Ayurvedic Management of Secondary Infertility Due to Polycystic Ovarian...

[Full title: Ayurvedic Management of Secondary Infertility Due to Polycystic Ovarian Syndrome - A Case Report]

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Case Study This work is licensed under a CC BY 4.0 License International Research Journal of Ayurveda & Yoga Vol. 5 (7),123-126, July, 2022 ISSN: 2581-785 X; https://irjay.com/ DOI: 10.47223/IRJAY.2022.5715 Ayurvedic Management of Secondary Infertility Due to Polycystic Ovarian Syndrome - A Case Report Anila.M 1 , Parvathy.S 2 , 1-Anila.M, Assistant Professor, Department Of Prasutitantra And Stree Roga, Govt. Ayurveda College Thiruvanathapuram 2. -Parvathy.S, PG Scholar Department Of Prasutitantra And Stree Roga Govt. Ayurveda College Thiruvanathapuram INTRODUCTION Infertility is a disease of male or female reproductive system defined by the failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse 1 . Ovulatory disorders make up 25% of the known causes of female infertility. Oligo-ovulation or anovulation results in infertility because no oocyte will be released monthly 2 . Polycystic ovarian syndrome represents 80% of anovulatory infertility cases 3 . Polycystic ovarian syndrome is an endocrine disorder characterized by oligoovulation, hyper androgenism, menstrual irregularities, insulin resistance, obesity etc. PCOS accounts for as many as 30% of cases of amenorrhoea. In PCOS Amenorrhoea is associated with chronic anovulation. If ovulation doesn’t occur, endometrium doesn’t uniformly shed and regrow as in a normal menstrual cycle. So, the endometrium becomes thicker and may shed irregularly, which can result in heavy and or prolonged bleeding. In Ayurveda for a healthy conception to happen proper r itu, kshetra, ambu, and bija 4 are necessary. PCOS cannot be directly correlated to an Ayurvedic disease. Its symptoms are often met in conditions like Nastartava, Artavakshaya, Sthoulya, Prameha and Pushpagni jataharini . Here we report a case of secondary infertility due to polycystic ovarian syndrome who came for Ayurvedic management. In this case patient had complaints of irregular menstrual cycle with prolonged bleeding. She was admitted and treated in Govt Ayurveda College hospital for women and children, Poojappura. MATERIALS AND METHODS Patient information 29-year-old women presented with secondary infertility. Her previous pregnancy was 9 yrs back and delivered a Article Info Article history: Received on: 01-06-2022 Accepted on: 21-07-2022 Available online: 31-07-2022 Corresponding author- Parvathy.S, PG Scholar Department Of Prasutitantra And Stree Roga Govt. Ayurveda College Thiruvanathapuram Email: - itzmeparu 744@gmail.com ABSTRACT: Polycystic Ovarian Syndrome is an endocrinological disorder which is common among women of reproductive age. It is the main cause of anovulatory infertility. The main features of PCOS are oligovulation/anovulation, Hyperandrogenism, menstrual irregularities, infertility, insulin resistance, obesity. In Ayurveda symptoms of PCOS are often met in nashtartava, artavakshaya, anapatyata, sthoulya , prameha . Here we report a case of secondary infertility due to PCOS. She was obese and her cycles were anovulatory with heavy bleeding. The patient underwent Panchakarmanusara shodana chikitsa in Govt Ayurveda college hospital, Thiruvanathapuram. The treatment aimed to correct agnimandya , control heavy bleeding, and regularize menstrual cycle. She conceived after treatment and delivered a healthy baby through LSCS. Keywords – Polycystic ovarian syndrome, anapatyata , case report

