PCOS WITH INFERTILITY AND ITS AYURVEDA MANAGEMENT – A CASE STUDY

Ashwini Narayan Karandikar *1 Assistant Professor, Department of Streerog Prasutitantra, Tilak Ayurveda Mahavidyalay Pune

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ABSTRACT PCOS (polycystic ovarian syndrome) is a complex disorder comprising of anovulation, hyperandrogenism and polycystic ovaries. It is the primary cause of infertility nowadays. In Ayurveda all gynecological disorders are explained under Yonivyapadas. Based on the principles PCOS can be diagnosed and treated as well. Following is a case study of a female having infertility due to PCOS. Her reports showed PCOS, right tubal block and unovulatory cycles. She was treated with different Ayurveda treatment modalities like Yoni dhavan (vaginal douche), Anuvasana and Niruha basti (oil and decoction enema) and internal medicines like Rasapachaka, Aarogyavardhini and Dashamoolarishta.

 KEYWORDS: PCOS, polycystic ovarian syndrome, infertility.

INTRODUCTION Polycystic ovarian syndrome is a disorder of the endocrine system caused by hormonal imbalance. It is characterized by excess androgen production by ovaries or adrenals which interferes growth of ovarian follicles. It consists of three diagnostic criteria – chronic anovulation hyperandrogenism and polycystic ovaries. It is the leading cause of infertility. 5-10 % of child bearing age women have PCOS. Patients with PCOS complaints of increasing obesity, menstrual disorders –like irregular menses, oligomenorrhea or amenorrhea. PCOS patients along with infertility can have long term metabolic consequences. These patients are at risk of developing Diabetes mellitus, endometrial carcinoma, hypertension and cardiovascular diseases. The conventional treatment for PCOS with infertility is metformin, OC pills and ovulation induction drugs. Long term use of these drugs can cause side effects like GIT symptoms, ovarian hyperstimulation syndrome and hepato toxicity also. But PCOS should be treated for infertility as well as menstrual disorders and to prevent long standing metabolic diseases.

In Ayurveda PCOS is not described as a separate disease. The clinical features, etio pathogenesis can be correlated to different gynaecological disorders. In Ayurveda all gynaecological disorders are incorporated in Yonivyapadas and Aartavadushti. Based on these principles PCOS and infertility can be considered as Rasa, Rakta, dushti, Vata dushti predominantly, associated Kapha or Pitta dushti and Dhatavagni mandya. As all female reproductive organs lie in pelvic area the Apana vayu governs all the physiological functions. So the management in PCOS should be targeted at Agni deepana, Pachana, Vatanulomona and Rasarakta prasadana.

Case Report A female of 28 years came to our OPD (no. 9209) with primary infertility and willing for conception. Her married life was 8 years. She was taking allopathy treatment for last 4 years with ovulation induction drugs, laproscopic ovarian drilling and failed to conceive.

Her other complaints were as follows Malavashtambha (constipation) frequently, P/V white discharge, P/v itching, P/R bleeding sometimes after defecation, irritability, anxiety.

H/o present illness: K/C/O PCOS since 4 years has taken allopathy medicines, hormones, ovulation induction drugs, has done diagnostic hystero laparoscopy, HSG, and twice IUI. Married life: 8 years.

Menstrual history: 2-3/45-60 days, irregular cycle, moderate flow sometimes with clots, dysmenorrhea Personal history: allergic to antifungals, occupation: part time typist. Diet: Irregular timings, junk food daily Chinese food for 4 years, Sleep: disturbed, insomnia sometimes Psychological aspects: disturbed, stressed, anxious, irritable Clinical examination: Patient well conscious, oriented Hemodynamically stable.

O/E : P -76/min, BP -100/60, Ht.-152cm, Wt.-54.5 kg, motion – sometimes constipation, urine- WNL , P/A – soft, non -tender, P/V- uterus-AVAF, fx clear , cervical motion non tender. P/S –Cervix healthy

Prakriti: Vata pittaja, Jaran Shakti (digestive power) –Madhyam, Agni dushti.

