E-ISSN:2456-3110

Case Report

Polycystic Ovarian

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 7 JULY
Publisherwww.maharshicharaka.in

Ayurvedic management of Tubal Block Infertility Associated with Polycystic Ovarian Syndrome: A Case Study

Shindhe RR1*, Naveen V2, Pradeep S3
DOI:10.21760/jaims.9.7.46

1* Roopali R Shindhe, Post Graduate Scholar, Department of Pg Studies in Dravyaguna, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.

2 Naveen V, Associate Professor, Department of Pg Studies in Dravyaguna, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.

3 Seema Pradeep, Professor and HOD, Department of Pg Studies in Dravyaguna, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in women of reproductive age, characterized by hormonal imbalances that cause irregular menstruation and ovarian cysts. A significant but often overlooked complication of PCOS is its association with tubal infertility, resulting from issues such as tubal blockages or dysfunctions, making conception more challenging. Infertility affects roughly 1 in 6 people globally, with about 70% of women with PCOS experiencing infertility, and tubal factor infertility accounting for 25-35% of female infertility cases. This case study examines the management of tubal blockage and PCOS through Ayurvedic treatments. A 36-year-old married woman with a history of PCOS reports no significant issues over the past six years of marriage, with irregular menstrual cycles. Clinical findings from a USG revealed bilateral polycystic ovaries, and an HSG indicated a blockage in the right fallopian tube. This infertility case was treated with a combination of Shodhana and Shamana Chikitsa was given to resolve the underlying Samprapthi from 10/7/2022 to 26/7/2023. After 12 months of treatment, the tubal blockage was resolved, PCOS had decreased, and epileptic attacks were reduced. Additionally, the absence of Reidel's lobe of the liver was noted, and the fatty liver decreased from Grade II to Grade I. The patient received a positive urine pregnancy test result on July 26, 2023, and gave birth on June 6, 2024. In this instance, Ayurveda demonstrated its reliability in treating infertility and PCOS, offering effective and holistic methods for managing these conditions.

Keywords: Tubal Block Infertility, Polycystic Ovarian Syndrome (PCOS), Vandhyatva, Ayurveda

Corresponding Author How to Cite this Article To Browse
Roopali R Shindhe, Post Graduate Scholar, Department of Pg Studies in Dravyaguna, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.
Email: 		Shindhe RR, Naveen V, Pradeep S, Ayurvedic management of Tubal Block Infertility Associated with Polycystic Ovarian Syndrome: A Case Study. J Ayu Int Med Sci. 2024;9(7):293-300.
Available From
https://jaims.in/jaims/article/view/3421

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-05-15 2024-05-26 2024-06-06 2024-06-16 2024-06-26
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.98

© 2024by Shindhe RR, Naveen V, Pradeep Sand 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

Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder affecting women of reproductive age, characterized by hormonal imbalances that can lead to irregular menstruation, anovulation, and the development of multiple small cysts on the ovaries. One of the lesser-known complications of PCOS is its association with tubal infertility, where the fallopian tubes are affected either directly or indirectly due to chronic hormonal disruptions.[1]

Tubal infertility, resulting from conditions like tubal blockages or dysfunction, poses significant challenges to conception, even in the absence of ovarian abnormalities commonly associated with PCOS. Understanding relation between PCOS and tubal factors is crucial in managing infertility in affected individuals, as it demands a multifaceted approach to treatment.[2]

Infertility impacts approximately 1 in 6 people globally of reproductive age, with consistent prevalence across diverse economic settings. This widespread health concern affects about 17.5% of adults worldwide.[3]

In India, infertility is estimated to affect 10% to 15% of the population, including both primary and secondary infertility cases. Among women with PCOS, infertility affects roughly 70%, while tubal factor infertility accounts for 25-35% of female infertility cases.[4]

Overall, PCOS is a major public health concern due to its impact on fertility and the associated long-term health complications. Addressing this condition requires awareness, proper diagnosis, and effective management strategies tailored to different populations.

In this case study, tubal blockage and PCOS were managed through treatment strategies that included Shodhana (cleansing therapies), a combination of Shamana Aushadhi (palliative medications), and the use of some Ekamoolika Dravyas (single herbs).