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Anila. M et. al “Ayurvedic Management of Secondary Infertility Due to Polycystic Ovarian Syndrome - A Case Report” : 2022; 5 (7):123-126 124 female baby through LSCS. Since then, she had irregular cycles with 2- 3 months interval and 10-13 days duration. Also, she started to gain weight. A trans abdominal ultrasound revealed polycystic ovaries. Semen analysis of husband was found normal. Patient was treated with 3 cycles of IUI, but did not result in pregnancy. Thereafter she came for IP management at Govt Ayurveda college, Thiruvananthapuram. Menstrual history Menarche- 11 yrs LMP-06/06/2021 Duration- 13 days Interval between cycles- 2-3 months Dysmenorrheanil Clotsnil Vaginal discharge-nil Obstetric history G 1 P 1 L 1 A 0 LCB- 10 yrs Mode of delivery - LSCS (failed induction) Sexual history Aware of fertile period No post coital bleed dyspareunia - nil Frequency of intercourse- 3-4 times/week Family history Mother and father - DM, HTN Physical examination Height- 155 Weight-107 Kg BMI- 44.5 kg/m 2 Local examination Inspection - No abnormalities in external genetalia P/S Examinationyellowish white discharge from vaginal wall Cervixmid position External os - erosion present P/V Examination- Uterus - retroverted Fornicesfree No iliac fossa tenderness CMT - Negative Investigations Blood on 7/7/2021 FBS-137 mg% PPBS- 228 mg% ESR- 56 mm/hr USS on 22-06-2021 Uterus normal Left ovary contains multiple cysts. b/l PCO pattern. Internal medicines 1) Amrutotharam kasayam - 45 ml-0-45 ml, before food 2) Musalikhadiradi kasayam - 45 ml-0-45 ml, before food 3) Chandraprabha gulika - 1-0-1, with kashaya 4) Pushyanugam churnam - 5 gm twice daily after food with honey 5) Shadharanam choornam - 5 gm twice daily after food for 3 days Procedures done Table 1 - She got her periods on 8/8/2021 with 7 days duration and moderate bleeding. She was discharged on 18.8.2021. Discharge medicines 1 Panchathiktakam kasayam + Musalikhadiradi kashayam - 90 ml twice daily before food 2 Nishakatakadi kashayam - 90 ml at noon before food. 3 Pushyanuga churnam - 5 gm twice daily with honey 4 Nagaradi lepa churnam - external application RESULT She got her next periods on 14/09/2021 with moderate bleeding and 5 days duration. She was advised to continue medicines till next cycle. Next period didn't came on expected date and on check up, her UPT was found positive. EDD by LMP was 21/06/2022. She delivered a female baby on 23/05/2022 through LSCS. DISCUSSION This is a case of Infertility due to PCOS. The patient is obese(class 3), insulin resistant, with clinical features of hyperdrogenism like acanthosis nigricans and hirsutism. Her menstrual cycles were irregular with prolonged bleeding and increased gap between cycles. Here we can apply the treatment principles of Sthoulya, Nashtartava, Prameha, and Asrigdara in Ayurveda. This is a case where there is agnimandya due to improper ahara vihara like sedentary life style, untimely food, excess intake of junk food, meat, curd, cold and unctous food . This agnimandya cause Rasadhatu dushti and affect utharothara dhatu parinama . Agnimandya leads to Ama formation. Lakshanas of Ama in body like debility ( Sadanam), foul smell (durgandha) are seen in this patient. Due to this agnimandya there is Rasadhatu dushti which intern cause Rakta dushti. Rakta dushti is manifested as increased bleeding ( Asrigdara ) during menstrual cycle in this patient. Here medodhatu dushti due to kapha medo vardhaka ahara vihara and Agnimandya is manifested as sthoulya . Agnimandya is contributing to kapha vitiation . This vitiated Kapha dosha cause avarana to artavavahasrotas and result in artavanasha .

