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1 An Ayurvedic Approach to Infertility Management Dr. Priyanka Gupta, Lecturer, I/c Head, Prasuthi Tantra & Streerog, MGACH&RC, Salod (MS)

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An Ayurvedic Approach to Infertility Management, Dr. Priyanka Gupta, Lecturer, I/c Head, Prasuthi Tantra & Streerog, MGACH&RC, Salod (MS)

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An Ayurvedic Approach to Infertility Management

1AnAyurvedic ApproachtoInfertility

Management

Dr. Priyanka Gupta, Lecturer, I/c Head, Prasuthi Tantra & Streerog, MGACH&RC, Salod (MS)

2Its hard to wait round for some thing you know might never happen; but its even harder to give

up when you know its every thing you want

PresenterPresentation NotesA WHO evaluation of Demographic and Health Surveys (DHS) data (2004), estimated that more than 186 million ever-married women of reproductive age in developing countries were maintaining a "child wish, translating into one in every four couples

3Ayurveda? Ayurvedaisamedicineand philosophytogethertomake

completenessofsociety Itcarestheprophylaxisand

therapeuticstoo Theinfertilityisaproblemevenin

oldendaystackledinmanyways TheInfertilityisgivenapriorityin

societywithasayingAputrasya

Gatir

naasti

i.e.

withoutachild thereisno eternity

Forwhichtheymadeaprotocolof Eugenics

4AyurvedaKnowledgeofGenetics Eugenicsisthestudyof

methodsofimprovinggenetic qualitiesbyselectivebreeding

(especiallyasappliedto humanmating)

Susruta

thefatherofsurgery

hasputforthmanyconcepts of

Conjugation[daysofselection

forachild],

PreConception[food,attitudes,

psychologicaldiscipline,etc]

Conception[nourishing,

modulatingtheBeeja

(Chromosome)/

Beejabhagaavayava

(genes)]

5AyurvedaMeddlersofGenetics

Ayurvedaorayurvedic

medicineisasystemof traditionalmedicinenativetotheIndian

subcontinent. Susruta

statesthat,theconjugationoneven

days(4681012)givesriseamalebabyand ontheodddays(57911)toafemalebaby.

[thedaycountisfromthedayofmenstruation] ToinitiateEugenicsAyurvedatookthechrono

biologyandchronopharmacologyastoolsand alteredsuccessfullythereleaseoftheovum

andquantityandqualityofthesemeninmale.

6DHAKA,14th 17thMARCH,2011

Whathappened? XIIIASCON,ICDDR,atBANGLADESH

Forwhat? MainstreamingTraditionalMedicine:

PotentialRoleforUniversalHealthCoveragein theIndianContext

Whataredeclarations?

7Declarations

Ayurvedaisinvariousforms Itincludesthe TraditionalTextual

aphorisms,FolkPractices,HomeRemedies, andComplementary&AlternativeMedicine,

etc.

Increasinglybeingacceptedinhighincome

countriesforitsefficacyandlowincome countrieslikeIndiaforitseconomicaland

usefulness. Itisestimated(WHO)that70%ofworld

GlobalAtlasisusingTraditionalmedicine

8 Thecostsofmodernconventionalmedicineare becomingdifficultforeventhedevelopedcountriesto

bear,andTMtendstobelessexpensive. Theiatrogenesis

ofmodernmedicineisincreasingly

beingrecognized(ahighproportionofhospital admissionsintheUSA)

Thereisarealthreatofresistancelevelstoantibiotics increasingtosuchlevelsthatotherregimenshaveto

besought,andtherearepresentlyfewlinesof researchfornewerantibiotics.

Declarations

9Todayspractice

Thefrontiersofmedicalresearchand practicetodayincludealargesectionon

herbalremedies,lifestyledeterminantsand therapies,bodymindtherapies,

interdisciplinaryresearchsuchaspsycho neuroimmunology.RCTs

haveprovided

evidenceforefficacyofseveralherbaland othertraditionaltherapies.

