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Primary Infertility- A Case Study

Authors Dr. Prashant Sawant M.D. (ayu), Dr. Jagtap Reshma M.D. (Ayu.),
Ayurlife Positive Health Centre and Research Institute, Chembur, Mumbai - 71

Introduction
Primary infertility is the term used to describe a couple that has never been able
to conceive a pregnancy, after at least 1 year of unprotected intercourse.
We present a case study in which PCOS (diagnosed by USG) and unovulation
were thought to be the cause of primary infertility. After taking the
conventional treatment for about 1 ½ year the patient was unable to conceive.
The conventional treatment was discontinued and ayurvedic treatment was
given. The patient conceived in 7 months and delivered a healthy child. 
The Case Report

Mrs. V. N, a 24 year old women, software engineer, married for 3 ½ years,
approached for the treatment of primary infertility. Since their marriage Mrs. V.
N and her husband were staying together and were sharing a healthy sexual
relationship. After one year of normal married life, as Mrs. V. N was unable to
conceive, she consulted a gynecologist for advice.

The gynecologist advised routine investigations and sonography of the abdomen
and ovulation study. On sonography, the ovaries were found to be polycystic
and a diagnosis of PCOS was made. On ovulation study, it was observed that
the ovarian follicles were not maturing, resulting into un-ovulatory cycle.  

She was advised a course of Human Chorionic Gonadotrophin (HCG) 5000 i.u.,
i.m. in mid cycle, which she took for 12 cycles. However, even after a year of
treatment, she was unable to conceive. 

The gynecologist then advised her to undergo exploratory laparoscopy, which
she was unwilling to undergo. At this stage she thought of ‘trying’ ayurvedic
treatment.

Complaints of: Inability to conceive after 2 ½ years of marriage

On examination: G.C - fair, Temp / Pulse / Respiration / Blood Pressure - Normal.
R.S, C.V.S - Normal, Weight 51 Kg.

No history of consuming oral contraceptives or the use of any IUCD.

Menstrual history- Regular, moderate, painless

Menarche- at age 12 years

Past history of illness- Insignificant
Family history- Insignificant
No menstrual complaints of mother and elder sister

Investigations:
CBC, Blood sugar- Normal
Hystero salpingography - Normal, both tubes patent
Husband’s Semen - Normal

Treatment:

The following medicines were advised:
1. Syrup Dashmularishta1 20 ml two times a day before meals 
2. Tablet Rajapravartini vati2 500 mg twice a day before lunch and dinner
from day 1 to day 13 of the cycle.
3. Phala ghruta3 10 gm twice a day after breakfast and after dinner from
day 14 till the next cycle.
4. Tab. Garbhapal Rasa4 250 mg twice a day after breakfast and after
dinner from day 14 till the next cycle. (And throughout pregnancy)
5. Tablet Laghumalini Vasanta rasa5 250 mg twice a day after breakfast
and after dinner from day 14 till the next cycle. (And throughout
pregnancy)

The same treatment was continued for 7 months. No other modern medicines
were given.

Result:
After about 7 months of treatment, Mrs. V.N. conceived. During the treatment
period her menstrual cycles were normal. There were no other complaints. She
delivered a healthy male child, weighing 2.5 kg,

Discussion:

According to ayurved, akin to the germination of a plant seed, the four most
important factors for conception are 1) Rutu (season), 2) Kshetra (the field-
uterus), 3) Ambu (water - nourishment) and 4) Beeja6 (seed - ovum and
sperm).The probability of conception increases if all these factors are in perfect
condition and in harmony with each other.

‘Rutu’, in this context, refers to the most fertile days of the menstrual cycle and
the fertile age of women. ‘Kshetra’ refers to the cyclical conditioning of the
uterus for making the uterine cavity most suitable for implantation of the
fertilized ovum. As both these factors are associated with rhythmicity /
periodicity, it is under the control of vata dosha. Also, the process of ovulation,
maintaining the pregnancy till its full term and parturition are controlled by
‘apana vayu’7. Diminution of vata dosha also results in unovulation7b
Therefore, procedures (ahyanga, basti) and medicines beneficial in balancing of
vata dosha, would be useful in ovulation, maintenance of pregnancy and in
normal childbirth. 

Nourishment of the fetus is carried out by ‘rasa’. Rasa dhatu in a pregnant
women is split into three parts one nourishes the mother herself, second part is
utilized to nourish the fetus and the third to produce milk8. Therefore, the
medicines acting on rasa dhatu would benefit the nutrition of the fetus.

‘Beeja’ refers to both ovum and sperm. Both need to be in perfect condition for
conception. The ovum is ‘agneya’9 (‘agni mahabhoota’ predominant) and shukra
is ‘soumya’ (jala mahabhoota predominant). Therefore the ‘rasayana’ medicines
predominant in agni mahabhoota and jala mahabhoota are beneficial for
producing best quality of ‘beeja’ - ovum and sperm.  

During the follicular and ovulatory phase of menstrual cycle, Rajapravartani vati,
which contains ‘hinga’ (asafetida) as one of its ingredient was given to induce
ovulation. As hing is ‘ati ushna veerya’ (very hot in potency, it helps the
maturation and release of ovum, which is also ‘agneya’ (hot) in nature.

During the luteal phase, presuming that the fertilization occurs, the medicines
which would help in anchoring of fetus and its nourishment namely, Garbhapal
rasa and Laghumalini vasanta rasa- were given.

As vata dosha plays a very important role in controlling the menstrual cycle
through its control over endocrine system, maintenance of pregnancy through
its full term and the act of parturition, ‘dashamoolarishta’- the medicine which is
very effective in balancing vata dosha and is fertility promoter- was continued
throughout the treatment period and pregnancy.