ISSN: 2322 - 0902 (P)

ISSN: 2322 - 0910 (O)

International Journal of Ayurveda
and Pharma Research

Case Study

A CASE REPORT ON AYURVEDIC MANAGEMENT OF SECONDARY INFERTILITY

Anila.M1, Sruthi Krishnan2*
1Assistant Professor, *2PG Scholar, Department of Prasutitantra and Streeroga, Government Ayurveda College,

Thiruvananthapuram, Kerala, India.

Article info ABSTRACT
Article History: Secondary Infertility is defined as the inability to conceive following at least one prior
Received: 22-01-2023 conception. Ovulatory dysfunction contributes 30-40% of infertility. Polycystic ovarian
Revised: 07-02-2023
syndrome is a common endocrinopathy typified by oligo/anovulation, signs of androgen
Accepted: 18-02-2023 excess, and multiple ovarian cysts. In Ayurveda, Vandhyatha (infertility) is considered as a
KEYWORDS: complication of Yoni vyapath and is also considered as Artavavaha srotodushti lakshana. This
Secondary is a case report of 30 years old lady complaining of inability to conceive a second child, heavy
Infertility, menstrual bleeding and curdy white discharge per vagina associated with itching. On USG,
Vandhyatha, she was diagnosed with Polycystic Ovarian Syndrome. She also had severe allergic
PCOS, complaints and skin rashes. In this case treatment was given primarily to correct the Rakta
Asrgdara, dushti which was causing Artava dushti in the form of excessive bleeding. For that, initially in
Upapluta. the bleeding phase, medicines for Rakta sthambana were given and after the stoppage of
bleeding, medicines were given for correction of Rakta dushti. After achieving the menstrual
regulation, the patient was given medicines for Vata kapha dushti for treating her Upaplutha
condition. For the management of Yoni roga, she was given Sthanika karmas (local
treatment) Yoni dhawana and Yoni pichu. Also local application of Nalpamaradi keram was
done to reduce her vulval itching. The outcome of the treatment resulted in conception and
delivered a full term female baby. So the present case signifies the effect of Ayurvedic
management in the field of infertility.

