Ayurveda Approach to Managing Infertility in Polycystic Ovarian Syndrome and Hypothyroidism: A Case Study

Introduction

Infertility, defined as the inability to conceive after one year of regular unprotected intercourse, is influenced by various factors. Ovulatory disorders contribute significantly to female infertility, accounting for 25% of cases. Despite differing causes, hypothyroidism and Polycystic Ovarian Syndrome (PCOS) share common features [1]. Primary hypothyroidism, for instance, can lead to increased ovarian volume and structural changes in the ovaries. Conversely, women with PCOS exhibit a higher prevalence of thyroid abnormalities compared to the general population.

Ayurveda texts provide insights into the understanding of PCOS, though specific classical explanations may not be readily accessible. In this case, Ayurveda management strategies focused on concepts related to infertility (Vandhya) and absent menstruation (Nashtartava), tailored to individual clinical presentations.

Case History

A 27-year-old woman presented to our outpatient department reporting infertility despite three years of unprotected sexual activity. She experienced menarche at the age of 12, with regular 3–4 day menstrual cycles occurring every 28–30 days, characterized by mild bleeding and occasional clots. Following marriage at age 25 to a non-consanguineous partner, her menstrual cycles became irregular, extending to 45-50 days with dark brown, clotted bleeding and dysmenorrhea. Diagnostic tests revealed a diagnosis of both PCOS and hypothyroidism, while her husband’s semen analysis was normal. On physical examination, she appeared moderately built with normal external genitalia and a healthy cervix without erosion. She had a history of hypothyroidism for six years, managed with daily 75 mg of Eltroxin, and a past medical history of intestinal tuberculosis. Pelvic ultrasound on October 12, 2022, confirmed a bilateral PCOD pattern. Her last menstrual period was on October 1, 2022, noted during her initial outpatient visit.

Diagnostic Assessment

            Following a comprehensive evaluation encompassing both subjective and objective assessments, the patient’s infertility was attributed to PCOS and hypothyroidism. According to Ayurveda, this condition aligns with Vandhyatva related to Nashtartava, Srotorodha, and Avarana (obstruction) of Artavavaha srotas (channels conveying menstrual flow). Detailed examination of signs and symptoms indicated a decrease in Pitta and an increase in Vata-Kapha dosha. The treatment principles of Vandhya and Nashtartava were applied accordingly, considering these factors.

Therapeutic Intervention:

For the correction of doshadushti, deepana, pachana, rajapravartaka and anulomaka medicines mentioned in table 1 were used for six months step by step. The aforementioned class of medications maintains agni’s functionality and bring about doshasamya.

Table 1: Medication Chart

Follow-Up & Outcome:

Following treatment, the patient demonstrated notable improvements in her menstrual cycle parameters. There was a marked regularization of cycle duration and increased menstrual flow, characterized by fresh red color without clots and absence of dysmenorrhea. A follow-up ultrasound on February 15, 2023, indicated no evidence of PCOS, confirming the efficacy of the treatment. Subsequently, during the sixth follow-up on March 5, 2023, the patient tested positive for pregnancy. An ultrasound on June 13, 2023, revealed a single live intrauterine fetus at 12 weeks and 2 days gestation. To support the pregnancy, the patient was prescribed Masanumasik tablets until full term. She successfully delivered a healthy female child at 39 weeks on December 9, 2023. This case highlights the successful management of infertility due to PCOS and hypothyroidism using integrative Ayurveda treatments, leading to restored reproductive health and a successful pregnancy outcome.

Discussion:

The patient’s primary infertility due to PCOS and hypothyroidism was successfully managed using Ayurveda principles. According to Ayurveda, the root cause of this condition involves Avarana (~obstruction) of Artavavahasrotas (~channels conveying menstrual flow), primarily caused by Nashtartava (absence of menstruation). Elevated Kaphadosha obstructs the mobility of Vata, particularly Apanavata, thereby hindering the natural function of Arthava (ovum).

