Ayurvedic Management of Infertility due to Anovulation- A Case Study

[Find the meaning and references behind the names: Janan, Kumar, Narendra, Mohan, Madan, Meena, Sangeeta, Jan]

Case Report This work is licensed under a CC BY 4.0 License International Research Journal of Ayurveda & Yoga Vol. 6 (1),23-28, Jan,2023 ISSN: 2581-785 X; https://irjay.com/ DOI: 10.47223/IRJAY.2023.6104 Ayurvedic Management of Infertility due to Anovulation- A Case Study Sangeeta 1 ,Narendra Kumar Meena 2 , Diksha khathuria 3 1.PG Scholar, Prasuti Tantra Evum Stree Roga Vibhag , Madan Mohan Malviya Govt Ayurveda College ,Udaipur 2.Associate Professor , Prasuti Tantra Evum Stree Roga Vibhag , Madan Mohan Malviya Govt Ayurveda College ,Udaipur 3.Lecturer , Prasuti Tantra Evum Stree Roga Vibhag Madan Mohan Malviya Govt Ayurveda College , Udaipur INTRODUCTION Polycystic ovary syndrome (PCOS) is an endocrine and reproductive disorder with a prevalence ranging from 5% 1 to 13% 2 in women of reproductive age. PCOS is the primary cause of hyperandrogenism and oligo-anovulation at the reproductive age and is often associated with infertility 3 and clinical and metabolic disorders 4 The prevalence of infertility in women with PCOS varies between 70 and 80%. According to the American Society for Reproductive Medicine, the evaluation of infertility in women with PCOS or other causes of subfertility should start after six months of attempting pregnancy without success if the couple has regular sexual intercourse (2 to 3 times/week) without using contraceptive methods 5 As per the current statistics male infertility problems constitutes 30–40% and Female infertility problems constitutes 40– 55% and both are responsible in about 10% cases. Remaining 10% unexplained 6 A critical evaluation on female infertility shows that ovulatory factors contribute almost 30–40% of the case. Among anovulatory causes of infertility, Poly Cystic Ovarian Syndrome (PCOS) plays a major role 7 Diagnosis of PCOS is based on anovulation, Article Info Article history: Received on: 02-12-2022 Accepted on: 22-01-2023 Available online: 31-01-2023 Corresponding author- Sangeeta, PG scholar, prasuti tantra evum stree roga vibhag , Madan Mohan Malviya Govt ayurveda college ,Udaipur. Email:sangeetabishnoi 0505@gmail.com ABSTRACT: Background: Infertility is the failure to conceive even after one or more years of regular unprotected sexual intercourse. Due to improper life style ,incidence of infertility increases .PCOS is a life style disorder and very common among reproductive age group . Acharya Sushrut explained about Bandhya Yonivya pada where Nashtartava is mentioned as the one and only symptom. In Ayurveda text word Aartava has been used extensively in different contexts; menstrual blood, ovum and ovarian hormones. Therefore Amenorrhea, anovulation, hormonal dysfunction can be considered as visible manifestations of Nashtartva . Material and method: Following is a case report of a female who was anxious to conceive after 3 years of active married life, she had irregular menses. Her USG reports showed polycystic appearance of ovaries .The treatment adopted were to balance vata and kapha . Result: the treatment patient was a known case of infertility due to PCOS and after treatment her PCOS was cured and she conceived . Discussion: Line of treatment was to enhance potency of ovum for ovulation and regularize vitiated Vata Dosha , Shrotoshuddhi and Aartava janan . Conclusion : Ayurveda therapy can be used in patients of infertility due to PCOS for better outcome and no adverse drug effect was noticed. Keywords: Infertility, Vata Dosha, Polycystic ovary syndrome

[Find the meaning and references behind the names: Main, Mala, Mass, Nil, Min, Sama, Ritu]