INTRODUCTION
According to WHO, Infertility is a condition of manifestation of androgen excess and other endocrine
male or female reproductive system defined by the dysfunction. Menstrual dysfunction (Artava dushti)
failure to achieve a pregnancy after 12 months or more may range from amenorrhea (Nashtartava) to
of regular unprotected sexual intercourse.[1] It can be oligomenorrhea (Artavakshaya) to episodic
primary or secondary. Primary infertility is when a menometrorhagia (Asrigdara). Women with PCOS may
pregnancy has never been achieved by a person, and have heavy and unpredictable bleeding and instability
secondary infertility is when at least one prior of thickened endometrium. Genitotract infections
pregnancy has been achieved. It is a multifactorial frequently occur in females of reproductive age group
condition and may be due to ovulatory dysfunction and are strongly associated with increased morbidity,
(30-40%), tubal factors (25-35%), uterine factors pelvic inflammatory diseases and can lead to infertility.
(10%), cervical and vaginal factors (5%) and the According to the concept of Ayurveda, Ritu
endometrial factors (1-10%).[2] Among the ovulatory (fertile period), Kshetra (reproductive system, Artava
dysfunction, PCOS is the primary cause which is vaha srotas), Ambu (nourishment) and Beeja (ovum
characterized by menstrual irregularities, and sperm) are the primary factors for fertility.[3] In
Access this article online Acharya’s opinion, specific etiologic factors which
Quick Response Code delays conception includes Yoni pradosha, Manaso
https://doi.org/10.47070/ijapr.v11i2.2698 abhitapa, Asrug dosha, Ahara-vihara dosha, Akala yoga
and Bala samkshaya.[4] All Yonivyapads (gynecological
Published by Mahadev Publications (Regd.)
publication licensed under a Creative
disorders), if not treated properly can lead to
Commons Attribution-NonCommercial- infertility.[5] Artava dushti which includes
ShareAlike 4.0 International (CC BY-NC-SA 4.0) abnormalities of ovum, ovarian hormones and
menstrual irregularities also lead to Vandhyatha
(infertility).
IJAPR | February 2023 | Vol 11 | Issue 2 78
 Anila.M, Sruthi Krishnan. A Case Report on Ayurvedic Management of Secondary Infertility
Case Report  Micturition- H/o recurrent UTI
A 30 yr old lady with a complaint of inability to  Sleep – Increased (she had a history of intake of
conceive a second child attended the outpatient medicines for insomnia for 3 yrs due to the night
Department of Prasutitantra and Streeroga, shift in hospital)
Government Ayurveda College, W&C hospital,  Occupation - Nurse
Poojappura, Thiruvananthapuram. Detailed history  Allergy- A k/c/o multiple drug allergy (allergic to
showed that she had her menarche at 13 yrs and taxin, paracetamol, rantac), cotton allergy
periods were regular up to marriage. She married to (including cotton pads, mask), Dust allergy
NCM of 31 yrs at her 23 yrs. Her first conception was (sneezing++), allergic to certain anaesthetics
after 3 months of marriage. Antenatal period was (xylocaine), allergic to stitching thread, allergic to
eventful. As there was no fetal pole and cardiac Cream, Dettol and Soaps.
pulsations visualized in the TVS scan corresponding to  Diet - Non vegetarian food preferred
6 weeks, there was a chance of missed abortion, and Daily Intake of fried fish, broiler chicken
doctor advised for termination of pregnancy, for which Intake of oil fried snacks – puffs, Chips etc
the patient didn’t give her consent and she continued Occasional use of refrigerated water, soft drinks,
her pregnancy and was under progesterone tablets. In ice creams, junk foods (burger, pizza, parotta)
16 weeks of pregnancy, she had severe cough and Skipping of breakfast occasionally
breathing difficulty and took symptomatic treatment. Family history
She delivered a male baby of 3kg birth weight through  Mother – 4 recurrent pregnancy losses
LSCS (Preterm-28 weeks). After 3 months of delivery, Known case of thyroid dysfunction,
she had her periods which lasted for 10-12 days with hyperlipidaemia
bleeding along with clots. She had spotting throughout Done hysterectomy at 37 yrs due to multiple cysts and
the next month & blood stained discharge occasionally. fibroids
She also had complains of severe lower abdominal pain  Sister – H/o an abortion, now under allopathic
and acne during her periods and gradual increase of treatment for infertility (due to PCOD)
