Presentation

1. JOURNEY WITH INFERTILITY
DR.ANUPAMA.V
PROFESSOR AND HOD
DEPATMENT OF PTSR
SKAMC
BANGALORE

3. STREE ROGA CHIKITHSA
VANDHYATVA CHIKITSA
PRE CONCEPTIONAL CHIKITSA

4. FIRST VISITATION
• NAMA, ADDRESS, AGE, OCCUPATION, SOCIAL STATUS, MARRIED LIFE
• PRADHANA VEDHANA
• ANUBANDHAVADANA
• POORVA VYADHIVRITTANT
DM,CARDIAC DISORDER, ASTHMA,EPILEPSY OR ANY TYPE OF KOCH’S
ANY INFECTION LIKE MEASLES,MUMPS,RUBELLA,CHICKENPOX,REPEATED
ENTERIC FEVER,ALLERGIC MANIFESTATION,GIT CONDITIONS

5. • PREVIOUS CONTRACEPTIVE HISTORY
• KOUTAMBIKA VRITHANTA
PARENTS/SIBLINGS OR FIRST DEGREE RELATIVES SUFFERING FROM
DM/ASTHMA/HTN/KOCH’S
TWIN PREG

6. PERSONAL HISTORY
• DIETARY HABITS
TYPE OF FOOD
RASA
TIME OF GOOD
IF THEY HAVE OUTSIDE FOOD
BASED ON THEIR PRAKRUTHI USE OF SPICE
BASED ON DESHA USE OF RASA

7. • VIHARA
LIFESTYLE THEY LEAD……
IMPACT OF OCCUPATION
QUALITY OF SLEEP….
MOBILE ADDICTION…..
• STRESS LEVELS
PSYCOLOGICAL STATUS OF THE COUPLE…
ACCEPTANCE …
SUPPORT..

8. • APPETITE
• BOWEL HABITS
• MICTURATION
• ADDICTIONS

9. RAJO VRITHANTA
• MENARCHE
• LMP OF ATLEAST 6 TO 8MONTHS
• PREMENSTRUAL SYPTOMS
• ONSET
• DURATION AND PATTERN OF FLOW
• CHARACTER OF FLOW TO UNDERSTAND RAJODUSHTI
• NO. OF PADS / DAY
• ANY DISCHARGE…

10. • A patient with a age of 29 years, gradually noticed dryness of vagina, severe pain during
coitus for which she was unable
• to continue the coital act since 4 yrs of married life. She consulted near by hospital where
investigations done and AMH
• level was low ( 0. 29ng/ml), FSH level was high( 14.7mIU/ml) , so they suggested for IVF
treatment WITH DONOR EGGS.
• FAMILY HISTORY :
• Premature ovarian failure and low amh in her mother, sister, cousins
• INVESTIGATION: Anovulation noted
• TREATMENT: Yoni abhyanga, yoni pichu WITH PHALAGRITHA, and yoni poorana with
dhanvantaram taila
• VAMANA
• BASTI WITH UTARRA BASTI
• MATRA BASTI – WITH PHALAGRITHA… OVULATION SEEN ON 15TH DAY
• IUI DONE IN SAME CYCLE WITHOUT ANY MORDERN MEDICATION AS HUSBAND HAD
ERECTILE DYSFUNCTION BUT FAILED
• but FSH 5.758mIU/ml
• Next cycle matra basti given and 16th day ovulation noted
• IUI done AGAIN – got conceived NOW IN 9TH MONTH OF PREGNANCY

11. • 3. CASE - 3
• Patient aged 36 years old with the obstetrical history of P2L2A0D0
underwent tubectomy after the 2nd delivery. After 2nd marriage 7yrs
back, she underwent recanalization of fallopian tube. She was anxious
to conceive since her recanalization but failed to do so, even after
having unprotected coitus. Patient had regular menstrual cycles and
complained of scanty menstrual bleeding of one pad completely
soaked on day one and only half pad of bleeding on day 2, since 2 and
half years. For the same, patient visited a gynaecologist and with all
the investigations it was noted that bilateral tubal block was present
and suggested for IVF.
• INVESTIGATION : TORCH test
• Rubella IgG – 231.4 IU/ML reactive
• Cytomegalo virus > 500 IUI /ml reactive HSG REPORT – Bilateral Tubal
Block
• Herpes simplex virus IgG- 116.64 IU/ml
• Follicular study shows bilateral prominent pelvic veins

12. • TREATMENT
• ❑ Udwarthana followed by vamana is given, after vamana the
• next consecutive cycle the patient improved with her
• menstrual flow (from 2 days to 4days. And no. of pads 1-2
• pads per day.
• ❑ Yoni prakshalana with pachavalkala kashaya, yoni poorana
• with Mahanarayana taila, and matra basti was given with
• phala ghrita. Ovulation was noted on the 16th day of
• menstrual cycle.
• ❑ Yoga basti and Uattara basti is given with the kshara taila
and phala ghritha for 1 cycle and planned for hysteroscopy for tubal
patency