Sangeeta et al “Ayurvedic Management of Infertility due to Anovulation- A Case Study” : 2023; 6 (1):23-28 24 elevated androgen levels and presence of multiple ovarian cysts on USG finding 8 Most of the time these conditions are presented with signs and symptoms such as obesity, amenorrhea and hirsutism 9 A direct description of Poly Cystic Ovarian Syndrome in classical Ayurveda Texts is not available According to Ayurveda the four main factors involved In the proper conception 10 are described as Garbh sambhav samagri; Ritu (Fertile period), Kshetra (Fertile uterus ), Ambu (nutrition) and Beeja (viable Ovum and Sperm). Absence or abnormality of any of the above factors can lead to infertility. Here Beeja can be referred as healthy ovum and sperm. Speaking of female infertility, Beeja dushti can be considered as ovulatory dysfunction; anovulation. Thus, anovulation is found to be an important factor causing infertility according to Ayurveda. Acharya Sushruta mentioned Nashtartavaas a cardinal symptom of Bandhya Yonivyapada . After discussing about of Asthaartva - dushthi, Nashtartava has been explained separately. In which Artava is not destroyed completely but it is not evident due to obstruction of its channels, as the passage is enclosed by Vata and Kapha and ultimately it results in amenorrhoea. In this particular case if we hypothesize Aartava as ovum then we can consider Nastartarva as anovulation which is an important cause of infertility. CASE REPORT Female patient of age 26 yrs came to OPD of Prasuti tantra evam strirog MMM Govt Ayurved college & hospital , Udaipur with complaints of irregular menses from 5 year ,wanting to conceive from 3 year of active married life and bloating from 1 months History of present illness : K/C/O PCOS for 5 years, was treated by different treatment modalities; Allopathy and Ayurveda as well management for irregular menses .After active married life for 3 years her USG report was suggestive of polycystic appearance of ovaries and in follicular study anovulation was noticed . Now she came to our OPD of Prasuti tantra evam strirog at MMM Govt Ayurved college & hospital , Udaipur Past History: No history of DM/HTN/hypohyperthyroidism or any major medical or surgical history Family History : No history of same illness in any of the family members Occupation: Housewife Menstrual History/Obstetric History: Menarche at: 13 years of age LMP: 03/03/2022 Menstrual Cycle: 1-2 days/irregular menses ,moderate flow sometimes with clots , painless . Married Life:4 years O/H– G 0 P 0 L 0 A 0 Contraceptive History – Nil General Examination Built: moderate , Nourishment: Moderate Pulse: 73 per min , Temperature: 97 F Weight: 68 kg Pallor - Absent , Icterus – Absent Cyanosis – Absent, Clubbing – Absent , Oedema -Absent, Lymphadenopathy- Absent On Examination – P/Asoft no palpable mass , no tenderness P/V Examination – Uterus – anteverted anteflexed. Cervixbulky with cervical motion non tender . P/S Examination - Healthy Cervix Investigation Male partner - Semen analysis :vol-1.5 ml Count- 91.5 million/ml ,motility -59.5 million/ml, normal morphology Female partner – USG (17/2/2019)- B/L PCO Hormonal assay – LH- 8.94 mIU/ml FSH-4.08 mIU/ml Ashtavidhapariksha Nadi (pulse)– VP, Mutra (urine) – Samyakmutrapravriti, Mala(stool)– Sama, Jihwa (tongue)- Sama, Shabda– Samyak , Sparsha (touch)- Ushna, Drika (eye)– Samanya, Aakriti (physical appearance)– Samanya

[Find the meaning and references behind the names: Guna, Sara, Guru, Rasa, Medo, Green]

