Ayurveda Interventions in the Management of Tubal Blockages- Case Studies

Failure to conceive within one or more years of regular unprotected coitus is defined as Infertility. Tubal blockage is one of the most common causative factors in female infertility. The prevalence is 19.1% in the fertility age group. This condition is not described in Ayurvedic classics as itself tubal blocks but Blockages of fallopian tubes can be better correlated with Vandhyatvadue to Artavbijavahasrotavrodha (Blockages in fallopian tubes). All three doshas are responsible for causing blockages. Normalizing the vitiated Vata-kapha-doshaleads to restoration of tubal function and easy conception. Here are two cases with bilateral tubal blockage which were treated successfully with certain Ayushakti herbal remedies and Uttarbasti (Intrauterine enema) with Ksharbasti. Recording and publishing this data is worthwhile as there are minimum chances of complication with assured results. With this treatment we can definitely avoid unnecessary use of hormones and IVF protocol and can give cost effective and promising results

Understanding the Concept of Tubal Blockage in Ayurveda

Infertility is the failure to naturally conceive a child even after one or more years of regular unprotected coitus or to carry a pregnancy to full term. The situation gets gloomier as it is a problem often involving multiple factors, the diagnosis and treatment of which puts the family to physical and mental stress in addition to the financial expenses it involves. Tubal blockage is one of the important factors for infertility and it needs to be reviewed from the ancient texts. In this present article attempt has been made to review the tubal blockage in Ayurvedic texts. Keywords: Infertility, Vandhyatva, Ayurveda, Tubal blockage.

ROLE OF CONVENTIONAL HYSTEROSALPINGOGRAPHY IN THE WORK UP OF FEMALE INFERTILITY IN RURAL TERTIARY CARE HOSPITAL, INDIA

Background: Infertility is a major problem throughout the world. In a country like India, it is associated with a social stigma. The cause can be multifactorial and many couples are seeking medical help for infertility nowadays. As part of the female infertility workup, hysterosalpingography plays an important role. Methods And Material: A retrospective study was done in the department of Radiodiagnosis of a rural tertiary care hospital, India. All patients who were referred for hysterosalpingography study as part of infertility workup between January 2018 and December 2020 to the department of Radiodiagnosis were included in the study. Results: A total of 173 patients are included in the study. Out of these 173 patients, 3 women had repeat Hysterosalpingography studies. 43.2% of these studies are abnormal. 56.8% cases showed normal ndings. Tubal abnormalities were the most common accounting for 34.6% of the total studies. Uterine abnormalities were seen in 6.8% of the total studies. Both fallopian tube and uterine abnormalities were seen in 1.7%. Post-operative follow-up imaging was available for 3 patients. All three patients had a bilateral tubal block in the rst study and showed tubal patency in post recanalization HSG study. Conclusion: Hysterosalpingography is a lesser invasive procedure, cost-effective, and does not require anesthesia compared to laparoscopy. This is a huge advantage, especially in a rural setup. It can be considered as a screening investigation along with an ultrasound examination. Tubal blockage is the most common abnormality accounting for nearly one-third of the causes of infertility in our study. Tuberculosis should always be ruled out as a cause of tubal blockage in India where it is more prevalent.

A comparative study on the effects of various factors to the revalence of pelvic inflammatory disease in North central Nigeria

Pelvic inflammatory disease is a gynaecological disease that affects the upper genital organs of reproductive age females. It is a disease associated with clinical sequalae such as tubal blockage, oophoritis and cervicitis which are said to result to high rate of disease (such as female infertility) and deaths among the females. This study therefore attempts to evaluate the association of various factors to high prevalence of pelvic inflammatory disease among women residing in developing countries such as Nigeria. Questionnaires were administered to all women enrolled for this study too obtain their data. Seven hundred and twenty (720) patients out of 1170 patients enrolled for this study were recorded to be pelvic inflammatory disease patients, of which 380(85%) were rural dwellers; 452(87.6%) were ignorant of pelvic inflammatory disease and were thus easily prone to the disease; 285(86.4%) were within the reproductive ages of 25-29 years; 350(85.2%) previously had urinary tract infection a year ago; 496(85.8%) and 343(83.5%) were both married and uneducated females. The high prevalence of pelvic inflammatory disease recorded in this study is due to certain predisposing factors practiced among females in their reproductive ages, hence it is necessary for government to enforce certain measures such as establishment of free education, continuous awareness of pelvic inflammatory disease and establishment of free medical check up to help prevent and control the spread of pelvic inflammatory disease.