body weight. After 3 months, she was diagnosed with  Father’s Sister – H/o 7 yrs of infertility
PCOD on USG. She took continuous allopathic Marital History
treatment for 2 years for the same and was advised  Married since 9 yrs (August 2013)
laparoscopic drilling. Patient also had a complaint of  Female – 23yrs
curdy white discharge per vagina after delivery,  Male – 31 yrs (NCM)
associated with foul smell and severe itching. She had a  First child conceived after 3 months
history of recurrent urinary tract infection. She was a Obstetric History
known case of multiple drug allergy including Taxin,
 P1 L1 A0
Paracetamol, Rantac. Also allergic to Cotton (including
 LCB –7 yrs
cotton pads, mask), Dust, certain anaesthetics
 Antenatal period was eventful
(xylocaine), Stitching thread, Cream, Dettol, and Soaps.
 Early pregnancy scan(Corresponding to 6 wks)–
History of past illness
no fetal pole and cardiac pulsations found,
 Skin allergy (occasionally) gestational sac only
 Dengue fever (1 yr back)  Chance of missed abortion – suggested for MTP;
 Pneumonia (2 yrs back) continued pregnancy
 Asthma (2 yrs back)  In 16 wks– H/o severe cough and breathing
 Migraine (2 yrs back) difficulty
Menstrual history  LSCS done – Preterm (28 weeks), cervical dystocia
 Duration: 10-12 days  Sterilization not done
 Interval: Irregular (AUB – Menometrorrhagia) Sexual History
 Allergic to pads and cotton –Tampons used  Dyspareunia: Nil
 Bleeding: Excessive (tampon change every 3hrs)  Post coital bleeding: Nil
 Clots: ++  Vaginal dryness: Nil
 Tampon Change 3-4 times  Aware of fertile period
 Dysmennorhoea: Lower abdominal pain ++(D1-  Frequency of coitus – 2-3 times /week
D3) Male Partner
 LMP- 22/3/2021  No h/o mumps, chicken pox, vericocele.
 PMP-1/3/2021  All the seminal parameters were within normal
Personal History limit
 Bowel- Regular
 Appetite- Normal range
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 Int. J. Ayur. Pharma Research, 2023;11(2):78-83
Investigations  No abnormal growth or polyp
 Routine blood and urine Investigations done were P/V examination
within normal limits. Thyroid function tests found  Uterus – normal size, anteverted, mobile
to be normal.  No cervical motion tenderness
 USG- Both ovaries showed multiple small  Fornices free
peripheral follicles appear like PCOS.  Iliac fossa tenderness - absent
 PAP smear-Negative for intraepithelial lesion or Ashtavidha pareeksha
malignancy and there was presence of  Nadi: Sadharanam
inflammation.  Mutram: Anavilam
General examination  Malam: Abadham
Built: Overweight  Jihwa: Anupaliptham
Nourishment: Well nourished  Sabdam: Spashtam
Weight: 65 kg  Sparsham: Seetham
Height: 157cm
 Drik: Prakrutham
BMI: 26.37kg/m2
 Akrithi: Sthoola
HR: 82/min
Dasavidha pareeksha
PR: 84/min
 Dooshyam: Rasa Raktha Meda Arthava
BP: 120/80mmhg
 Desham: Deham - Garbhasaya, Bhumi - Sadaranam
Gynaecological Examination
Local Examination  Balam: Madhyamam
Inspection  Kalam: Kshanadi -Sarvarithu Vyadhyavastha -
 Vulva – Normal Purana
 Labia – normal  Analam: Vishamam
 Curdy white discharge present externally  Prakruthi: Kapha vata
 Cystocele- Absent  Vaya: Madhyamam
 Rectocele – Absent  Sathwam: Madhyamam
 Urethrocele – Absent  Sathmyam: Sarvarasa sathmyam
 Blackish discolouration of groin present  Aharam: Abhyavaharana sakthi - madhyamam
P/S examination  Jaranasakthi - vishamam
 Vagina – Discharge +, curdy white; foul smell - Ayurvedic Management
Present Line of Treatment
 Vaginitis- present In this particular case, main Doshas involved were Vata
 Cervix – Mid position, unhealthy kapha and there was also Raktha dushti. So the Chikitsa
adopted were according to the Dosha predominance
 Cervicitis ++
along with Nidana parivarjana.
 Erosion ++
In the bleeding phase – 10 days
 Discharge ++- thick curdy discharge from os
Medicine Dose Kala Anupana
Musali khadiradi kashaya 90ml-0-90ml 2times/day Before food Honey
Pushyanuga churna 1 tsp 3 times /day Before food Honey, Thandulodaka
Kutajarishtam+Asokarishtam 30ml 3 times /day After food
Drakshadi phantam For panam Muhurmuhu (frequent)
After the bleeding phase,
Medicine Dose Kala Anupana
Madhusnuhi rasayanam 1 tsp 2 times/day before food
Guggulu pancapala churnam 1tsp 2 times /day Before food Honey
Triphala churna 1 tsp 3 times/day Hot water
Nalpamaradi keram External application over
the groin and vulva region
Sthanika chikitsa
Yoni dhawana with Traiphala kwatham * 7 days
Yonipichu with Mahathikthaka gritham * 7 days