Ayurveda treatment focused on disrupting the Samprapti (pathogenesis) of the disease. Kapha and Vata were considered as Dosha, while Rasa (~plasma), Meda (~adipose tissue), Rakta (blood), and Mamsa (~muscle) were identified as Dooshya (~ affected parts) involved in the pathogenesis. The vitiated factors (Dushti karana) affecting Rasavaha (~plasma channels), Raktavaha (~blood channels), Mamsavaha (~muscle channels), Medovaha (~fat channels), and Arthavavaha (~reproductive channels) were addressed through therapies aimed at resolving Sanga (~blockage) and Granthi (~cysts).

Treatment interventions included Vaishvanarachurna to correct agni (digestive fire) in the koshta (gastrointestinal tract), crucial for restoring metabolic balance. Kumaryasava was administered for its properties in promoting Arthava (ovum) quality and quantity, while Kanchanara Guggulu, known for its Granthihara (cyst-dissolving) properties, aided in breaking down Kaphaja Granthi (cysts) and regulating reproductive health.

Chandraprabha Vati, prescribed for its hormone-regulating and menstrual cycle-normalizing effects due to Pippali (long pepper) and Loha Bhasma (iron), complemented the treatment regimen. Its Kaphahara (~reducing Kapha), Lekhana (~scraping), Chedana (~breaking down), and Granthihara properties contributed to eliminating blockages and reducing the size of ovarian cysts associated with PCOS.

After successful conception, Masanumasika tablets were prescribed to support a healthy pregnancy for nine months. Patient education on lifestyle modifications and dietary recommendations further contributed to a positive outcome.

Conclusion:

This case study exemplifies a systematic approach in managing primary infertility associated with PCOS and hypothyroidism using Ayurveda therapies. The favorable outcome achieved in this single-case study warrants consideration for larger-scale studies to validate its efficacy across broader populations. The holistic principles of Ayurveda offer promising avenues for integrative management of reproductive health disorders, emphasizing personalized treatment approaches tailored to individual constitution and pathology.

Informed Consent: Taken

Financial Support & Sponsership: Nil

Conflicts of Interest: Nil

References:

1. [Walker, M. H., & Tobler, K. J. (2022). Female infertility. In StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2024 Jan–. PMID: 32310493.
2. Ashtanga-Hridaya. (n.d.). Sutrasthana, Doshadivijnaneeyaadhyaya, 11/5-8. Available from https://vedotpatti.in/samhita/Vag/ehrudayam. (Accessed on 7/5/2024)
3. Govinda Das, S. (2013). Bhaishajya Ratnavali (Shri Bhrama Shankara Mishra, Ed.). Varanasi: Chaukhamba Prakashan, p. 618.
4. Govinda Das, S. (2013). Bhaishajya Ratnavali (Shri Bhrama Shankara Mishra, Ed.). Varanasi: Chaukhamba Prakashan, p. 730.
5. (2013). Sharangadhara Samhita with the commentaries Adhamalla’s ‘Dipika’ and Kashirama’s ‘Gudhartha-dipika’ (Pt. Parashuram Shastri Vidyasagar, Ed.). Varanasi: Chaukhamba Surbharati Prakashan.
6. Govinda Das, S. (2013). Bhaishajya Ratnavali (Shri Bhrama Shankara Mishra, Ed., pp. 829-830). Varanasi: Chaukhamba Prakashan.
7. (2013). Sharangadhara Samhita with the commentaries Adhamalla’s ‘Dipika’ and Kashirama’s ‘Gudhartha-dipika’ (Pt. Parashuram Shastri Vidyasagar, Ed.). Varanasi: Chaukhamba Surbharati Prakashan.
8. Sharma, P. V. (2003). Dravyagunavijnana Vol. II (Vegetable Drugs). Chaukhambha Visvabharati, p. 236.
9. Ayurveda Pharmacopeia of India, Vol. 1 Part I. (1985). Department of Ayurveda, p. 173.