Investigations: Haemogram –WNL BSL – Normal Urine–NAD TSH- 2.45 normal AMH, Sr.FSH, Sr.E2, Sr. Prolactin –WNL USG –

1. 29/05/18- s/o Bilateral polycystic ovaries, Rt ovary- 15.1, left-10.6cc
2. 6/07/18- right ovary- 13cc, left-10.6 cc

HSG on 25/05/18 –

1. Uterus Normal, left tube partially visualized, No Spill
2. Right tube blocked at cornu of uterus

Male partner: Semen analysis 30/05/18 Vol- 1.5 ml Count- 60 million/ml Motility- 40% Dead sperms- 40% Treatment I st visit: LMP: 22/03/18

1. Rasapachaka vati 2BD
2. Aarogyavardhini 2 BD

iii. Dashamoolarishta 2 tsf BD

1. Yonidhavan – Triphala, Darvi kwatha for 7 days

II nd visit: LMP: 24/04/18 without hormones

1. Rasapachaka vati 2BD
2. Aarogyavardhini 2 BD

iii. Avipattikar churna vati 2 HS

1. Yonidhavan – Triphala, Darvi kwatha for 7 days
2. Anuvasana basti- Sahachara taila alt., Niruha- Dashamoola.

III rd visit: LMP: 20/05/18 Same as above, Shatagandha vati 2 BD For husband: Tab. CoQ forte BD and Shatavari Ashwagandha Ksheera pak. IV th visit: LMP: 20/06/18

1. Shatagandha vati 2 BD
2. Varunadi kwatha 2 tsf BD

iii. Anuvasana basti (oil enema)– Sahachara taila alt., Niruha- Dashamoola

V th visit: LMP: 11/07/18 Shatagandha vati 2 BD

Follow up Every time when she visited she was counselled, timely diet and exercise were advised. At every follow up her bowel habits, Basti pratyagam kal and other symptoms were assessed After 5 months of treatment her monthly cycles were regular plan on next visit was to do follow up HSG, ovulation study and semen analysis. But patient came on 27/08/18 after 1 month 16 days amenorrhea and with UPT positive.

Drugs

1. Rasapachaka vati –Kalingaka, Patola, Kutaki
2. Aarogyavardhini vati –Triphala, Shuddha shilajita, Guggulu, Chitraka and mainly Kutaki and Nimba.
3. Varunadi kwatha -Varun, Pashanbheda, Shunthi, Gokshur.
4. Dashamularishta -Shaliparni Prishniparni Kantakari Bruhati Gokshur Bilva Agnimantha Patala Gambhari Tintuk Dhataki Draksha Koshtha Pippali Jatamansi.

Drugs used in the patient

DISCUSSION

In the present case considering all laboratory and clinical findings female partner had PCOS, unovulatory cycles and so infertility.

1. Line of management was Dhatavagni vardhana (improve digestive power, Deepana, Pachana, Vata pacification and Garbhashaya poshana.
2. Clinical examination and history revealed Dhatavaagni mandya, Rasa dhatu dushti, Vata and Kapha vaigunya, especially Apana vayu vaigunya (abnormal Vata and Kapha doshas).
3. Rasapachaka vati is of Tikta (bitter), Katu (pungent) Rasa so used as Agnideepana, Pachana and for Prasada rasa and Raja nirmitee.
4. Aaroghyavardhini mainly acts on Rasa and Rakta dhatu and helps in Prasadabhuta rajanirmitee (quality follicular development) the drug is also useful for individuals suffering from indigestion and irregular bowel movements. It brings about the promotion of the digestive power of the body, acts as a tonic for liver, heart, kidneys, uterus, rectum and intestine. It is also beneficial for chronic fevers and water retention. Arogyavardhini vati reduces inflammation of spleen, liver, bladder, kidneys, uterus and intestine. So it helped in relieving her constipation.
5. Yonidhavana of Triphala and Daruharidra, both are of Kashaya rasa (astringent) were useful to control local vaginal infection and, Kapha Shoshana (absorption).
6. Anuvasan and Niruha basti helped in Vata pacification and Anulomana which is Ardha chikitsa for Vata dosha and it is the main causative factor for yoni Vyapadas and PCOS.
7. After first cycle of Anuvasana and Niruha basti she started getting normal periods without hormones and over a period of time she had monthly regular cycles.

CONCLUSION Depending on Ayurveda basic principles of Dosha, Dhatu, Agni any disease can be diagnosed and treated as well. In the case mentioned Ayurveda treatment helped in improving ovarian function as well as in combating hormonal imbalance and regularizing normal menstrual cycles. So, it can be concluded that Ayurveda treatment can be successfully applied in PCOS and infertility in today’s era for better outcome and with no side effects.

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