Ayurvedic management of female infertility due to tubal blockage

Objectives Secondary Infertility is a major concern worldwide, accounting for about 40% of female infertility due to lifestyle factor. Secondary Infertility is having a close proximity to a disorder Vandhyatwa explained in Ayurvedic classics, due to a variety of causes. Several Ayurvedic interventions are advised such as Panchakarma (∼purification therapy) for vitiated Doshas in female reproductive organs, Snehapana (∼oral intake of medicated oil) followed by Virechana (∼purgation) to produce quality ovum. Other internal medications like Phalaghrita, Ashokarishta, Kanchanara guggulu etc. have a probable mode of action with enhancing the perceptibility of endometrium for implantation. Correlating fallopian tubes with the Artavavaha Srotas, its block is compared with the Sanga Srotodushti (obstructive pathology occurring in channels)of this Srotas. By virtue of the purification therapy and internal medication working synergistically might remove the Srotodustht. Case presentation A 30 year old female with a history of eight years post marital infertility was treated with Panchakarma along with Ayurvedic medicines after being diagnosed as infertility due to tubal blockage for a period of 16 weeks. Conclusions After 16 weeks of treatment, she reported with amenorrhoea and found Urine Pregnancy Test positive. Subsequently, confirmed the pregnancy by USG, as single live intrauterine foetus of Sonic Gestational Age – 8 weeks 5 days.

Ketamine Use in Hysterosalpingography (the Jimah Procedure): A Follow-Up of Bilateral Tubal Evaluation of 27 Infertile Women at a Teaching Hospital, Ghana

Background. Pain, anxiety, and distress are common in radiological investigations including hysterosalpingogram (HSG). Studies suggest that sedation allows patients to better tolerate diagnostic imaging and image-guided procedures by relieving anxiety, discomfort, and pain. This study aimed at assessing the safety and effectiveness of ketamine use in HSG and the proportion of true positive bilateral tubal blockage during HSG using the Jimah Procedure. Methods. We performed repeated HSG workup under IV ketamine (20–40 mg/mL) sedation for 27 infertile women at the Cape Coast Teaching Hospital. The exclusion criteria included unilateral tubular blockage, acute infection of the vagina or cervix, active vaginal bleeding, glaucoma, and high blood pressure at the time of the study. Data were entered with Microsoft Excel and analyzed using SPSS version 21. Results. A total of 27 patients (age range: 25–48 years) previously diagnosed of bilateral tubal blockage or spasm were enrolled for the repeat HSG procedure. The median age was 34 years (IQR: 32–37), while secondary infertility (20) (74.1%) was the commonest indication. None of the patients reported of pain or distress during or after the procedure. Two (7.4%) women vomited after HSG. Twelve patients (44.4%) had bilateral tubal blockage (true positive), while tubal patency was seen in 15 (55.6%) patients on HSG under ketamine sedation. Conclusion. This study found IV ketamine sedation produces profound anesthesia and analgesia and eliminates tubal spasm. We recommend that radiologists in developing countries should consider sedating patients during HSG and documenting observations and patients’ feedback to help assess safety and effectiveness in local settings.

STUDY OF LAPAROSCOPIC EVALUATION OF FEMALE FACTORS IN INFERTILITY AT ANMMCH, GAYA, BIHAR

Objective:To nd out different causes of female infertility with diagnostic laparoscopy and their comparative frequency in primary and secondary infertility. Study Design:Acase series. Place and Duration of Study: Department of Obstetrics and Gynaecology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, August 2018 to July 2019. Methodology:All infertile women underwent diagnostic laparoscopy for primary and secondary infertility during the study period were included. Couples who had not lived together for at least 12 months, and those with male factor infertility were excluded. Data were collected on a proforma, and analysed on SPSS package for windows version 10. Frequencies were calculated for laparoscopic ndings regarding primary and secondary infertility. Results: Fifty infertile women underwent laparoscopy during the study period, 32 (64%) had primary infertility while 18 (36%) secondary infertility. Eight (25.0%) patients with primary and 2 (11.1%) patients with secondary infertility had no visible abnormality. The common nding was tubal blockage in 7 (21.9%) and 6 (33.3%) cases of primary and secondary infertility respectively. Five (15.6%) cases of primary infertility were detected as polycystic ovaries (PCO) which was not found in cases of secondary infertility. Endometriosis was found in 4 (12.5%) cases with primary infertility and 2 (11.1%) cases with secondary infertility. Pelvic inammatory disease (PID) was found in 1 (3.1%) and 2 (16.7%) cases of primary and secondary infertility respectively. Peritubal and periovarian adhesions were detected in 2 (6.3%) cases with primary infertility and 4 (22.2%) cases with secondary infertility. Fibriod was found in 2 (6.3%) and 1 (5.6%) cases of primary and secondary infertility respectively. Ovarian cyst detected in 2 (6.3%) cases with primary infertility while none was found in cases of secondary infertility. Conclusion: Most common causes responsible for infertility were tubal occlusion, endometriosis, peritubal and periovarian adhesions. Ovarian causes were seen in primary infertility only