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Anila. M et. al “Ayurvedic Management of Secondary Infertility Due to Polycystic Ovarian Syndrome - A Case Report” : 2022; 5 (7):123-126 125 Treatment is aimed to correct Agni thereby causing proper utharothara dhatu parinama . Shodana procedure is needed to eliminate already vitiated dosa . Internally patients was given Amrutotharam kasayam 5 and shadharanam 6 for Ama pachana and agnideepana. Musalikhadiradi kasayam 7 and pushyanuga churna 8 are indicated in pradaram . It helps in preventing excessive bleeding during menstruation seen in this patient. Chandraprabha gulika 9 is indicated in prameha, which has action over basthi pradesha and is effective in artava ruja. Acchasnehapana was given with Gugguluthiktaka Ghrita 10 and M ahathiktakaghrita 11 in equal quantity. medicine was selected by considering prolonged duration of menstruation in patient, obesity, anovulation and insulin resistance. Gugguluthikakam ghritam has Indication in G ulma, Meha, Shopha. Mahathiktaka ghrita has its indication in A srigdara, Gulma. After Sneha Sweda procedures virechana was opted as shodhana procedure. Virechana is directly indicated in yonidosha. Virechana helps in Agnideepana there by correcting Datwagnimandya which leads to proper formation of Rasa dhatu and thereby correcting Raktadushti. Considering vatakapha prakruti of patient G andarva eranda was selected Virechana yoga selected include a combination of nirgundi swarasa, lemon juice, honey, ginger juice along with Gandarva eranda to improve action and palatability. Patrapotala sweda was done for 7 days with murivenna . It is a Sneha sweda procedure which brings dosas vitiated in shakas to koshta . These dosas are eliminated out of body by V irechana with same G andarvaeranda, Nirgundi swarasa combination. Yogavasthi is selected with 3 days V aitharana vasthi and 5 days S nehavasthi with M urivenna . Vasthi is a best treatment choice in vathadosha . Since the Apana vayu is responsible for the menstrual irregularities, vasthi can be adopted. Yonikshalana with T riphalakashaya was done for 7 days. Sthanika chikitsa was advised after shodhana procedures in our classics 12 Triphala has proven anti-microbial property, anti-inflammatory property and antineoplastic property. So, it helped in reducing yellowish discharge and erosion of cervix. Patient conceived after the IP management. Her antenatal period was uneventful and delivered a full-term female baby through LSCS on 23/05/2022. CONCLUSION Ayurvedic management has found to be effective in managing secondary infertility due to PCOS. The treatment procedures helped in correcting agnimandya thereby correcting rasadhatu , raktadhatu , and artavavahasrotas . Panchakarma anusara shodana chikitsa helped in making her cycle ovulatory and thereby correcting her bleeding pattern and bringing about conception. Acknowledgements- Nil Conflict of Interest – None Source of Finance & Support - Nil ORCID Anila. M , https://orcid.org/ 0000-0003-2085-4620 REFERENCES 1.World Health Organisation( WHO) Interntional classical of diseases, 11 th revision (ICD-11) Geneva: WHO 2018. 2.Walker MH, Tobler KJ. Female Infertility. [Updated 2021 Dec 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK 556033/ 3.Melo AS, Ferriani RA, Navarro PA. Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice. Clinics (Sao Paulo). 2015 Nov;70(11):765-9. doi: 10.6061/clinics/2015(11)09. PMID: 26602525; PMCID: PMC 4642490. 4. Murthy K.R.S. Susrutha samhitha sareerasthana 2/33 Choukamba orientalia.Varanasi.2012.pp.26 5.Krishnan KV, Sahasrayogam. Kashayayoga for jwara Vidyarambham publishers, Mullakkal 2013.pp.29 6.Dasji G , Bhaishajyaratnavali 28/10.Chaukambha Sanskrit sansthan. Varanasi 2014.pp.277 7. Krishnan KV, Sahasrayogam. Kashayayoga for Asirgdar Vidyarambham publishers, Mullakkal 2013.pp 101 8.Sharma RK, Vaidya Bhagwan Dash, Agnivesa’s Caraka Samhita chikitsasthana 30/90-96. Chaukambha Sanskrit sansthan. Varanasi.2013.pp.152 9. Murthy K.R.S. Susrutha samhitha Chikitsa sthana 7/40-49 Choukamba orientalia.Varanasi.2012.pp.105 10.Vaidyar PM Ashatanga hrudayam, Chikitsa sthanam 21/57,Devi book stall.kodungallor.2018.pp.603 11. Dasji G , Bhaishajyaratnavali 54/243-249.Chaukambha Sanskrit sansthan. Varanasi 2014.pp.280 12. Murthy K.R.S. Astanga Hrdayam. Choukamba Krishnadas Academy.Varanasi 2012.pp.231 How to cite this article: Anila.M, Parvathy.S Ayurvedic Management Of Secondary Infertility Due To Polycystic Ovarian Syndrome - A Case Report ” IRJAY.[online]2022;5(7); 123-126. Available from: https://irjay.com DOI linkhttps://doi.org/10.47223/IRJAY.2022.5715

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Anila. M et. al “Ayurvedic Management of Secondary Infertility Due to Polycystic Ovarian Syndrome - A Case Report” : 2022; 5 (7):123-126 126 Table 1 Shows Procedures done Procedure Medicine Dose and Duration Snehapanam Gugguluthikthakaghritam Mahathiktaka ghritam Achasnehapana done with starting dose 12 ml each. Maximum dose 100 ml given on 4 th day Abyanga oshmaswedam Murivenna 3 days Virechanam Gandharva eranda 25 ml 1 day Patrapotala Sweda Murivenna 7 days Virechanam Gandharva eranda 25 ml 1 day Yoga vasthi Vaitharana vasthi with Dhanyamlam, Murivenna Snehavasthi with murivenna 100 ml 8 days Yoni Kshalana Triphala kasaya 7 days USG report before treatment USG report After treatment

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