In Ayurveda, infertility is explained as Vandhyatva. Susrutha explained factors responsible for successful pregnancy (Garbha Sambhava Samagri) in detail. They are Rithu, Kshetram, Ambu, and Beejam. Any abnormality in any of these four can lead to infertility. Rithu stands for the fertile period in the cycle.

Kshetram represents healthy reproductive organs. Ambu represents proper nutrition after fertilization. It can be correlated with corpus luteal function up to the establishment of the placenta and then onwards placental function. Beejam stands for healthy ovum and sperms.[5]

Acharya Charaka opines that Soumanasyam (peaceful mind) is the best remedy for getting a progeny.[6] So psychological factors are also important in conception. Arunadatta comments ‘Dimbamsyat Drakta Mamsasya Prasaadaadaantra Sambhava’. The ovary is taken as Kosthnga by the name Dimba or Dimbham, formed from Rakta and Mamsa.[7] PCOS symptoms can be correlated with conditions like Dimba Roga, Jatiharini, Vataja Artava Dusthi, Artava Kshaya, Ksheenartava, etc.

In this case study, tubal blockage and PCOS were managed through treatment strategies that included Shodhana (cleansing therapies), a combination of Shamana Aushadhi (palliative medications), and the use of some Ekamoolika Dravyas (single herbs).

Case Study

Patient Information

A 36-year-old married woman from Hebbal, Bangalore, Karnataka, visited a private clinic on [31/6/2022] for primary infertility. She had previously experienced two pregnancies, both resulting in abortions (G2A2).

Chief Complaints

  • No issues noted in the past six years of married life.
  • Complaints of bloating, reduced appetite, increased weight (95 kgs), anxiety, irritation, and fear for the past year.

Medical History

  • PCOS: Since 13 years.
  • Epilepsy: Since 10 years, under medication (Levacetum 500mg: (1-0-1) A/F)
  • Not a known case of diabetes, thyroid, hypertension.

Menstrual History

  • Menarche: 12 years
  • Irregular Cycles: Present for the past six years with a frequency of 30-60 days and a length of 7-10 days.

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  • Spotting noted in between the cycle for 5-10days.
  • Last Menstrual Period (LMP): 10/02/2021
  • Amount of Bleeding: Heavy, with 6-7pads/day on Day 1, 5-6 pads/day on Day 2, and 4-5 pads/day on Days 4 and 5.
  • Clots: Present on Days 1 and 2.
  • Dysmenorrhea: Mild.

Marital History

  • Marital History: Since 2016
  • Married age: 26 years

Personal History

  • Bowel: Regular
  • Appetite: Good
  • Bladder: Regular
  • Sleep: Normal
  • Allergy: None
  • Food Habits: Consumes junk foods, fried food, pastries, and ice cream.

Past Illness: None reported.

Diagnostic Assessment

Transvaginal Scan: 2nd day of period

B/L features of PCOS seen

  • 30Gfs <1cm
  • ENDOMETRIUM: 4mm
  • POD: Clear

Hysterosalpingography (HSG) (21/1/22)

  • No spillage seen on right side.
  • Impression: Right tubal block

Ultrasonography: (4/4/22)

  • B/L polycystic ovaries
  • Reidel’s lobe of liver
  • Grade II fatty liver

Treatment History

The patient underwent conventional treatments, including two cycles of intrauterine insemination (IUI) and hormonal therapy, both of which were unsuccessful. Hence, approached the clinic on June 31, 2022, for further assistance.

SNTreatmentNumber of days
1.Udvartana 7 days
2.Vamana 16 (including Samsarjana Krama)
3.Internal Medication (Shamana Aoushadi)4 months
4.Virechana 16 (including Samsarjana Krama)
5.Internal Medication (Shamana Aoushadi)4 months

Treatment Plan and Timeline

A combination of Shodhana and Shamana Chikitsa was utilized to address the complexity of the case and to resolve the underlying Samprapthi.

