Ayurvedic management of Secondary Infertility associated with Polycystic Ovarian Syndrome - A Case Report

Juli Kotwani; Tejaswini Dhiraj Buchade

doi:10.21760/jaims.9.6.50

Ayurvedic management of Secondary Infertility associated with Polycystic Ovarian Syndrome - A Case Report

Juli K^1*, Tejaswini DB²

DOI:10.21760/jaims.9.6.50

^1* Juli Kotwani, Pg, Department of Stree Roga and Prasuti Tantra, All India Institute of Ayurveda, New Delhi, India.

² Tejaswini Dhiraj Buchade, Assistant Professor, Department of Stree Roga and Prasuti Tantra, All India Institute of Ayurveda, New Delhi, India.

PCOD is the main cause of infertility in the present generation among the reproductive age group due to undesirable lifestyle changes. In the case report an infertile couple who had not been able to conceive since 2 yrs. The wife was diagnosed with PCOS. The ovulatory factor that contributes to infertility is 30 -40 %. PCOD may be diagnosed if any 2 of the following criteria are present – clinical or biochemical hyperandrogenism, evidence of oligo- anovulation, polycystic appearing - ovarian morphology on USG. The objective of the present treatment included Ayurvedic management of PCOS, ensuring regular ovulation and thereby helping to develop healthy pregnancy and successful childbirth.

Case presentation: A female patient, 32 years old, visited Prasuti Tantra and Stri- Roga OPD of All India Institude of Ayurveda, New Delhi on 7 march 2024 with secondary infertility associated with Irregular menses. Methodology: Detailed history with all clinical, physical examination, and laboratory investigations were carried out which were normal. Ultrasonography reveals bilateral PCOD. So the treatment was planned accordingly. Result: Patient got her menstruation of drug intake with improvement in menstrual pattern. She continued to take drugs during the second month and missed her period consequently after that. UPT was done and was found positive on 18 April.

Keywords: PCOS, Artava dushti, Nashtartava, Artavakshaya, Vandhyatha

Corresponding Author	How to Cite this Article	To Browse
Juli Kotwani, Pg, Department of Stree Roga and Prasuti Tantra, All India Institute of Ayurveda, New Delhi, , India. Email:	Juli K, Tejaswini DB, Ayurvedic management of Secondary Infertility associated with Polycystic Ovarian Syndrome - A Case Report. J Ayu Int Med Sci. 2024;9(6):309-312. Available From https://jaims.in/jaims/article/view/3252

Introduction

According to WHO, Infertility is a condition in which failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. It can be primary or secondary. Primary infertility is when a pregnancy has never been achieved by a person, and secondary infertility is when at least one prior pregnancy has been achieved.

It is a multifactorial condition and may be due to ovulatory dysfunction (30-40%), tubal factors (25-35%), uterine factors (10%), cervical and vaginal factors (5%) and the endometrial factors (1-10%).^[2] Among the ovulatory dysfunction,^[3] PCOS is the primary cause which is characterized by menstrual irregularities, manifestation of androgen excess and other endocrine dysfunction.

Menstrual dysfunction (Artava Dushti) may range from amenorrhea (Nashtartava) to oligomenorrhea (Artavakshaya) to episodic menometrorhagia (Asrigdara). Women with PCOS may have heavy and unpredictable bleeding and instability of thickened endometrium. All Yonivyapads (gynaecological disorders), if not treated properly can lead to infertility. Artava Dushti which includes abnormalities of ovum, ovarian hormones and menstrual irregularities also lead to Vandhyatha (infertility). Bijotsarga is one of the causes for ovulatory dysfunction.

In this condition, there is inadequate growth and function of the corpus luteum. There is inadequate progesterone secretion. The lifespan of corpus luteum is shortened. As a result, there are inadequate secretory changes in the endometrium which hinder implantation. In Ayurveda science, it can be correlated with Sapraja.^[4]

Case Presentation

Female patient, 32 years old, came to Prasuti Tantra and Stri Roga OPD of All India Institute of Ayurveda, New Delhi on 7 March 2024 with secondary infertility associated with Irregular menses for 2 years. She had one issue of spontaneous miscarriage in June 2023 followed by D & C. So, she came to AIIA for the treatment of same problem.

Menstrual History
The duration of her menstrual cycle was of 3 to 4 days with interval of 15 to 45 day, irregular, flow moderate pain mild, colour blackish, clots present.

