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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 2  |  Issue : 1  |  Page : 40-43

An ayurvedic approach to a case of primary infertility


1 Department of Prasuti Tantra and Stree Roga, Govt Ayurvedic Medical College and Teaching Hospital, Shimoga, India
2 Department of Kayachikitsa - Rasayana Vajeekarana, KAHER's Shri BMK Ayurveda Mahavidyalaya Post Graduate Studies and Research Centre, Belagavi, Karnataka, India

Date of Submission10-Feb-2021
Date of Decision28-Feb-2021
Date of Acceptance02-Mar-2021
Date of Web Publication17-Apr-2021

Correspondence Address:
Swarda Ravindra Uppin
Assistant Professor, Dept of Kayachikitsa - Rasayana Vajeekarana, KAHER's Shri BM Kankanawadi Ayurveda Mahavidyalaya, Post Graduate Studies and Research Centre, Shahapur, Belagavi, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijaim.ijaim_9_21

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  Abstract 


Infertility is a multifactorial condition affecting both partners, of which the female contributes about 40% cases of infertile couples. Of all the various factors, the most frequently contributing factors are those of ovarian and uterine. Polycystic ovarian disease is the most common cause of an ovulatory infertility, being found in 75% of cases. It now proves to be a significant factor in female infertility with the prevalence of 0.6%–3.4% in infertile couples. While uterine or endometrial polyps are one among those that can affect the shape and functioning of the uterus, thereby leading to infertility. On an average, the prevalence of endometrial polyps can vary from 7.8% to 34.9%. The contemporary medical science extends hormonal and surgical intervention as the prime line of the management. Ayurvedic treatment modalities can bypass the surgical management to avoid the related burden and provide a fruitful outcome in such conditions. Here, we present a case of primary infertility with a known polycystic ovarian disease and sonologically diagnosed endometrial polyp. The case was successfully treated with Ayurvedic treatment modalities such as virechana karma, uttara basti, nasya karma, and shaman aushadi. The treatment course resulted in the regression of the polyp, re-established ovulation, and a successful conception with full-term normal labor.

Keywords: An-ovulation, endometrial polyp, infertility, Nasya karma, polycystic ovarian disease, Shaman Aushadi, Uttara Basti


How to cite this article:
Hosur A, Uppin SR. An ayurvedic approach to a case of primary infertility. Indian J Ayurveda lntegr Med 2021;2:40-3

How to cite this URL:
Hosur A, Uppin SR. An ayurvedic approach to a case of primary infertility. Indian J Ayurveda lntegr Med [serial online] 2021 [cited 2021 Jun 18];2:40-3. Available from: http://www.ijaim.com/text.asp?2021/2/1/40/314001




  Introduction Top


Infertility can be defined as a disease of the reproductive system characterized by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.[1] It is estimated that about 10%–15% of the couples of reproductive age face fertility issues. Fertility is a relative aspect affecting both the partners, the male factor affecting 30%–35%, the female 40%, both contributing about 10%–15% and unexplained 10%–15% of the total infertile couples.[2] The various and frequently contributing factors to female infertility are ovarian and ovulation factor, tubal factor, uterine factor, and cervical factor.

Among these, polycystic ovarian disease is the most common cause of an-ovulatory infertility, being found in 75% of cases. Polycystic ovarian disease (PCOD) now proves to be a significant factor in female infertility with the prevalence of 0.6%–3.4% in infertile couples.[3] While uterine or endometrial polyps are one among those that can affect the shape and functioning of the uterus, thereby leading to infertility. On an average, the prevalence of endometrial polyps can vary from 7.8% to 34.9%.[4] However, the actual incidence till date is unknown due to its asymptomatic nature.[5]

Ayurveda, elaborates the four important factors responsible for conception, i.e., rutu, kshetra, ambu, and beeja. Here, kshetra is the garbhashaya, also termed as ”Yoni,”[6] where fertilization and implantation occurs and any abnormality in the yonipradesha will lead in failure to conceive.

Here, we put forward a known case of PCOD and asymptomatic presentation of endometrial polyp which was diagnosed through sonological findings during an evaluation for primary infertility. The condition was successfully treated with Ayurvedic protocol.


  Presenting Concerns Top


A 30-year-old female patient, with a known case of PCOD and complaints of no issues since 5 years, approached the outpatient department of Prasuti Tantra and StreeRoga (Obstetrics and Gynaecology), at KLE Ayurved Hospital, Belagavi, Karnataka, India.