SNTreatmentMedicines usedNumber of daysCommencement of treatmentCompletion of treatment
1.Udvartana Triphala, Devadaru, Haridara7 days10/7/2217/7/22
2.Vamana Deepana -Pachana Hinguvastaka Churna (½ Spoon with  Ghritanna)3 days20/7/22 - 6/8/22
RookshanaContinued with Pathya (Yava, Takra, Upma)2 days
Snehapana Varunadi Ghritha4 days
Vishrama KaalaBanana, Curd Rice, Dahi Vada, Payasa1 day
Vamana Ksheera, (Akantapaana)
Madanapippali-10gm,
Yastiphanta,
Saindava Jala		1 day
Samsarjana
Krama 		Anna Peya, Vilepi, Yavagu5 days

Shamana Aoushada given after Vamana

SNMedicinesTreatment/formulationDoseAnupanaCommencementCompletionDuration
1.Kanchanara Guggulu 2-0-2 (after food)With Varunadi + Sukumara Kashaya15/8/22 - 20/12/224 months
2.Varunadi Kashaya 20ml-0-20ml (after food)With equal warm water
3.Sukumara Kashaya20ml-0-20ml (after food)With equal warm water
4.Brahmi GhritaPratimarsha Nasya 2drops - 0 - 2drops
Early morning and night 

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Virechana

ProcedureTreatmentIngredientsNumber of daysCommencement - Completion of treatment
Virechana Deepana -Pachana Musta-Shunti Jala3 days5/3/23 - 21/3/23
Snehapana Maha Kalyanaka Ghritha4 days
Vishrama KaalaGanji, Pongal With Pomegranate-1 Each Day
Lemon Juice		3 days
Virechana Trivrut Lehya - 50gm1 day
Samsarjana Krama Laja Peya, Anna Manda, Vilepi, Yavagu5 days

Shamana Aoushada given after Virechana

SNMedicinesTreatment/formulationDoseAnupanaCommencementCompletionDuration
1.Bhrami TailaShiro Pichu Alternate days-25/4/23 - 26/8/234 months
2.Bhrami Ghritha Pratimarsha Nasya0 - 0 - 2drops
Night (Nishi Kaala)
3.YastimadhuKsheerapaaka 50ml-
4.Yastimadhu +Shatavari KsheerapakaKsheerapaaka50ml-
5.Shatavari (rub the fresh root with milk on stone)Lehya 1tspMilk
6.Mahakalyanaka GhrithaGhrita 2tspYasti+Shatavari Ksheerapaaka

Lifestyle Modification (Based on Dinacharya)

  • Regular Yoga practice: 1 hour each morning
  • Abhyanga: Every morning before taking bath
  • Consuming Satmya Pathya Ahara (healthy food)
  • Reading books: 1 hour per day
  • Dhyana/Deva Nama Japa: 30 minutes each early morning and before bedtime
  • Pada Abhyanga: performed at bedtime

Observations and Results

  • No spotting observed
  • Regularisation of periods with frequency of 30-35days
  • No clots present.

Ultrasonography (27/3/23)

  • Grade I Fatty liver
  • Mild polycystic pattern of both ovaries

Hysterosalpingography (Hsg) (21/4/23)

  • Both tubes are patent with good spillage.
  • IMPRESSION: Right tubal block.

Hsg Report

Before Treatment
jaims_3421_01.JPG

After Treatment
jaims_3421_02.JPG


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Pregnancy Report

  • Last Menstrual Period (LMP): June 26, 2023.
  • Urine Pregnancy Test (UPT): Positive on July 26, 2023.
  • Ultrasound (USG) Report: November 7, 2023.
  • Estimated Due Date (EDD): June 1, 2024.

jaims_3421_03.JPG

Discussion

PCOS is a disorder involving Kapha-Pitta Doshas, Rasa, Medo, Shukra (Arthava) Dhatu and Rasa, Rakta, and Artava Vaha Srotas.[8] Formulations Such as Hinguvashtaka Churna, Kanchanara Guggulu, Varunadi Kashaya, and Ghritha are used, Especially after Vamana. These formulations predominantly feature Katu-Tikta-Kashaya Rasa, Ushna Virya, and Katu Vipaka, with common actions of Kapha-Medohara and Lekhaniya Karma. Research has shown that these formulations can regulate hormonal levels and enhance menstrual regularity. Additionally, their anti-inflammatory properties aid in reducing inflammation, improving insulin resistance in PCOS by boosting metabolism.[9]

