Featured Case

TITLE OF CASE

Ayurveda Management of primary infertility associated with Polycystic Ovarian Syndrome (PCOS): A case report.

Dr Asmabi

ABSTRACT

A 35-year-old female complained of inability to conceive even after 14 years of regular unprotected sexual life. She was also having menstrual irregularities- 5 days menstruation with an interval of 2 to 3 months for the next cycle to begin. Since menarche at the age of 14, she always had irregular cycles. At the age of 16, her menstrual cycle became regular. She was married at the age of 21, and since then she underwent 13 years of hormonal treatment and 5 attempts of Intra Uterine Insemination. The results were disappointing. It was at the age of 28, that the diagnosis was confirmed with USG abdomen and pelvis as Polycystic ovarian syndrome. She decided to try Ayurveda and approached Dr Asmabi in 2020. The biomedical diagnosis was Primary infertility associated with PCOS. The Ayurvedic diagnosis was Vandhyatva associated with nashtartava caused by avarana of artavavavaha srotas, kapha medodushti and srotorodha. The treatment was planned at removing the srotorodha of Artavavaha srotas. Her Last Menstrual Period recorded was 11/08/2020. After 3 months of Ayurvedic treatment, the patient conceived with LMP of 26/11/2020. She delivered a full-term female baby on 2/09/2021 through LSCS.

KEYWORDS

Primary infertility, Vandyatwa, Nashtartava, Ayurveda, Case report, Standalone

INTRODUCTION

Healthcare providers consider a couple infertile if they try but fail to get pregnant within one year. When the woman is older than 35, the amount of time trying to conceive drops to six months for an infertility diagnosis. In women over 40, immediate evaluation is warranted. Infertility does not include miscarrying or being unable to carry a baby to childbirth.

Diagnostic criteria: Ovulation testing, Hysterosalpingography, Ovarian reserve testing, Other hormone testing, Imaging tests, Hysteroscopy, Laparoscopy.

Treatment: Stimulating ovulation with fertility drugs, Intrauterine insemination (IUI), Surgery to restore fertility, and assisted reproductive technology (ART) are some of the commonly followed treatment protocols.

Prognosis: Approximately 9 out of 10 couples get pregnant after undergoing fertility treatments. Success rates vary depending on the cause of infertility, the couple’s ages and other factors. In general:

•           Each IUI attempt has a 20% success rate.

•           An estimated 1 in 2 women under the age of 35 conceive with ART. That number drops to 1 in 30 women (3%) for women in their early to mid-40s.

PATIENT INFORMATION

A 35-year-old female complained of inability to conceive even after 14 years of regular unprotected sexual life. She was also having menstrual irregularities-  5 days menstruation with an interval of 2 to 3 months for the next cycle.

Medical History:  She attained menarche at the age of 14, and her menstrual cycle was always irregular. However, the menstrual cycle became regular  at the age of 16. After getting married at the age of 21, over a period of 14 years, she underwent hormonal treatment and Intra Uterine Insemination 5 times. But the results were disappointing. So she consulted Dr Asmabi.

CLINICAL FINDINGS/PHYSICAL EXAMINATION

The patient was medium built with a BMI of 26. There was clear evidence of acanthosis nigricans on the neck and hirsutism with prominent hair growth on the chin and upper lip during physical examination. As per vaginal and speculum examination, the cervix was moderately healthy, and mild discharge was noticed. USG reports showed both ovaries were bulky with a PCOS pattern and increased central stroma.

TIMELINE

Image 1. Timeline of events is attached below

 

DIAGNOSTIC ASSESSMENT

Modern Diagnostic parameter: USG abdomen scan and pelvis confirmed PCOS. Based on the medical history taking and clinical evaluation, the biomedical diagnosis was made as primary infertility due to PCOS.

Image 2. Proof document of biomedical diagnosis added below

Image 3. USG scan of abdomen and pelvis dated 16.3.2013 added below

Ayurvedic Assessment was done based on the clinical evaluation by the ayurvedic physician.

Differential Diagnosis- This does not apply as the patient came in with a definite diagnosis.

Prognosis- Primary infertility is a condition that is caused due to several reasons. One primary reason for its occurrence is PCOS which can be cured if detected early. Intrauterine insemination (IUI) may be conducted as a first-line treatment other than oral medications in such situations. The pregnancy rate (PR) chances are 20% when IUI is done. Here, the patient conceived just after three months of Ayurveda treatment. Both mother and child are healthy.

THERAPEUTIC INTERVENTION

See the tab ‘Treatment details’

FOLLOW-UP AND OUTCOMES

Clinician-based assessment; After 3 months of ayurvedic treatment patient conceived with LMP 26/11/2020. She delivered a full term female baby on 2/09/2021 through LSCS. 

Image 4. A follicular study dated 2020 is added below

Image 5. Scan reports of intrauterine fetal growth are added below

Patient-assessed; Not relevant.                

Intervention adherence and tolerability – The patient adhered to the prescribed treatments and tolerated the treatments well.

Method of assessment- By monitoring the patient.

Adverse and unanticipated events; None reported.

DISCUSSION ;

The Nidana attributed could be Avyayama and intake of excess Abhishyandi Ahara leading to Kapha Medo Dushti and Srotorodha. Here the movement of Vata especially Apana Vata got obstructed by the increased Kapha which in turn obstructed the natural functioning of Artava also. The ultimate aim of the treatment was to release the obstructed Vata so as to execute its normal functions in the Koshṭa, especially in Garbhashaya. The obstruction was because of the accumulated Kapha in the channels of Vata, especially in Artavavavaha Srotas. Saptasara Kashaya in combination with Chandraprabha Vati was given the first time during the OP visit. Kumaryasava and Dasharatha are Artava janaka and nourish the endometrium. Once the expected outcome from Purva karma is obtained, it was decided to move to the next phase- Shodhana therapies. As Kapha and Meda became the key factors for the development of the disease, it was decided to go for a Ruksana procedure as a preliminary step. Udvartana along with Takrapana was Kapha medonashana. The next step was Snehapana with plain Sukumara ghrita and Pippalyadi Anuvasana taila which became the ideal medicine for Snehana in the conditions where the predominance of Kapha and Vata were present. It was decided to do virecana by using Gandharva hastadi eranda taila. On the next cycle during pre-ovulatory time Lekhana vasti, and Uttara vasti were done.

PATIENT’S PERSPECTIVE

Not available.

LEARNING POINTS/TAKE-HOME MESSAGES

The couple had a stressful life due to inability to concieve since 14 years of married life. The results were disappointing with all the conventional treatments done. And finally, they approached Ayurveda to address this condition. The female infertility was managed with several treatment procedures, and after three months of treatment, the patient conceived and gave birth to a healthy baby girl. Ayurveda treatment can be considered an option in the case of primary infertility with a long medical history of PCOS.

INFORMED CONSENT

Written consent obtained from patient to publish the case report.

CONFLICT OF INTEREST

None declared.

 

FUNDING

None

Image 1. Timeline of events is attached below

Image 2. Proof document of biomedical diagnosis added below

 

 

Image 3. USG scan of abdomen and pelvis dated 2015

 

Image 4. A follicular study dated 2020 is added below

 

Image 5. Scan reports of intrauterine fetal growth are added below