13. • Orally,
• 1. Cap viscovas 1-0-1 A/F
• 2. Cap panchavalkala 1-1-1 after food
• 3. Gandharvahastadi taila 20ml HS with 1 glass of milk
• 4. Cap Torchnil 1-1-1 (A/F)
• 5. Cap Sujath 1-0-1 (A/F)
• 6. Streevyadhihararasa 1-0-1 (A/F)

14. LEFT TUBAL PATENCY RIGHT TUBALPATENCY

15. MITHUNA VRITHANTA
• FREQUENCY OF COITUS/WEEK
• TIME OF COITUS
• PSYCHOLOGICAL STATUS
• SEXUAL DYSFUNCTION
• LACK OF ENTHUSIASM

16. • BOH
• CAUSE OF BOH
• IF PREVIOUS CHILD HAS ANY
ABNORMALITY

17. • 1. CASE – 1
• A patient 36 years of age is anxious to conceive approached for opd with the OH of A2P0L0DO and having a regular menstrual history of 4-5
days of bleeding with the duration of 28-30 days.
• Not a known case of DM/HTN/THYROID DISFUCTION/ASTHAMA/EPILEPSY.
• INVESTIGATION: Cytomegaly – 16.50 IU/ML (IgG)
• TREATMENT : VAMANA ( Snehapana with panchathiktaka ghrita)
• BASTI – Anuvasana with phala ghrita
• Niruha with Eranda moola kwata
• UTTARA BASTI – Phala ghrita
• MATRA BASTI – Phala ghrita
• Ovulation noted on 16th day of menstruation
• Patient conceived after next cycle of menstruation.
3RD MONTH SCAN SHOULD OVARIN CYST OF 6CMS
INTERNAL MEDICATIONS
• 1. Cap sujath 1-0-1 (a/f)
• 2. Cap torchnil 1-0-1 (a/f)
• 3. Cap repromed 1-0-1 (b/f)
• 4. Dadimavalehya 30ml bd

18. • ANOTHER CASE ALSO WITH 5 ABORTIONS WITH BAD OBSTETRICS
HISTORY BUT ALWAYS CAME AFTER PREGNANCY AND WHATEVER
MEDICATIONS WE USED ENDED IN MISSED ABORTION
• LATER THE PATIENT WAS ADVISED SHODHANA AND GARBHA
STHAPANA
• SHE CONCEIVED
• BUT HER DOUBLE MARKER AND TRIPLE MARKERS SHOULD PROBABLE
ANUEPLODY AFTER WITH THE AMNEOCENTESIS WAS DONE AND
RULED OUT ANY GENETIC ABNORMALITY.
• DELIVERED A HEALTHY BABY

19. EXAMINATION
BOTH PARTNERS SHOULD BE EXAMINED
• SYSTEMIC
• LOCAL

20. INVESTIGATIONS
FEMALE MALE
USG USG
CBC CBC,ESR
ESR THYROID PROFILE
THYROID PROFILE SEMEN ANALYSIS
SERUM PROLACTIN IF NECESSARY SCROTAL DOPPLER
FASTING INSULIN
IN CASE OF OBESITY LIPID PROFILE
SERUM TESTOSTERONE IF NECESSARY
OTHER HORMONAL TESTS IF NECESSARY
TORCH TEST

21. ANALYSING THE FINDINGS
• DOSHA
• DUSHYA
• SROTAS AND SROTHODUSHTI
• AGNI AND AMA
• UDHBHAVA STHANA AND VYAKTHA STHANA
• ROGA MARGA

22. CHIKITHSA
BAHU DOSHA AVASTHA
SHODANA
AUSHADHA CHIKITHSA
DAIVA VYAPASRAYA CHIKITHSA
CORRECT THE RUTHU, KSHETRA,
AMBU AND BEEJA
HRIDHI

23. • 4. CASE – 4
• A female Patient of age 32 years, case of secondary infertility where (P1 L1, 9yrs female baby,
LSCS) irregularity of the menstrual cycle is noted from 8 years. With a history of 3 cycles of IUI.
• HYSTERO SALPHINGIOGRAPHY – Normal
• USG – POLYCYSTIC OVARIES
• ET – 7.3 mm ( 18th day of menstruation)
• TREATMENT GIVEN : UDWARTHANA
• VAMANA
• PLANNED FOR BASTI
• CONCIEVIED IMMEDIATELY AFTER HER NEXT CYCLE.
• INTERNALLY
• ➢ Aloes compound
• ➢ Cheriya madhusnuhi rasayana
• ➢ Vyosha jeevanilehya
• ➢ Nastapushpantaka rasa
• ➢ Kumaryasava
• ➢ Jeerakadyarista