10

Thus,multiplereasonsforexaminingthe potentialroleofTMpopularchoice,a

scientificneed,afinancialneed,equity requirements

andtherebyapublichealth

imperative.

Conclusions

11

INFERTILITYvisvisVANDHYATVA

12

TypologyofVANDHYATVA

13

BeforeattemptingtotreatVandhyatwa,itisessentialto knowaboutthefactorsessentialforconceptionaccordingto

Ayurveda 1

Ritu

(Ageofcouple&appropriatetimeofthemenstrual

cycleie,welldevelopedproliferative

phaseaccompanied

withovulation) 2

Kshetra

(Ahealthybodycontainshealthywomb)

3Ambu

(metabolicproductsaswellashormonessupplied

forthegrowthoffetus) 4Beeja(HealthySperm&Ovum

)

Factorsofaffecting Conception

14

Otherconsiderableimportant Factorsforconception

1.

MANASOBHITAPAM(Psychological)

2.

AHARADOSHAM(Diet)

3.

VIHARADOSHAM(Modeoflife)

4.

BALAKSHAYAM(Generalhealth)

15

Diagnosis&Management Ayuvedic gynaecologist follow the trend of Diagnosis

with modern diagnostic tools and treat with traditional Ayurvedic principles.

In any fertility work-up, both male and female partners are scrutinized

If pregnancy fails to occur after a year of regular unprotected sexual intercourse it is considered for Medical /Procedural management in Ayurveda.

An analysis of the man's semen should be performed before the female partner undergoes any invasive testing

16

Diagnosis MedicalHistoryandPhysical

Examination Thefirststepinanyinfertilityworkupis

acompletemedicalhistoryandphysical examination.

patient'shistoryofsexualactivity, especiallyfrequencyandtimingof

intercourse. Menstrualhistory,

17

Diagnosis

lifestyleissues(smoking,drug andalcoholuse,andcaffeine

consumption), anymedicationsbeingtaken,and

aprofileofthepatient'sgeneral medicalandemotionalhealth

18

LaboratoryTestsHormonalLevels.

Folliclestimulatinghormone (FSH)

Luteinizing

hormone(LH)

Prolactine Thyroidprofile

Clomiphene

ChallengeTest

TissueSamplesTestsforAutoimmuneDisease

19

ImagingTestsandDiagnosticProcedures

Ultrasound(particularlyavariationcalled salineinfusionsonohysterography)

Hysterosalpingography Hysteroscopy Laparoscopy Combinationsoftheseimaging

proceduresmaybeusedtoconfirm diagnoses.

20

AyurvedicApproachto Infertility

1.

Nidana

Parivarjana

(avoidanceofcause) whenitisabletobenoticed Papaya

(ergot),Tulasi

(antifertility),etc.

2.

Shodhana

(purification) the obstructions(PCOD,Tubal

Block,etc)

eitherinthelocalizedorgeneralizedare removed

3.

Shamana

(pacification)

4.

Garbha

sthapaka

(establishmentof pregnancy)

21

AyurvedaShodhana/Panchkarma

AyurvedausemodalitiesforInfertility Snehana

(Internalunction),

Nasya

(Nasalapplication) Basti

(Medicatedenema),and

uttara

basti

(Uterovesical

douche) Usuallythesepurificationtherapiesare

followedbyoralsupplementations

22

Ovulatory

Factors

AcourseofProgressiveinternalUnction (Arohan

krama

snehpana)followedby

purgation(Virechana) Nasalapplication(Nasya)

shown

encouragingresultswith

Narayan

taila, Satpushpa

tail,etc.

Ovulatory

induction(Artava

Janana) is donewith

Phala

ghrit,Shatavari

ghrit,

Rajahpravartani

vati,Pushpadhanva

ras, etc.