They also help in lowering cholesterol levels, which is beneficial for women with PCOS who often struggle with lipid metabolism and obesity.[10] The detoxifying effects can help clear blockages in the reproductive organs, potentially boosting fertility.[4] Furthermore, the antioxidants in these formulations reduce oxidative stress and are associated with improved fertility outcomes.[11]

Additionally, Sukumara Kashaya helps with PCOS and infertility by regularizing menstrual cycles, which improves ovulation and boosts fertility.[12] It also enhances blood circulation to the reproductive organs, providing better nourishment, reducing period cramps, and improving overall reproductive health.[13]

Mahakalyanaka Ghritha was administered as both Shodhana and Shamana Aushadi due to its effectiveness in treating both Vandhyatwa (infertility) and Apsmara (epilepsy).[14]

It contributed to reducing epileptic attacks, alleviating anxiety and fear, and enhancing fertility. Research indicates that it has neuroprotective effects, providing a calming and stabilizing impact on the nervous system, and improves fertility by enhancing the quality of reproductive tissues and overall reproductive function.[15]

Shodhana procedures like Udvartana and Vamana can effectively balance hormonal levels and alleviate symptoms of PMS and PCOS by improving insulin resistance, boosting metabolism, managing weight, and enhancing overall reproductive health.[16] These therapies address tubal blockages through Sroto Shodana, Deha and Kshetra Shodhana, and strengthening the Dhatus and Beeja.[17]

Kashyapa states that Akarmanya Beeja, which is associated with anovulation, is best treated with Virechana. He quotes "Beejam Bhavathi Karmukam," meaning that Virechana enhances effectiveness or trajectory outcome of the action of the Beeja (sperm and ovum). As a result, it positively affects germ cells and improves their quality.[18]

Yastimadhu: (Shonithasthapana, Medhya Rasayana) was given in the form of Ksheerapaaka. Yastimadhu is known for its adaptogenic properties, which help in balancing hormones.[19]

It has phytoestrogens that can mimic the action of estrogen, thus potentially aiding in the regulation of menstrual cycles and improving ovulation and help to ease symptoms of PMS and PCOS. It helps in maintaining a healthy endometrial lining, which is essential for implantation and successful pregnancy.[20]

Shatavari: (Vrushya, Rasayana). Shatavari is renowned for its uterine tonic properties. It strengthens the uterine muscles and enhances the endometrial lining, which is crucial for implantation and sustaining pregnancy.[21]

The mucilage in Shatavari tones and protects the mucous membranes of the cervix, helping it produce sufficient mucus to facilitate sperm and egg fertilization.[22]


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Bhrami: (Prajasthapana, Medhya Rasayana)was given in form Ghritha and Taila. Brahmi rich in antioxidants like bacosides supports reproductive health by reducing oxidative damage and alleviating psychological stress, which in turn decreases oxidative stress. It helps regulate hypothalamic-pituitary-ovarian axis and supports ovulation.[23]

Initially, Shamana Aushadis used before and after Vamana, with Lekhaniya properties, helped reduce weight, leading to a decrease in the size and number of cysts, alleviation of inflammation in the reproductive organs, and clearance of blockages in the fallopian tubes. After Virechana, Rasayana Dravyas, known for their nourishing qualities, were chosen to support the maintenance of the endometrial lining, essential for implantation and successful pregnancy. Additionally, these Dravyas, with their Rasayana and Medhya effects, also contributed to a reduction in epileptic episodes.

Conclusion

Treating the present case with necessary Shodana (purification therapies), along with Ekamoolika Dravyas (single-herb formulations), and incorporating counselling and lifestyle modifications facilitated Samprapti-Vighatana (breaking the pathogenesis) by promoting Aartavajanana (enhancement of menstrual function), Sroto Suddhi (purification of channels), Kshetra Suddhi (purification of the reproductive organs), and Prajasthapana (promoting fertility).Regular monitoring and patient adherence to the treatment plan were essential for achieving successful outcomes. Tailoring treatments according to the patient's progress ensured effective therapy. Following 12 months of treatment, the patient found a positive urine pregnancy test result on July 26, 2023 and gave birth on June 6, 2024. In this instance, Ayurveda demonstrated its reliability in treating infertility and PCOS, offering effective and holistic methods for managing these conditions. Ayurveda also holds potential for further adaptation to address similar cases in the future.

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