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.