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 Anila.M, Sruthi Krishnan. A Case Report on Ayurvedic Management of Secondary Infertility
OBSERVATIONS AND RESULT
Before treatment After treatment
Duration of menstrual cycle 10-12 days 5-6 days
Interval of menstrual cycle Irregular 30-32 days
Bleeding AUB-Menometrorhagia, heavy bleeding Within normal limit
tampon change in every 3 hrs Tampon change in every 6 hrs
Clots Present Absent
Dysmennorhoea Present (day 1 – day 3) Reduced
Per vaginal discharge Curdy white associated with foul smell Amount of discharge reduced,
& itching foul smell and itching absent
The treatment continued for 3 months and follow up Nidana
was done. Considering the Nidana of disease she had
Patient got great relief from the symptoms. habit of Intake of fried food,junk foods which can be
Follow Up Virudha Ahara, Vidahi ahara, Vishama ashanam,
She was explained about the fertile period and pathya Adhyashanam causes Vata Rakta dushti. Excessive use
apathya that to be followed. of Mamsahara (meat), ice creams, sweet included
RESULT under Santarpaniya ahara (nourishing diet) is a
After 6 months UPT found to be positive Nidana for Kapha Medo dushti and Rasavaha
Her LMP was 24/10/21, first USG EDC was 31/7/22 srotodushti. Excessive use of Theekshna, Katu, Amla
Lavana ahara like pickle and Kshara Vidahi Ahara
She delivered a full term female baby of 3.320kg
leads to Raktha Pitha dushti. Use of refrigerated water
through LSCS on 12/7/22.
after exposure to sun and other aerated cool drinks
Antenatal period was uneventful.
occasionally causes Apana vata vaigunyam, and it is
DISCUSSION also included under Nidana for Kushta and Gulma.
In this particular case, we can see that patient Patient had features of Rakthadushti including Kandu,
was having Upaplutha yoni vyapath and also had Kushta, Asrigdara. Habit of late night sleep and night
Artava dushti. On the basis of history, clinical duties, Vegadharana during working hours, skipping of
examination and investigations, it was considered that breakfast (Anashanam, Alpabhojanam) causes Vata
it was a case of Vandhyatha (infertility) as a dushti.
complication of Yoniroga and Artava vaha srotho
dushti.
Samprapti
Due to Nidana