Sangeeta et al “Ayurvedic Management of Infertility due to Anovulation- A Case Study” : 2023; 6 (1):23-28 25 Dashvidhapariksha – Prakriti (nature)- Vatapittaj, Sara (Purest body tissue) - Madhyama (medium), Samhanana (Body compact) – Madhyam (medium), Pramana (Body proportion)- Madhyam (medium), Satmya (homologation) - Madhyam (medium) , Satva (mental strength) – Madhyam (medium), Vaya(age)- 26 years Plan of treatment ; For 3 months , In shaman chikitsa we give: 1 panchkol churna - 1 gm Punarnawa mandur – 250 mg Baalsudha - 250 mg ½ TSF BD 2 kankayan vati 2 bd 3 dashmool kwath 30 ml bd (empty stomach) 4. erandmuladi taila anuwashana basti -60 ml for 5 alternate days after menses . ADVICE : Green leafy vegetable High fiber rich food Regular exercise and yoga Avoid processed and high calorie food Result : after taking this treatment along with healthy diet and regular exercise her periods become regular . follow up USG reveal normal uterus and ovaries . After one month when she missed her period and her UPT was positive . USG – single live intra uterine fetus, EDD- 8/12/2022. DISCUSSION In this case report, according to history and clinical examination considered as a case of infertility due anovulation(nashtartava), Aratavaha-shrotorodha and apan vata vaiguniya .Hence main line of treatment could be vata kapha shamak, agnidipana, pachaka , vatanulomaka and artavajanak . As per ayurveda classics basti is the best treatment in vatarogas and here we gave basti in follicular phase for the normal beeja nirmana and beejo utsarga (ovulation). Panchkol churna : katu,tikshna ,ushna ,pachak, agnni dipan, kapha - vata nashak ,pitavardhaka ( bhawpraksh ,72- 73) Punrnava mandur - many ingredients of punarnava mandoor have Aampachak, Vata Kapha Dosh Nashak, Ushna , and Teekshna properties and Punarnava have antiinflammatory property, improves appetite, corrects digestive system, removes excess Kapha , balances Kapha and Vata , and corrects anemia 11 Baalsudha : katu rasa, ushna, kaphaghna, vatahara, pittakrut, artvajanan,vishghana, it improves digestion power ,relieves bloating 12 Dashmool kwath : contains Brihat Panchmoola and Laghu Panchmool . The combination of these ten roots is used widely in Ayurveda which acts on Vata doshas . It has Vata Kapha shaman , and Medo nashak properties. Its antiinflammatory and analgesic property is all potent it’s also reduced back pain 13 Kankayan vati : PCOS is represented by menstrual irregularities mainly, which is also included in ashtoartava dushti , It is caused by mainly vata and kapha. In kaankayan vati , all these drugs are having mainly katu-tikta rasa, ruksha, ushna, tikshna gunaas, ushna virya and vata kaphagna doshaghnata Erandmuladi taila :( anuvasna basti): According to Charaka Erand have Bhedniya properties (used for purgation), vrishya and vataharanam , Shushurat have included Erand in Adhobhaghara varg (removes doshas from lower part of body) and in Vata Sanshaman (pacifying vata ), Eranda has been attributed with madhurakatu-kashaya rasa, madhura vipaka and ushna virya; has guru, snigdha, tikshana and sukshma gunas . It pacifies kapha-vata doshas. CONCLUSION : The Ayurvedic approach to infertility due to PCOS was very effective. The treatment protocols mainly aimed to correct menstrual abnormality, correcting hormonal imbalances and producing a healthy ovum. The ayurvedic management was found to be very effective in infertility due to PCOS and the patient got conceived and gave birth to a healthy progeny. Acknowledgments- Nil Conflicts Of Interest- Nil Source of finance & support – Nil ORCID Sangeeta , https://orcid.org/ 0000-0002-6792-9362

[Find the meaning and references behind the names: Sharma, Rajashekar, Silva, Cardoso, Wang, Patil, Motilal, Long, Vieira, Krishna, Yildiz, Rosa, Med, Bharti, Ras, Hum]