23

Tubal

Factors

Partial/completetubal

blockor adhesions/pelvicinflammatory

diseasearemanagedwith Uttravasti

Medicinesusedare Kshar

tail, Lashuna

tail, Kaishor

Guggulu, Triphala

Guggulu, Guduchi, Kutki

(Picrorrhiza

kurroa)and Punarnava,etc.

24

UterineFactors

EndometrialQualityis improvedwithUttravasti

Medicinesusedare Aswagandha

ghrit,

Ashoka

Ghrit, Ksheerabala

(101)tail,

Balatail,etc.

25

CervicalFactors CervicalmucuspH/Sperm

penetrationfactorsarehandled withYoniPichu

(Vaginal

tampon)andYoniDhavan (Vaginalwash)

Medicinesusedare Kshara

taila

(Vaginaltampon)

Triphala

Kwath,(Vaginalwash) Varunadi

Kwath,(Vaginalwash)

26

AyurvedicTreatment Femaleinfertilityaccountsfor3540%ofoverallinfertility.

Treatmentdependsuponthespecificidentifiablecause

Ovulationdisorder Chandraprabha

Vati,

Yograj

Guggulu,

Ashokarishta

andDashmoolarishta.

Ashoka

(Saraca

indica),

Dashmool

(TenRoots),

Shatavari

(Asparagusracemosus),

Aloes(Aloevera),Guggulu

(Commiphora

mukul),

Hirabol

(Commiphora

myrrha)and

Harmal

(Paganum

harmala)1

27

AyurvedicTreatment Femaleinfertilityaccountsfor3540%ofoverallinfertility.

Treatmentdependsuponthespecificidentifiablecause

Ovulationproblems

causedduetopolycystic

ovariansyndrome(PCOS)

Latakaranj

(Caesalpinia

crista),Varun

(Crataeva

nuevula),

Kanchnaar(Bauhiniavariegata)andGuggulu.Thyroidglanddisordersaretreated

Arogya

Vardhini,

Kanchnaar

Guggulu

and

Punarnava

Guggulu

28

Premature ovarianfailure

(POF)

Ashoka,Dashmool,Chandraprabha,

Shatavari,Guduchi,andJeevanti(Leptadania

reticulata).

Thesemedicinescanbe giveninadditionto

hormonereplacement therapy

29

Cervical mucus

Vata(Ficusbengalensis),Ashwatha(Ficusreligiosa),

Udumbara(Ficusglomerata),Plaksha

(Ficus

infectora),

Shirisha

(Albizia

lebec),Haridra

(Curcumalonga),

Yashtimadhuk

(Glycerrhiza

glabra), Saariva

and

Manjishtha

(Rubia

cordifolia)

30

Womenwho areunderweight

orhaveasmall, undeveloped

uterusorcervix

Shatavari,Ashwagandha

(Withania

somnifera),Vidarikand

(Pueraria

tuberosa),

Ksheervidari

(Ipomoeadigitata),Bala

(Sida

cordifolia),

Samudrashok

(Argyria

speciosa), Nagbala

(Grewia

hirsuta),

Shrungatak

(Trapa

natans)andYashtimadhuk

31

Somewomendo

conceive,butareunable toretainthe

pregnancytillfullterm

Guduchi,Kantakari

(Solanum

xanthocarpum),

Brihati

(Solanum

indicum),

Gokshur

(Tribulus

terrestris),

Bhrungraj

(Eclipta

alba),

Yashtimadhuk,Pippali

(Piperlongum),

Bharangi

(Clerodendrum

serriatum),

Padmakashtha

(Prunus

cerasoides),

Rasna

(Pluchea

lanceolata)and

Manjishtha

.UWennerholm,CBergh.11844355HumFertil;2000,3,5264..EHughes,DFedorkow,JCollins,PVandekerckhove.TheCochraneLibrary,2004,1,241.

.ISTummon,LJAsher,JSBMartin,Fertil

Steril;1997,68,812.AMundewadi,FemaleInfertility,AyurvedicHerbalTreatment.2009,3,121125.

.AMundewadi,FemaleInfertility,AyurvedicHerbalTreatment.2009,5,141145.

