Infertility

Definition:-  Failure to conceive within one or more years of regular unprotected coitus.

1) Primary infertility
2) Secondary infertility

Incidence:- 10%

80% achieve conception within 1 year, 10% by second year and 10 % remain infertile.

Causes of infertility

1) Physiological
2) Pathological

1) Physiological-Before puberty, after menopause, 10 weeks postpartum in lactating mothers
2) Pathological- Infertility due to fault in

Male:     30-40 %
Female: 40-50 % and  
Both:     10 %

Aurvedic review of infertility

“Styayate asya garbha iti stree…” cha. Shaa. 4

Etilology:

1) Yonipradosha or abnormalities of reproductive organs-
    Yonivyapada or gynaecological disorders
    Injury to artavavaha strotas
    Yonyarsha
    Garbhakoshabhanga (injury to uterus or its displacement)
    Bhagasankocha (constriction of vulva and vagina)
    Sphalit mutratva (inflammation of reproductive system alongwith urinary tract)

2) Psychological abnormalities
Saumanasyam garbha janananam….cha. Su.25

3) Abnormalities of shukra – Abnormalities of sperms alongwith seminal fluid leads to infertility.

4) Asruk (asruk means ovum, menstrual blood and ovarian hormones)

5) Abnormalities of diet i.e. aahara cause loss of dhatus influencing hormones.It also cause  vitiation of  doshas causing gynaecologic disorders,  Hampers nourishment of fertilized egg or implantation.

6) Abnormalities of mode of life (Vihara) like  vitiation of doshas , Defective coital practice like coitus with woman in her hump – back position or lateral position, deposition of semen over samirana nadi.

7) Akala yoga or coitus in improper time- Rutukala and age i.e. before or afer rutukala or premenarche and postmenopausal .

8) Loss of bala or strength- Physical strength depends upon dhatus.

9) Abnormalities of atma and satva – like misdeeds of previous life or idiopathic causes.

10) Affliction by jaataharini – Jataharini refers to idiopathic causes of infertility. E.g. Pushpaghni jataharini.

11) Curses of God or Fate- Idiopathic causes of infertility.

Classification of vandhya:

According to Charaka and Harita

1) Vandhya (Absolute sterility)
2) Apraja (Primary infertility)
3) Sapraja (Secondar infertility)

According to Harita

1) Kakavandhya (one child sterility)
2) Anapatya (primary infertility)
3) Garbhastravi (repeated abortions)
4) Mrutavatsa (repeated stillbirths)
5) Balakshaya (loss of strength)
6) Infertility due to childhood age, injury or prolapse of uterus, loss of dhatus.

Prognosis ( Sadhyasadhyatva)

Sadhya: Five types of infertility according to Harita , Apraja , sapraja,  Jataharini- andaghni, pushpaghni, durdhara, kalaratri are sadhya.
Yapya:  Nakini jataharini is yapya i.e. can be treated with difficulty.
Asadhya: Infertility due to incurable diseases of yoni or artava , Congenital absence of uterus and artava ,Vashya jataharini are incurable.

Treatment

Principles of treatment-
1) Treatment of specific causes. eg. Gynaecological disorders, Injury to uterus, Prolapse of uterus,  Diseases of artava and shukra ,  yonyarsha etc.
2) Nidan parivarjana – Etiological factors should be avoided like Abnormal diet and mode of life Coitus before and after rutukala ,  Psychological trouble.
3) Bruhana – Use of strength producing and bruhana articles to compensate loss of bala and dhatus.
4) Panchakarma – After sharirshuddhi by panchakarma, man should be given milk and ghrita medicated with madhur aushadhi and woman should be given taila and masha. Asthapana, anuwasana, Yapana basti is very helpful in infertility.
5) Drugs prescribed for pusavanakarma.

Specific treatment:

Drugs for external use

- Nasya of lakshmana pestled in cow milk or lakshmana mool pestled in ghrita
- Nasya, abhyanga, basti of- Narayanataila , Lashuna taila , Shatapaka taila ,Traivruta sneha and Balataila  is very helpful.
- Basti of other drugs- Shatavaryadi anuwasana,  Guduchyadi rasayana , Sahacharadi basti and  Mustadi yapana basti is indicated.

Drugs for oral use

- Treatment of vataj, pittaj and kaphaj rajodushti as per samhita should be done accordingly.
- Churna- Baladya  and  Drakshadya churna is helpful to achieve pregnancy.
- Lakshmana kalka
- Shatapushpa kalpa
- Ashwagandha siddha milk, ghrita
- Jeevaniya gana dravya
- Garbhasthapana gana dravya
- Yogaraj guggulu
- Maharasnadi kwatha
- Taila- Narayana,  Shatavari,  Balataila ,Shatapushpa taila.
- Ghrita – Laghuphalaghrita ,Phalaghrita ,Kamadeva ghrita, Paniyakalyanak ghrita, Sheetakalyan ghrita,  Brihatshatavari, shatavari ghrita ,Kashmaryadi , Jeevaniya gana siddha  Ksheersarpi , Lashuna ghrita
• Dashamoolarishta
- Khandakadyavaleha
- Poogapaka

Pathyapathya
Pathya- Lashuna , Milk, Mamsa, Root of vandhya karkoti,  Langali,  Katutumbi, Devdali,  Bruhati dvaya, Suryaballi, Bheeruka, Coitus during ritukala , Use of clothes, garlanda and water left over by  woman  having  son are all pathyakara i.e. congenial.
Apathya – Kacchara,  Surana,  Amla, Kanji, Vidahi, pungent  things. These are all non congenial i.e. prohibited while treating infertility.