Sangeeta et al “Ayurvedic Management of Infertility due to Anovulation- A Case Study” : 2023; 6 (1):23-28 26 REFERENCES 1 The Rotterdam ESHRE/ASRM—Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS) Hum Reprod. 2004;19(1):41–7. doi: 10.1093/humrep/deh 098. [PubMed] [CrossRef] [Google Scholar] 2 Melo AS, Vieira CS, Barbieri MA, Rosa-E-Silva AC, Silva AA, Cardoso VC, et al. High prevalence of polycystic ovary syndrome in women born small for gestational age. Hum Reprod. 2010;25(8):2124–31. doi: 10.1093/humrep/deq 162. 3 Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004;89(6):2745–49. doi: 10.1210/jc.2003-032046. 4 Wang S, Alvero R. Racial and ethnic differences in physiology and clinical symptoms of polycystic ovary syndrome. Semin Reprod Med. 2013;31(5):365–69. doi: 10.1055/s-0033-1348895. 5 Practice Committee of American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril. 2013;99(1):63. doi: 10.1016/j.fertnstert.2012.09.023. 6 Practice Committee of American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril. 2013;99(1):63. doi: 10.1016/j.fertnstert.2012.09.023. 7 Rajashekar L., Krishna D., Patil M. Polycystic ovaries and infertility: our experience. J Hum Reprod Sci. 2008;1:65–72. 8 Azziz R., Woods K.S., Reyna R., Key T.J., Knochenhauer E.S., Yildiz B.O. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004;89(6):2745–2749. doi: 10.1210/jc.2003- 032046. 9 Ferriman d., gallwey jd. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab. 1961;21:1440–1447. doi: 10.1210/jcem-21- 11-1440. 10 Shastri AD, Sushruta Samhita sharir sthana, 2/35 Chaukhambha Sanskrit Sansthan, Varanasi, Edition: Reprint, 2010. Pp.19. 11 Shastri S, Charaka Samhita II, Comm. with vidyotini Hindi commentary Published by Chaukhamba Bharti Academy, Varanasi, pp-501 12 Sharma S, edited by Kashinath Shastri, Ras Tarangini,11 th edn, Taranga 13, Shloka 77 – 78 Varanasi, Motilal Banarasi Das, 1979.pp.318 13 http:// ayurmedinfo.com/ tankanbhasmabenefitsdosage-side-effects ingredients.2012. How to cite this article: Sangeeta, Meena N.K, Khathuria D “Ayurvedic Management Of Infertility Due To Anovulation- A Case Study ” IRJAY.[online]2023;6(1); 23-28 Available from: https://irjay.com DOI linkhttps://doi.org/10.47223/IRJAY.2023.6104

Sangeeta et al “Ayurvedic Management of Infertility due to Anovulation- A Case Study” : 2023; 6 (1):23-28 27 BEFORE TREATMENT

Sangeeta et al “Ayurvedic Management of Infertility due to Anovulation- A Case Study” : 2023; 6 (1):23-28 28 AFTER TREATMENT

Other Health Sciences Concepts:

[back to top]

Discover the significance of concepts within the article: ‘Ayurvedic Management of Infertility due to Anovulation- A Case Study’. Further sources in the context of Health Sciences might help you critically compare this page with similair documents:

Vatadosha, Healthy diet, Vata and Kapha, Reproductive age, Menstrual cycle, Female Partner, Regular exercise, Treatment Protocol, Kapha dosh, Case report, Female infertility, Ayurvedic approach, Ayurvedic Management, Anovulation, Ovulatory factor, Ovulatory dysfunction, USG report, Beeja Dushti, Ovarian cyst, Ayurveda therapy, Polycystic Ovary Syndrome, Panchkol churna, Irregular menses, Healthy ovum, Vata-Kapha Shamak, Nashtartava, Dashmool Kwath, Ayurveda Classic, American Society for Reproductive Medicine, Unprotected sexual intercourse, Uterine fetus.