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Secondary Infertility
Presenting Complaints with unable to conceive after earlier 2 pregnancy failures
1. Secondary Infertility High severity more than 5 years
2. Scanty menstrual flow High severity more than 4 months
Associated complaints: 3.Bony overgrowth in right wrist with pain high severity 2 years
Brief Relevant Medical History (Onset, Duration, Ag/Rel Factors, OTT, Prior Confirmed Diagnoses if applicable):
- Married life since 6 years G2 P2 A2 L0
- First pregnancy 5 years back due to congenital cardiac anomaly (Mitral valve dysplasia and TR)Termination done vaginaly at 5th month
- Operative hysteroscopy+Laproscopy done-Adhesiolysis+Fulgralton of endometrial cysts.
- Second pregnancy-Ectopic pregnancy october 2011 -laproscopic surgery done(In november 2011 Left ectopic rupture.Left salpingectomy done.
- Right F.Tube is patent
- One cycle of IUI in jan 2013 and 2nd march 2014 not succesful,Patient was reffered for IVF
- Husbands age:33years,Healthy, no unhealthy habits
- First Consultation at AVHD on 3/9/14
History of past illness:
K/C/O: Hypothyrodism Family historty: DM MotherCurrent medication: Thyronorm 25 mg
Clinical Status
| Allopathy | Ayurveda | ||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Vital Parameters • BP:100/70mm of hg • Pulse:68 per min • Weight:52.8 kg • BMI:21.42 | Asta Sthana Pariksha • Malam:Niraama • Mutra:Normal • Jihva:Liptha • Shabda:Sadharanam • Sparsha:Anushna seetha • Drik:Prakrutha • Akruti:Madhyama | ||||||||||||||||||||||||||||||||||||
| Examinations • GC:Fair • CVS:NAD • CNS:NAD • RS:NAD • PA:NAD | Dasa Vidha Pariksha • Prakriti:Vatha pitha • Vikriti:Vatha • Sara:Raktha sara • Samhanana:Madhyama • Pramana:Madhyama • Satmya:Rooksha,Katu • Satva:Alpa • Aharashakti:Abyavaharana sakthi and jarana sakthi madhyama • Vyayam Shakti:Madhyama • Vaya:Yowana • Desha:Jangala • Kala:duration-5 years Nityaka-Varsha Avastika-Upadrava(Tubal blockage) | ||||||||||||||||||||||||||||||||||||
| Rogi Bala- Madhyamam | |||||||||||||||||||||||||||||||||||||
| Roga bala-Pravara | |||||||||||||||||||||||||||||||||||||
| Nidana Panchaka • Nidana:Mithya aahara vihara(Ushna,Thiktha,Katu aahara,Jala kreeda,Athi chinthana,Rooksha aahara) • Purvaroopa:Garba srava • Roopa:Kruchrarthavam,Anapathya • Updrava:Tubal blockage • Samprapti Dosha:Vatha Pitha Dushya:Rasaadi shuklathwam Agni:Sama Ama:Niraama Srotas:Arthava vaha,Rasa vaha-Shukla vaha Sroto Dushti Prakara:sanga | |||||||||||||||||||||||||||||||||||||
| Lab Tests: | • Roga Samprapti Flow Chart Vatha pitha vardhaka aahara vihaara+Jalakreeda----------------Vatha pitha vrudhi-----------------Arthava vaha srotho rodha -------------------------Garbhasaya------Anapathya
USG abdomen: Impression: Small anterior wall intra mural uterine fibroid Husband semen analysis: 90million/ml 80% motile | ||||||||||||||||||||||||||||||||||||
| Differential Diagnosis with reasoning | Differential Diagnosis with reasoning | ||||||||||||||||||||||||||||||||||||
| Secondary infertility | Puthragni yonivyapath: ''Roukshyathaayuryadha garbha jatham jatham vinasayeth Dushta sonithajam narya: puthragni saa matha//(Charaka.chi30) ''Shitham sthitham hanti garbha puthragni raktha samsravath Chathasrushvapi chaadhyasu pitha lingochrayo bhaveth// ''(su.sa) Charaka says that vayu aggravated due to predominance of rooksha properties in the body repeatedly destroys the fetuses conceived with vitiated sonitha (Abnormalities of sonitha by vayu). Susrutha says that in this condition, the fetuses after attaining stability are repeatedly destroyed due to bleeding, besides there are other clinical features of disordered pitha. Anapathya Vandhya- ”Vandhyam nashtarthavam vidhyath.......//'' | ||||||||||||||||||||||||||||||||||||
| Evidence Based Diagnosis with References Secondary infertility | Evidence Based Diagnosis with References Puthragni | ||||||||||||||||||||||||||||||||||||
| Chikitsa Vivechana: | |||||||||||||||||||||||||||||||||||||
| Details of Allopathy medicine if continued Tab. Thyronorm | ''Sarva: vyapannayonim thu karmabhirvamanaadibhi: Mrudhubhi: panchabhirnaareem snigdhaswinnaamupaachareth/ Sarvatha: suvisudhaayaa: sesham karma vidheeyathe//'' Yaccha vathavikaraanaam karmoktham thaccha karayeth//'' In all these gynecological disorders after proper oleation and sudation,emesis etc. all five purifying measures should be used. Only after proper cleansing of doshas through upper and lower passages other medications should be given. These emesis etc cleansing measures cure gynecologic disorders in the same way as they cure the diseases of other systems. ''Basthou rogeshu naareenaam yoni garbhaasayeshu cha/ Dwisthrayasthaapana sudhebhyo vidhadhyadwasthimutharam'' Type – IPT+Internal medications Duration – Pathyam-Thaila,Masha,Madhura rasa Apathyam-Katu aahara,Dadhi,Lavana,Thiktha Primary Treatments- Udwarthanam(For preparing body for receiving snehana) Snehapaanam Main Treatments- Shodhana- Virechanam-Vathanulomana,Amashaya sodhana. After the very next periods. Yogavasthy (after 2 ruthukala.) (Uthara vasthy was also planned on next ruthukala after yogavasthy programme ,not done as she got conceived shortly after Yogavasthy) • From 3/9/14 ( first consultation) to 15/9/14 Internal Medicines: Lakshmanaaristam 3-3-3 tsp after food with water Balathailam 10 drops with milk morning empty stomach and evening 6 pm. • Patient got her periods on 11/9/14.Patient observed good Menstrual flow. • Treatment start date-15/9/14 Internal medicines (15.9.14 to 19.9.14 ): Lakshmanaaristam 3-3 -3 tsp after food with water During snehapana no internal medications were given.