The apparently healthy patient, approached with a marital life of 5 years with a satisfactory sexual life and no H/O contraception or consanguineous marriage. Initially, she had regular menstrual cycles. About a year after marriage, she experienced amenorrhea for 2 months, but urine pregnancy test (UPT) showed negative result. She further consulted a gynecologist and was prescribed oral medication to regularize the cycle. Within the duration of 1 month, she gained about 4–5 kg of weight and also failed to conceive for a period of more than 1 year. She was thus advised ultrasonography (USG) which revealed PCOD and was put on external hormonal therapy to induce ovulation. During this course, the menstrual cycles were regularized and she underwent intra-uterine insemination 4 times with no fruitful outcome. USG was then repeated which revealed the presence of endometrial polyp measuring about 2 mm × 3 mm. The patient refused the routine surgical intervention for polyp, and as no positive outcome was achieved with the on-going treatment, she approached KLE Ayurved Hospital on August 04, 2016 with the above stated complaints.


  Clinical Findings Top


Menstrual history

  • Last menstrual period : August 01, 2016
  • Menstrual history: 4–5 days/28–35 days; regular, no h/o clots, dysmenorrhea, abnormal discharge
  • Married life: 5 years
  • Trying period: 5 years
  • Sexual life: Satisfactory.


General examination

The patient was afebrile with pulse rate 74/min and blood pressure 110/70 mmHg. She was moderately built weighing about 50 kg.

Systemic examination

The findings of the central nervous system, cardiovascular system, respiratory system, and per abdomen were within the normal limits. No any contributing abnormality was noted in the external genitalia. On per speculum examination, normal vagina and healthy cervix were observed. On bimanual examination, the findings exhibit normal sized retroverted uterus, fornices free with no palpable mass, absence of tenderness, and freely movable uterus.


  Diagnostic Focus and Assessment Top


Investigations

  • Hematological tests: Normal
  • Biochemistry tests: Normal
  • Serological tests: Normal
  • Thyroid function test: Normal
  • Urine analysis: Normal
  • USG: (July 22, 2016) Bilateral PCOD with Endometrial Polyp measuring 2 mm × 3 mm with endometrial thickness 6.8 mm
  • Partner profile: Normal.


Diagnosis

K/C/O PCOD and sonologically diagnosed endometrial polyp leading to primary infertility.


  Therapeutic Focus and Assessment Top


[Table 1] showing the details of visits, follow ups and treatment.
Table 1: The details of visits, follow ups and treatment

Click here to view



  Follow-up and Outcomes Top


Before treatment

  • USG: (July 22, 2016) bilateral PCOD with endometrial polyp measuring 2 mm × 3 mm with endometrial thickness 6.8 mm
  • Follicular report: (Post to Virechana karma and Basti).


[Table 2] showing the follicular report before treatment.
Table 2: The follicular report before treatment

Click here to view


After treatment

  • USG: (November 09, 16) No significant abnormality (suggesting the absence of endometrial polyp)
  • Follicular report: (Posttwo cycles of Nasya karma).


[Table 3] showing the follicular report after treatment.
Table 3: The follicular report after treatment

Click here to view


After the third cycle of nasya karma, the couple was advised to have unprotected intercourse, after which she missed her next cycle. UPT on 16/02/17 showed positive result.


  Discussion Top


Infertility is a condition wherein multifactorial involvement is observed. The case presented above had a history of PCOD and recently diagnosed endometrial polyp which was an interfering factor for conception. The condition of PCOD involves the vitiation of vata kapha dosha, thereby affecting the course of arthava, which can be regarded as an initial pathology. PCOD in itself is a variable disease and is marked by amenorrhoea, obesity and occasionally hirsutism, being one of the most common causes of an-ovulatory infertility. The dushita arthava, further can vitiate rakta and mamsa producing an umbrella-shaped muscular sprout in the yoni pradesh (uterus), thereby affecting the normal functioning of uterus.[7] This endometrial polyp can be correlated to yonyarsha[7], and may be asymptomatic,[8] and to some extent contribute for infertility.[9] Theorized mechanisms by which polyps could adversely affect reproductive performance include: Irregular intraendometrial bleeding; inflammatory endometrial response similar to an intrauterine device; an obstructive defect inhibiting sperm transport; a physical surface area effect preventing exposure of the embryo to the endometrium.[10] The contemporary science elaborates the involvement of the estrogen as the polyps are sensitive to this hormone.

Antagonizing the properties of pathological body elements is the basic principle of dosha dhatu viruddha chikitsa. Thus, for the purpose of obtaining Deha-shuddhi, virechana karma[11] was opted. Further, for obtaining Kshetra-shuddhi, Uttarbasti[12] with Varunadi Ghrita[13] was advised which has lekhaniya property and must have helped in resolving the endometrial polyp. Although the patient had been treated for PCOD, the latest follicular study report showed an-ovulatory cycle which can be correlated to the improper development of beeja. For this Nasya karma with Shatavari ghrita[14] was administered. Shatavari is proved to contain phyto-constituents known as phyto-estrogens which help to maintain endogenous harmony, and supports to regulate hormonal secretions. Furthermore, nasyakarma acts on the hypothalamus to regularize the hormonal imbalance. This must have resulted in the appearance of dominant follicle and ovulation, i.e., Prakrutbeeja.