AYURVEDIC MANAGEMENT OF SECONDARY INFERTILITY DUE TO POLYCYSTIC OVARIAN SYNDROME AND TUBAL BLOCK: A CASE STUDY

Secondary infertility is defined as the inability of a couple to conceive who had at least one prior conception. Ovarian factor and tubal factor are the most frequent causes of secondary infertility in woman. Polycystic Ovarian Syndrome is a common endocrinological disorder and it is characterized by menstrual irregularities and anovulation. It can be correlated with Nashtartava in Ayurveda. Tubal factor infertility occurs when an obstruction in fallopian tube and it can be correlated with Sanga srotodushti of Artavavaha srotas or Beejavaha srotas. A 36 year old female presented with a complaint of secondary infertility a diagnosed case of Polycystic Ovarian Syndrome and tubal block with a history of neonatal death due to preterm delivery at 24 week gestation and husband aged 38 year with normal semen analysis. The present case was treated on Ayurvedic management protocol including shodhana, samana therapies and uttaravasti. Treatment was started with Deepana - Pachana medicines. Then Udwarthanam, Virechanam, Mathra vasti and Uttaravasti were done which removes the srotorodha and helps in proper formation of each dhatu. Uttaravasti is the most effective local treatment in gynaecological disorders. Uttaravasti with hot potency medicine is very effective in treating tubal blockage. The outcome of the treatment resulted in twin pregnancy and delivered two female babies. So the present case signifies the fruitful outcome of Ayurvedic treatment in the field of infertility. Keywords: Secondary infertility, Polycystic Ovarian Syndrome, Tubal block, Nashtartava, Artavavaha srotas, Uttaravasti

MANAGEMENT OF TUBAL BLOCKAGE BY UTTARA BASTI – A CASE REPORT

A clinical study was carried out with the aim of clinical evaluation of effect of Uttara basti with Apamarga Kshara Taila in bilateral tubal block. Achievement of conception depends on the fertility capacity of both the male and female partner; male is directly responsible in around 30% of cases, female in 30% and both are respon- sible for 30% of cases, and in the remaining 10% of cases cause remains unexplained As per the FIGO manual, Tubal factors are causing infertility in around 30 to 40% cases. Tubal factors include tubal injury, blockage, or paratubal adhesions. In the existing modern system of medicine, there is no proper intervention available to clear the tubal block. This condition is dealt with ART or invasive procedures like tubal reconstructive surgery which are not accessible to majority of population. This article presents a successfully managed case of Bilateral Tubal Blockage by Uttara Basti in the form of a case study. Uttara Basti was planned for duration of 3 months. Post treatment HSG revealed patent bilateral tubes and after 4 months she got conceived. Keywords: Uttara Basti, Apamarga kshara taila, HSG, ART, Tubal block

AYURVEDIC MANAGEMENT OF INFERTILITY DUE TO TUBAL BLOCKAGE- A CASE STUDY

Infertility is defined as failure to conceive within one or more years of regular unprotected coitus. Tubal blockage is one of the most common causative factors for female infertility. The prevalence of fallopian tubal obstruction was 19.1% in the fertility age group. In this case study patient suffered from infertility since 3yrs and diagnosed as primary infertility due to right tubal blockage after allopathic consultation. IUI has done thrice which went unsuccessful and was advised for IVF. But she was reluctant to do the same. So she approached OPD of GAVCH for W&C, Poojappura, Kerala for Ayurvedic management. Patient was managed with Ayurvedic treatment protocol including internal medications and purification therapies. The line of treatment was to normalize the Vata-kapha dosha and removes the Sroto avarodha in the fallopian tube. Uttaravasti delivers medicines close to Garbhashaya & Yoni especially in fallopian tubes. Taila can help to clear the Sroto rodha due to its Vyavayi, Vikashi and Sookshma property. Just after one cycle of treatment patient came with positive urine pregnancy test after one week of missed period. Then she took regular antenatal care from an allopathic hospital and delivered a healthy male baby of 2.8 kg.