Her last menstrual period was on 23/01/2024.
Pad history - 2 pad soaked per day

Obstetric history - G1L0P0A1D0
A1 - spontaneous abortion, 1.5 month gestational age in June 2023 followed by D & C.

Family history - No relevant family history<
Past surgical history - No history of surgery in the past was found.

Personal History -
1. Appetite - poor
2. Sleep - Normal
3. Bladder - Burning micturition.
4. Bowel habits - Normal

Clinical Findings

General examinations
Built - Normal
Weight - 62kg
Height - 153 cm
Pulse rate - 72/min
Blood Pressure - 120/80 mm of hg
Respiration rate - 18/min
Temperature - 98.6°F
Per abdomen - It was soft, nontender and no organomegaly was detected.

Physical examination

Ashtavidhapariksha
Nadi - Vatakapha
Mutra - Samyak mutra pravriti
Mala - Sama
Jihwa - Sama
Shabda - Samyak
Sparsha - Ushna
Drika - Samanya
Aakriti - Madhyama

Dashvidhapariksha
Prakriti (nature) - Vatakapha
Sara (purest body tissue) - Madhyama (medium)
Samhanana (body compact) - Avara (minimum)
Pramana (body proportion) - Madhyam (medium)
Satmya (homologation) - Madhyam (medium)
Satva (mental strength) - Madhyam (medium)
Vaya (age) - Yuvati
Vyayamshakti (to carry on physical activities) - Madhyam (medium)
Aharashakti (food intake and digestive power) - Madhyam (medium)
Abhyavaranashakti & Jaranashakti - Madhyam (medium)

Systemic Examination
CVS: Heart sounds (S1S2): normal, Respiratory system: normal bilateral air entry, no added sounds.
No abnormality found on other system

Diagnostic Assessment

CBC with ESR (7/3/24)
HB - 12.3 gm/dl
Platelet count - 2.93lakh/cumm
ESR - 24mm

TFT (7/3/24)
T3 - 1.12ng/ml
T4 - 8.31 ug/dl
>TSH - 2.56ulU/ml

Blood sugar (7/3/24)
Fasting - 103mg/dl
PP - 112mg/dl

Hormonal assay (25/02/24)
Sr. FSH - 5.62MIU/ML
Sr. LH - 8.55 MIU/ml
Sr. PRL - 9.56 ng/ml

HAS (09/03/24)
Total sperm count - 60milon/ml
Rapid progressive - 40%
Slow progressive - 20%
Non progressive - 10%
All progressive - 60%
Vitality - 70%
Normal forms - 70%
Abnormal forms - 30%
Pus cell - 2-3 /hpf
Fructose - present

USG report (27\02\2024)
Uterus - 6.1*3.1*4.7cm
Endometrial thickness - 8.7 cm
Right ovary - 5.3*1.3*4.7, volume - 19cc
Left ovary - 3.9*3.6*2.4 cm, volume - 10cc
Impression - bulky bilateral ovarian suggestive of polycystic ovarian morphology.

Samprapti Ghataka (Pathogenic factor)^[4-6]
Dosha - Vata (Apana, Vyana, Samana),
Kapha (Kledaka), Pitta (Pachaka, Ranjaka)
Dushya - Rasa, Rakta (blood), Artav
Agni (digestive fire) - Jatharagnimandya, Dhatwagnimandhya
Srotas (channel) - Artavahasrotas (channels carrying menstrual blood)
Srotodushti - Sanga (obstruction)
Vyaktisthana - Artava, Beejashaya Granthi

Treatment Schedule
In this particular case, main Doshas involved were Vata kapha and there was also Raktha Dushti. So, the Chikitsa adopted were according to the Dosha predominance along with Nidana Parivarjana. On the first visit (7 march 2023) - Her LMP was 23/01/2024.

Drug	Dose
Raj Pravartini Vati	2 Tds (stopped after menses) A/F
Kumaryasava	20 ml bd A/F with equal amount of water
Ajmodadi Churna 2 gm + Tankana Bhasma 250 mg + Sphatika Bhasma 250 mg with honey
Punarnavadi Mandoora	2 Bd

Her second visit on 09/03/2024 with complaining of mild cough) she got menstruation on 9 march 2024.

Kanchnar Guggulu	2 Bd A/F
Punarnavadi Mandoor	2 Bd A/F
Patoladi Kwatha	20 ml Bd B/F
Sitopladi Churna	3gm Bd with honey
Phala Sarpi	5 ml Od with milk

Her third visit on 21 /03/2024 with complaining of disturbed sleep.

