condition that can hinder successful conception. Ayurveda encompasses not only physical health but also psychological and spiritual well-being, aiming for a balanced state of body and mind conducive to conception and pregnancy.

The concept of "Vandyatwa" is intricately linked to the harmony of Ritu, Kshetra and Bija Samyoga, and Garbha Sambhava Samagri. Any imbalance or defect in these components can lead to reproductive disorders, emphasizing the importance of addressing each aspect comprehensively.

Among these components, the discussion emphasizes the pivotal role of Kshetra, which corresponds to the endometrium, the inner lining of the uterus. A thin or unhealthy endometrium can disrupt the implantation process and hinder pregnancy. In such conditions Vata Dosha imbalance is observed particularly in the Artavavaha Srotas, as a key factor contributing to defects in Kshetra.

Strengthening and nourishing the endometrium emerge as crucial objectives in the treatment of infertility, and Uttar Basti stands out as a highly

effective therapy. Through its Vata-pacifying properties and Rasayana qualities and the drugs used in Uttar Basti not only addresses Vata imbalance but also promotes endometrial growth and enhances embryo implantation.

Comparatively, modern treatments for thin endometrium focus on enhancing endometrial thickness and receptivity through techniques like intrauterine infusion of growth factors such as G-CSF and PRP therapy. These interventions aim to stimulate endometrial regeneration and improve thickness, thereby increasing the chances of successful implantation and pregnancy. Similarly, Uttara Basti is a solution to various kinds of Vandhyatwa and ensures successful outcome. Integrating the strengths of both systems can potentially optimize outcomes in treating infertility and related conditions, offering hope to couples seeking to conceive.

Conclusion

The practice of Uttara Basti in Ayurveda is deeply rooted in holistic principles, striving to not only rejuvenate Arthavavaha Srotas but also to specifically address concerns such as thin endometrium, enhancing both its thickness and receptivity. This approach not only aligns with Ayurvedic philosophy but also offers a cost-effective alternative to treatments like G-CSF and PRP instillation. Moreover, Uttara Basti can be easily administered in a safe and comfortable environment, making it accessible and convenient for individuals seeking natural and holistic solutions for their health concerns.

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