Internal medicines after Virechana programme Pulimkuzhambu 1 tsp with hot water before food(11 am a7.30 pm) Gandha thailam 10 drops with warm milk on empty stomach(6 am)(for bone growth and pain in fingers??) Draksharistam+Kumaryasavam 15ml+15ml thrice daily after food Sahacharadi thailam for application on body before bath Review on 7/10/14 Medicines: Phalsasarpis 1-0-1 tsp with warm milk on empty stomach Balathailam 10 drops with ghee in the morning Review on 8/11/14 Review on 6/12/14
Suggested to come back for utharavasthy (if not conceiving in that cycle) . 16/01/15- Phala sarpis:Ashtanga sangraha uthara sthana Indi:Yoni sukla doshas “Phala sarpirithi khyatham pushpe peetham phala yath// Mriyamaanaprajaanam cha poojitham//'' Lakshmanaristam-indi:sthree roga Bhaishajya rathnavali,sthree roga,pradara chikithsa. Balathailam:indicated in Vatha vyadhi,Sahasra yogam Pulimkuzhambu indi;Asta vidha gulma,shoola,Antra vrudhi,Pandu Draksharistam:indi:Bala krith,Mala shodhanam.Saranga dhara samhitha,madhyama khanda,Sandhana kalpana. Kumaryasvam:indi:Vrushyam,Bala varna agni deepanam,Bruhmanam,Sukla dosha,Raktha pitha. Sahasra yogam Sahacharadi thailam-indi: yoni roga,Gulma,Sosha,Astanga hrudayam-chi-vathavyadhi |
• Samyak Lakshanas
Samyak snigdha lakshanas were observed on 25/6/14.
Samyak virechana lakshanas were seen with 8 vegas on 26/09/14.
Basthi samyak lakshanas were achieved duely.
• Other outcomes as per following table to be duly filled
| # | Outcome Parameters | Date-Time: | TSD | T | T | TED | N/ R/ TSD/ T/ TED/ R-T | N/ R/ TSD/ T/ TED/ R-T |
|---|---|---|---|---|---|---|---|
| 11/2/15 | 17/2/15 | 23/2/15 | 25/2 | ||||
| 1 | Appetite (Agni) | Sama | Nirama | Nirama | Nirama | ||
| 2 | Urination (Mutra) | 1-2/ N | 1/N | 1/N | 1/N | ||
| 3 | Stress (Manas) | Fair | Fair | Good | Good | ||
| 4 | Vitality (Ojus) | Fair | Good | Good | Good | ||
| 5 | Wellbeing (0-10) | 3 | 5 | 7 | 8 | ||
| 6 | BP | 140/90 | 130/90 | 140/90 | 120/86 | ||
| 7 | Pulse | 70 | 70 | 72 | 68 | ||
| 8 | Weight, Kg | 64 | 64 | 64 | 64 | ||
| 9 | W-U, cm | ||||||
| 10 | Diet (Ahara) | Mixed | Veg | Veg | Veg | ||
| 11 | Exercise (Vyayama) | No | No | No | No | ||
| 12 | Low back pain (Lt side) (0-10) VAS | 9 | 7 | 2 | 1 | ||
| 13 | Radiating pain to Lt leg (0-10) VAS | 8 | 6 | 1 | 3 | ||
| 14 | Ability to sit in minutes | < 1min | 15min | 1hr | > 1hr |
Patient’s Outcome Scale
| # | Presenting Complaint | Weightage | Status 15-9-14 | Status 25-9-14 | Status 11/12/14 | Status 17-1-15 | Status_6 Months |
| 1 | Secondary infertility/Inability to conceive | 100% | 1 | 1 | 1 | Conceived 5 | |
| WEIGHTED AVERAGE SCORE-----> | - | - | - | - | - | ||
| IMPROVEMENT SCORE-----> | 0.0 | -2.0 | -2.0 | -2.0 | |||
| IMPROVEMENT %ge-----> | 0% | -100% | -100% | -100% |
Adverse Incident Report (Drug or Treatment):Not reported.
| Date | At the start of Treatment | During the Treatment | Post treatment | |
| Images/ Details of the site | 16/01/15- Early fetal scan report Pregnant 6 weeks Single intra uterine gestation ,Estimated gestational age-6 weeks one day |
''Evam yonishu suddheesu garbha vindhanthi yoshitha:
Adhushte praakruthe beeje jeevopakramano sathi//''(Cha.Chi 30)
After achievement of healthy state of yoni(Reproductive system) with the help of treatment. Conception occurs with the union of healthy seed(Sukra or sperms and sonitha or ovum)possessing all its normal qualities
Disclaimer: * Outcomes may vary from person to person