Chirabilwadi Kashya	20 ml Bd B/F
Kanchnar Gugglu	2 Bd A/F
Punarnavadi Mandoor	2 Bd A/F
Phalasarpi	5 ml Bd with milk

Her fourth visit on 18/04 /2024 with complain of delayed menses. UPT was suggested, her UPT was positive on 18/04/2024

Result

At the end of the second month of treatment, the patient was satisfied with the results. Patient had got menstruation after one month of medication.

She continued to take treatment in the second month and UPT was done on 14 November 2023 which was found positive. Ultrasonography done on 13^th December 2023 shows single intrauterine early pregnancy of 8 weeks 5 day.

Patient consent: Patient's written approval was taken before publishing this case study in your journal.

Pathya-Apathya^[6-8]
1. Avoid psychological stress.
2. Follow Rajaswala Paricharya during menses.

3. Avoid overly spicy, heavy, baked items, fermented foods, fast food (pasta, peaches, pizza), and cold beverages.
4. Intake more green leafy vegetables (spinach, cabbage, capsicum, broccoli), sesame seeds, flax seeds, fruits (orange, apple, papaya), and jaggery.

Discussion

4 basic elements are necessary such as seed, season, soil & water. Similarly, for Suprajanan i.e., for conception proper functioning of Female reproductive system (uterus & ovary), Menstruation, healthy ovum & sperm are of prime importance. This is called as Garbha Sambhav Samagri. Out of these 4 basic elements Kshetra i.e., Garbhashaya (uterus) should be in good condition. This is very necessary for embedding fertilized zygote in the uterine wall, as well as it should have proper elasticity needed for the growth of the Foetus. The Vatakapha properties of Kanchnar Guggulu, Kashaya (decoction) & Lekhana (scrapping) all contribute to shrinking the cyst size & halting future growth. The regulation of menstruation cycle with use of Kumaryasava. The Kumari is also an ingredient of Rajapravriti Vati, which is indicated in Kashtartva (Dysmenorrhea) & Rajorodha (Amenoorhea).^[8] Phalagrutha helped to bring balance & strength to the menstrual system because it contains anabolic action, it increases more secretary units. This plan of treatment was selected according to principles of Ayurveda along with proper drug, duration, Anupana, Pathya & Apathya, the result were found meticulous.^[3-5]

Conclusion

Patients had conceived within the follow-up period of 3 months. No significant complication is evident during the study. The patient follow-up in AIIA ANC OPD with regular follow up.

References

1. Tiwari P.V, 2003, Ayurvediya Prasutitantra & Stri Roga, Part 1, Chaukhambha Orientalia,

2. Varanasi DC Dutta’s Textbook of Gynecology, 7th Edition, 2016, Hiralal konar.

3. https://ayurmedinfo.com,26/7/2012 World journal of pharmaceutical and medical research,

4. A review towards PCOS in ayurveda, Dr.Muneesh shama www.wjpmr.com Arogyamandir Patrika, April: 2010, Garbhini Visheshank, Vd.Shailesh Nadkarni.

>5. Gyanendra D. Shukla, Shweta Pandey, Anup B. Thakar. Pharmacodynamic Understanding Of Basti: A Contemporary Approach.

6. Evaluation of the role of chitrakadi vati in the management of bhandhyatva w.s.r to anovulation (as a consequence of unruptured follicle). Ibid, Ayurvediya Prasutitantra & Stri Roga, Part 1 Ibid, DC Dutta’s textbook of gynecology

7. https://ayurmedinfo.com,26/7/2012 Ibid, www.wjpmr.com Ibid, Arogyamandir patrika.

8. Gyanendra D. Shukla, Shweta Pandey, Anup B. Thakar. Pharmacodynamic Understanding Of Basti: A Contemporary Approach.

9. T K Priyanka, Role of Shatapushpa Taila oral use in Vandhya w.s.r. to PCOS - Retrospective case series. J Ayu Int Med Sci. 2023; 8(3): 174-177. Available From https://jaims.in/jaims/article/ view/2257

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted

Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Authors state no conflict of interest.	Non Funded.	The conducted research is not related to either human or animals use.		All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

Case Report

Polycystic Ovarian Syndrome

Journal of Ayurveda and Integrated Medical Sciences