Vata kapha dusti and Raktha dushti

Agni vaishamya

Dhathwagni mandya

Rasa medovaha Rasa raktha vaha

sroto dushti sroto dushti

Saama dosha sthaana Rasa dhatu dushti Raktha dhatu dushti

samsraya to garbhasaya

Dosha dushya samurchana Aama, Kleda vrdhi Sthana samsraya to

artava vaha srothas

Yoni dushti Vikrutha artava utpatti rajasa abhivrudhi

 Swetha pichila srava  Ghana Raktha srava

 Durgandha srava  Along with Ruja
 kanduyuktham  Kati parswa vedana

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 Int. J. Ayur. Pharma Research, 2023;11(2):78-83
The Kapha vata dushti lead to Upaplutha yoni and Vata pitha hara & Sramahara action and also
vyapat, Artava vaha sroto dushti both of which can lead useful in Pandu. So Yoga is useful in bleeding phase.
to Vandhyathwa (infertility). Rakta dushti in this case is After 10 days, bleeding stopped. So the next phase
causing excessive bleeding and other menstrual of treatment aimed at treating the chronic vulvo
irregularities. vaginitis, reducing the abnormal discharge per vagina
Chikitsa with itching and foul smell, along with treatment for
In this case treatment was given primarily to Asrigdara. The symptoms indicated the vitiation of
correct the Rakta dushti which was causing Artava Rakta dosha along with Kapha and Vata. The
dushti in the form of excessive bleeding. For that, properties of given medicines were analysed.
initially in the bleeding phase, medicines for Rakta 1. Madusnuhi rasayanam[11]
sthambana were given and after the stoppage of Main ingredient of this Yoga, Madusnuhi (chopachini,
bleeding medicines were given for correction of Rakta Smilax glabra) is Tikta rasa, Laghu ruksha guna, Katu
dushti. After achieving the menstrual regulation, the vipaka, Ushna virya and its Karma include Tridosha
patient was given medicines for Vata kapha dushti for samana, Kushtahara and Sakrt mutra visodhana. It is
treating her Upaplutha condition. For the management indicated in Guhyabhava vrana.
of Yoni roga she was given Sthanika karmas like Yoni The Yoga is Deepana, Rasayana and Sarva dhatu
dhawana and Yoni pichu. Also local application of vardhana which means it acts at the level of
Nalpamaradi keram was done to reduce her vulval Dhathwagni.
itching. 2. Guggulu panchapala churnam[12]
Initially the aim of treatment was to control the Yoga mainly indicated in Kushta, Bhagandhara and
heavy menstrual bleeding. As Raktha is Jeevana, Nadi vrana which shows it has Vrana sodhana and
Raktha sthambhana chikitsa were adopted. Ropana properties. Also the treatment principle for the
Considering the probable mode of action of Yogas Kaphaja yonivyapath is Sarvam Rookshoshnam-
given in the bleeding phase, oushadham. Hence Churna used. Guggulu is Tridosha
1. Musali khadiradi kashayam[6] samaka, Vatasamaka due to Ushna virya, Pittahara due
Considering the pharmacological action of drugs, it is to Tikta madhura kashaya rasa and Kaphahara because
Rakthasthapana, Vrushya, Balya and Vata pittha of Ushna virya, Katu vipaka and Tikta katu kashaya
samana. Due to Seetha virya of drugs, it has Sthambana rasa. It is Medohara, Kushtagna, Sophahara, Krimihara,
action. So the yoga helps in regularizing bleeding Deepana and Rasayana. Hence it can be useful in the
pattern. Kashaya is given along with Madhu, which is management of Upaplutha.
having Yogavahi guna and Rakthapithahara property. 3. Triphala churnam
2. Pushyanuga churnam[7] Triphala is having the property of Srotosodhana and is
The yoga having 26 drugs, which are Kashaya tiktha anti-inflammatory. It is indicated in Sopha and
rasa, Katu vipaka, Laghu seeta guna and Seetha virya. Kushta.[13] The Chikitsa sthana of Susruta samhitha
The Kashaya tiktha rasa act as Grahi & Sthambana and recommends Triphala is good for purifying wound
due to Seeta virya of most of the drugs, it has a (Vrana ropana). So it can be given for chronic cervicitis
Pitharakta samana action. It is indicated in Raktayoni and cervical erosion.
and other Srava rogas. 4. Nalpamaradi keram[14]
3. Kutajarishtam[8] It includes Nygrodhadi gana, Triphala, Haridra and
Kutajarishtam is taken from Bhaishajya ratnavali Kushta, which is indicated for skin diseases (Kushta,
Athisara chikitsa, mainly indicated for Jwara, Visarpa) and having anti allergic action. Since the
Agnimandya, Rakthathisara and is Deepana. It cures patient was a known case of skin allergy, mainly the
Agni vaishamya and Ama avastha, also having Raktha pitha dushti, it was a best choice for external
Sthambana action. Since Kutaja is Agryoushadha of application throughout the body especially over groin
Raktarshas and principles of Raktharsas can be used in and vulva region.
Asrigdara chikitsa. It can be used in bleeding phase of Sthanika Chikitsa
this patient. As the patient had complaint of discharge per
4. Asokarishtam[9] vagina, along with internal medicines, Sthanika chikitsa
Here Asokarishtam mainly helps in management of (local treatment) also had a significant role.
Asrigdara. Yoga indicated for Asrigdara (menorhagia) Yoni dhawana with Traiphala kwatham useful
and Ruja (dysmennorhoea). It functions as a uterine in cleansing and clearing excess secretion and
tonic. discharges of vagina. Here Traiphala kwatha having
5. Drakshadi Phantam[10] Soolagna, sravagna and Dourgandhyahara properties.
Phantam is indicated in Raktapitha. Drakshadi According to Bhaishajya Ratnavali, Traiphala is
phantam is given as it has Raktha sthapaka properties indicated in Vatasleshmodbhava sopha occurring at

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 Anila.M, Sruthi Krishnan. A Case Report on Ayurvedic Management of Secondary Infertility
Vrshana. It is also used for Kshalanam in Upadamsa REFERENCES
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Cite this article as: *Address for correspondence
Anila.M, Sruthi Krishnan. A Case Report on Ayurvedic Management of Secondary Dr. Sruthi Krishnan
Infertility. International Journal of Ayurveda and Pharma Research. PG Scholar,
2023;11(2):78-83. Department of Prasutitantra and
https://doi.org/10.47070/ijapr.v11i2.2698 Streeroga, Government Ayurveda
Source of support: Nil, Conflict of interest: None Declared College, Thiruvananthapuram,
Kerala.
Email:
[email protected]

Available online at: http://ijapr.in 83