Ayurvedic Approach to Conquer Secondary Infertility with Hypothyroidism-A Case Report

Infertility is a disease of the male or female reproductive system defined by the failure to conceive after 12 months or more of regular unprotected sexual intercourse. In Ayurveda infertility is termed as ‘ Vandhyatwa ’. The factor for a healthy conception, pregnancy and delivery is mentioned as “ Garbha sambhava samagri ” (factors essential for conception) by Acharya Sushruta. i Artava (ovum) and Shukra (Sperm) are considered as “ Antima dhatus ”. Therefor uttarotara Dhatuposhana is essential for the good quality of Artava and Shukra. A 33-year-old female patient presented to the Streeroga OPD at ITRA on 1 st Nev. 2021, complaining of Failure to conceive, Scanty menstruation, and weight gain for 3 years. In this case the patient had the history of Hypothyroidism and Low AMH, which affect the process of metabolism which further results in improper development of follicles and anovulatory cycle leading to infertility. In this case evidences of defective Dhatuparinama can be visualized like irregular menstrual cycles, thin endometrium and infertility. She has been taking allopathic medicine for the same for the 6 months which was later discontinued. Ayurveda treatment including Shodhana and Shamana therapy is adopted. Patient had undergone Virechana karma followed by D ashamooladi yogabasti and Shatapushpa Taila Matrabasti in next cycle, On 30 th Apr 2022 patient came with amenorrhea of 1 month 6 days. The outcome of the Ayurvedic intervention was the conception and on 7 th dec 2022 she delivered a healthy male baby of 3.2 kg.


Introduction:
Thyroid disorders were found to be the most common endocrine problems seen in the world.In most of cases, thyroid can lead to infertility or miscarriages.It is estimated that 10-15% of married couples suffer from infertility.ii Secondary infertility indicates Previous pregnancy but failure to conceive subsequently.In Ayurveda infertility is termed as 'Vandhyatwa'.Acharya Harita has mentioned 6 types of Vandhya, Amongest them one is the Kakavandhya (secondary infertility).iii According to Ayurvedic classics, the causes of Vandhyatwa are: Yonivyapada, Artavavaha strotodushti, Yoniarsha, Manasika Abhitapa (psychological abnormalities), Shukra Dosha, Asruga Dosha, Ahara-vihara Dosha (abnormalities of diet & mode of life),Akala Yoga (coitus in improper time), Balasamkshaya, Jataharini ,Daivaprakopa.iv According to FIGO manual causes are: tubal and peritoneal factors (25-35%), ovulatory factors (30-40%), and endometriosis (1-10%).v Prevelance of hypothyroidism in the reproductive age group ranges from 2% to 4%.Women with hypothyroidism may have either oligo-or amenorrhea.Any impairment in thyroid hormone level causes impairment of foliculogenesis, which prevents the differentiation of granulosa cells and promotes apoptosis into atresia follicles, resulting in low AMH levels.Lincoln and associates (1999) found a 2% incidence of elevated thyroid-stimulating hormone (TSH) levels in 704 asymptomatic women seeking evaluation for infertility.Correction of hypothyroidism in those with ovarian dysfunction and elevated TSH levels lead to pregnancy in 64% of patients.vi In addition to infertility and miscarriages, previous studies observed that 20% of patient with low AMH (premature ovarian insufficiency) before the age of 40 years based on clinical and laboratory findings, tends to suffer from thyroid autoimmune disorder.AMH plays important role in the regulation of the development of the follicles.A patient with hypothyroidism, due to Agnimandhya there is improper formation of Utarottara Dhatu and Upadhatu which result in scanty menstruation or Irregular menses.Due to Dhatwagnimandhya Dhatuparinama is defective, which result in low level of AMH (diminished ovarian reserve) leads to defective folliculogenesis or Anovulation.

AIM AND OBJECTIVES:
1. To assess the efficacy of Ayurvedic medication in treating secondary infertility caused due to Hypothyroidism.

MATERIAL AND METHOD:
Case report: A 33-year-old married woman with a married life of 7 years visited the OPD of Prasuti tantra evam Stree roga of ITRA, Jamnagar with complaints of Failure to conceive, Scanty menstruation, and weight gain for 3 years and she had the history of Hypothyroidism and Low AMH.Personal history: After asking about routine lifestyle, it was found that the patient had the history of irregular dietary habits and she used to take fast food and followed a sedentary lifestyle.Had a habit of eating fast food 2-3 times in a week.Bowel habit was not regular with hard stool and occasional constipation.There was no problem with micturition.Patient had a habit of day sleep of about 1-2 hrs. in afternoon.

History
Menstrual history: (LMP: 02/11/2021) Patient had her menarche at the age of 13 years.She had a regular menstrual cycle with normal menstrual flow up to 20 years with an interval of 28-32 days and duration of 3-4 days for 3 years she had a complain of scanty menstruation with duration of 2 days.Bleeding was scanty with (1-2 pad/day-not fully soaked).

DISCUSSION:
Conception requires a complex sequence that includes ovulation, fertilization, transport of fertilized ovum into the uterus, and implantation into a receptive uterine cavity.In today's fast world due to lack of time, sedentary lifestyle, and increasing mental stress, Infertility is emerging as a disorder affecting the social and psychological aspects of life.Thyroid disorders are prevalent in reproductive-aged individuals and affect women four to five times more often than men.In women, oligomenorrhea and amenorrhea are frequent findings.Both thyroid disorders and decreased ovarian reserve increase with aging.Autoimmune thyroid disorders have also been reported in 10 to 30% of patients with ovarian failure, suggesting thyroid disorders are associated with ovarian reserve.Subclinical hypothyroidism may also be associated with ovarian dysfunction due to diminished ovarian reserve.In addition, subclinical hypothyroidism may also adversely affect pregnancy outcomes.

FOLLOW UP AND OUTCOMES:
Within 5 months of treatment, she got conceived in the month of April.Her LMP was 24/03/2022.sheunderwent USG on 29/04/22 and suggested that there is a single live intrauterine gestation, the yolk sac with fetal pole seen.she was underwent the regular check with medications such as Thyronorm(25 mcg), Phala Ghrita-2 tsp OD, and Iron-Calcium supplements.She delivered per vaginal healthy male baby of 3.2 kg on 7 th dec.2022.

CONCLUSION:
The treatment of infertility is typically initiated only after a thorough investigation.The initial focus is to identify lifestyle or environmental issues that may contribute to or cause the reproductive impairment.Vata Dosha regulates menstrual flow with uterine vasculature and receptibility.Thus, we can conclude that infertility due to hypothyroidism is managed by using Shodhana and Shamana Chikitsa which has helped in conception.Following a healthy regimen along with a nourishing diet.
k/c/o Hypothyroidism for 3 years (on medication thyronorm 25 mcg), No H/o DM and HTN.Family history-No specific family history of infertility or any other disorder.