Shamana Aushdi such as Nityanda rasa, Kanchanar guggulu, Chirbilavadi Kashya, and Abhayarista are kapha medo hara dravya possessing lekhaniya property. They act as granthihara and are proved effective in treating various conditions of kshetra from PCOD to endometrial polyp. Phalaghrita[15] is proved to have Garbhasthapaka property.

Thus, the treatment protocol adopted in this case successfully served in establishing a healthy conception by normalizing the underlying hormonal imbalance.


  Conclusion Top


Infertility is a condition which involves impairment in the reproductive hormones which in turn give rise to conditions such as anovulatory cycles and PCOD, and endometrial polyps, as seen in the case presented above. The contemporary medical science extends standard hormonal replacement therapy and surgical management. This can be bypassed by Ayurvedic interventions which are effective in achieving deha and kshetra shuddhi and normalizing hormones to establish a healthy pregnancy. Thus, the Ayurvedic line of treatment can be considered as an effective modality in treating the multiple factors that lead to infertility.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dutta's DC. Textbook of Gynaecology. Konar H, editor. 6th ed. Kolkata: New Central Book Agency; 2013. p. 217.  Back to cited text no. 1
    
2.
Sharma JB. Textbook of Gynaecology. 1st ed. Sirmour (HP): Avichal Publising Company; 2018. p. 206.  Back to cited text no. 2
    
3.
Chandnani K, Jawalkar K. Study the overview of recent management options for polycystic ovarian disease. J Evol Med Dent Sci 2013;2:2364.  Back to cited text no. 3
    
4.
Dreisler E, Sorensen SS, Ibsen PH, Lose G. Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20-74 years, 2009;33:102-8.  Back to cited text no. 4
    
5.
American Association of Gynecologic Laparoscopists. AAGL practice report: Practice guidelines for the diagnosis and management of endometrial polyps. J Minim Invasive Gynecol 2012;19:3-10.  Back to cited text no. 5
    
6.
Tewari P, Ayurvediya Prasutitantra Evam Striroga. 2nd ed., Part. II. Varanasi: Chaukhambha Orientalia; 2012. p. 132.  Back to cited text no. 6
    
7.
Patil VA. Ayurvedic management of uterine Polyp: Acase study. J Biolo Sci Opin 2015;3:139-142.  Back to cited text no. 7
    
8.
Dreisler E, Stampe Sorensen S, Ibsen PH, Lose G. Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20-74 years. Ultrasound Obstet Gynecol 2009;33:102-8.  Back to cited text no. 8
    
9.
Hinckley MD, Milki AA. 1000 office-based hysteroscopies prior to in vitro fertilization: Feasibility and findings. JSLS 2004;8:103-7.  Back to cited text no. 9
    
10.
Silberstein T, Saphier O, van Voorhis BJ, Plosker SM. Endometrial polyps in reproductive-age fertile and infertile women. Isr Med Assoc J 2006;8:192-5.  Back to cited text no. 10
    
11.
Murthy Srikanth KR, Vagbhata's Ashtanga Hridaya, Chowkhamba Krishnadas Academy. 6th ed., Vol. 18. Varanasi: Sutra sthana; 2009. p. 8-10.  Back to cited text no. 11
    
12.
Deshpande AP, Ranade S, Vijnyan D. 1st ed. Pune: Anmol Prakashan; 2004. p. 629.  Back to cited text no. 12
    
13.
English Translation by Dr Rao GP. Bhaishajya Ratnavali of Kaviraj Shri Govind Das Sen. 1st ed., Vol. 2. Varanasi: Chaukhamba Orientalia; 2014. p. 230.  Back to cited text no. 13
    
14.
Magdum S, Jahagirdar S, Hosur A. The Role of Nasya Karma with Shatavari Ghrita in the management of Menopausal syndrome- An open clinical trial; 2014.  Back to cited text no. 14
    
15.
Murthy Srikanth KR. Vagbhata's Ashtanga Hridaya, Chowkhamba Krishnadas Academy. 6th ed. Varanasi: Sutra sthana 34/63-67; 2009.  Back to cited text no. 15
    



 
 
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  [Table 1], [Table 2], [Table 3]



 

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Abstract
Introduction
Presenting Concerns
Clinical Findings
Diagnostic Focus...
Therapeutic Focu...
Follow-up and Ou...
Discussion
Conclusion
References
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