27.JAbdulmubeen

"FemaleInfertility,AyurvedicHerbalTreatment,2008,7,111115..DMEisenberg,RBDavis,SLEttner.JAMA;1998,280,156975.

32

BeneficialEffectsofPanchakarmaTherapy

PKTremovesthetoxicmaterials (1)thegrosslevel,wherevariousorgans

andsystemsofthebodyarethoroughly cleansed

(2)thecellularlevel,wherepurification andcleansingofthebodyisproducedat

thelevelofcells,cellmembranes,and molecules.

PKThelpsinrejuvenationand revitalizationofReproductivesystem

33

STUDYOFUTTARAVASTHIWITH DHANVANTARITAILAINFEMALEINFERTILITY*

Studyprovedthatuttaravasti

withDhanvantari

taila

shows

theconceptionrateas75%. Majorfactorsattendedare

PolycysticOvarianDisease, Tubal

block,

Menstrualdisordersand Anovulation

cycles

TheeffectofthetreatmentonPCODandtubal

blockfound

highlysignificant.

Kamidi Vijaya Kumari et al, STUDY OF UTTARAVASTHI WITH DHANVANTARI TAILA IN FEMALE INFERTILITY, Int. J. Res. Ayurveda Pharm. 4(2), Mar Apr 2013

34

FewmoreStudies

1.

AclinicalapproachbyNarayanatail

inTubal

block inducedfertilityStudyprovedthatNarayana

tail

uttaravasti

for7days(5ml)forsixconsecutive sittingsshow56%ofsuccessin36months

2.

Secondaryinfertilitybeingtreatedwith Pushpadhanwa

ras

andOjaswini

vati

alongwith

Uttaravasti

gotasuccessof65%offertility.

1. Anitha S, Uttaravasti a clinical approach by Narayanatail in Tubal block induced fertility, Proceedings of RAV, Feb-2009

2. Susheela sharma (2008), Ayurvedic approach for the management of secondary infertility, Journal of Ayurveda, Vol-2, N2, 2008 (April-June)

35

IntegratingModernAnd TraditionalIndianMedicine

InAsiaandAfrica80percentofpeopleusetraditional medicine

IndiausestheAyurveda/Herbalmedicinevividlyinall levelsofInfertility

ManycasesofInfertilityarenotreportedtothefertility centersandgottreatedatVillagelevelsbyherbal

practitioners Thereportedcomplicatedcasesdorequirethorough

investigationsofscientificparlanceandatraditional expertiseutilization

Source:http://www.scidev.net/global/disease/feature/integrating-modern-and-traditional-medicine-facts-and-figures.html

36

NeedoftheHour DMIMS(DU)have

multifaculty specialties,whereold

rootsandnew technologiescan

makethebest managementplans

Traditiontomeet thetechnology

Dr.Priyanka

Gupta

An Ayurvedic Approach to Infertility ManagementSlide Number 2Ayurveda?Ayurveda Knowledge of GeneticsAyurveda Meddlers of Genetics DHAKA, 14th 17th MARCH, 2011Declarations Slide Number 8Todays practiceSlide Number 10INFERTILITY vis--vis VANDHYATVATypology of VANDHYATVAFactors of affecting ConceptionOther considerable important Factors for conceptionDiagnosis & ManagementDiagnosis Diagnosis Laboratory TestsImaging Tests and Diagnostic ProceduresAyurvedic Approach to InfertilityAyurveda Shodhana/PanchkarmaOvulatory FactorsTubal FactorsUterine FactorsCervical FactorsAyurvedic TreatmentAyurvedic TreatmentSlide Number 28Slide Number 29Slide Number 30Slide Number 31Beneficial Effects of Panchakarma TherapySTUDY OF UTTARAVASTHI WITH DHANVANTARI TAILA IN FEMALE INFERTILITY *Few more StudiesIntegrating Modern And Traditional Indian MedicineNeed of the Hour -