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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 5  |  Issue : 2  |  Page : 89-92

Effect of Nitya virechana before intrauterine insemination: A case report


1 Department of Stree Roga Evum Prasuti Tantra, National Institute of Ayurveda, Jaipur, India
2 All India Institute of Ayurveda, New Delhi, India

Date of Submission13-Jul-2020
Date of Acceptance31-May-2022
Date of Web Publication28-Jun-2022

Correspondence Address:
Dr. Neha Dixit
Department of Stree Roga Evum Prasuti Tantra, 3rd floor, Academic block, National Institute of Ayurveda, Madhav Vilas Palace, Amer Rd, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacr.jacr_47_20

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  Abstract 


In modern medical science, diagnosis and treatment are based on a direct vision which is made by a number of diagnostic tests. When infertility evaluation failed to detect any cause of infertility, it is called “Unexplained Infertility.” Intra-uterine insemination (IUI) is a basic treatment option in such unexplained cases. In Ayurvedic classics, Ritu (~menstruation), Kshetra (~uterus), Ambu (~nutrition), and Beeja (~ovum and/or sperm) are described as essential factors for conception. Adequate physiological functioning of these factors is also necessary with the absence of causative factors to achieve conception. Along with that normal psychology is also described as an important aspect for conception. A 35-year-old female presented to Stree Roga Evum Prasuti Tantra OPD, on December 2019 with chief complaints of long-standing unexplained infertility. The patient was advised IUI along with Ayurvedic management. Vata is a principle Dosha in Vandhyatva (~infertility) and Mridu sanshodhana (~mild purification) described as a line of treatment to treat vitiated Vata dosha. Virechana is also maintained for “Agarbha” Stree (~infertile woman). Hence, the patient was treated with Nitya virechana (~daily therapeutic purgation) by Eranda sneha (~castor oil). Eranda sneha maintains Agni (~digestive power) and normalizes Vata dosha by Vata anulomana karma (~carminatives). It also affects the psychological status of the patient by Medhya (~intellect power) and Smritikara (~improving memory) properties. This concept was followed in this case to manage infertility. After the second cycle of IUI, urine pregnancy was achieved in April 2020, and delivered a healthy male baby in November 2020.

Keywords: Eranda sneha, intrauterine insemination, Nitya virechana, unexplained infertility, Vandhyatva


How to cite this article:
Dixit N, Dhiman K. Effect of Nitya virechana before intrauterine insemination: A case report. J Ayurveda Case Rep 2022;5:89-92

How to cite this URL:
Dixit N, Dhiman K. Effect of Nitya virechana before intrauterine insemination: A case report. J Ayurveda Case Rep [serial online] 2022 [cited 2022 Aug 13];5:89-92. Available from: http://www.ayucare.org/text.asp?2022/5/2/89/348697




  Introduction Top


When irrespective of any reason couples do not achieve conception, it is called unexplained infertility. In approximately 15% of infertile patients, standard infertility evaluation will fail to identify a likely etiology. For these patients, Intra Uterine Insemination (IUI) is a basic treatment option. Studies have found that the pregnancy rate for each natural IUI cycle is about 3%–4%.[1] Superovulation with IUI is more effective in unexplained infertile couples in comparison to the natural IUI cycle. The success rate of IUI depends on the type of ovulation induction protocol.[2]

Ayurveda has a different perspective about conception. Ritu (~menstruation), Kshetra (~uterus), Ambu (~nutrition), and Beeja (~ovum and/or sperm) are the essential factors for conception mentioned in Ayurvedic classics.[3] Not only the absence of causative factors but also adequacy and physiological functioning of essential factors are necessary for conception. Virechana (~therapeutic purgation) is mentioned in the management of Yoni roga (~gynecological diseases). Acharya Kashyapa quoted that Beeja becomes efficacious by the use of Virechana karma.[4] Nitya virechana (~daily therapeutic purgation) is a therapeutic modality of Virechana karma which is easy for implementation in day-to-day life and also time-saving therapy. Considering these approaches, a case of unexplained infertility was successfully treated with IUI along with Ayurvedic management.


  Patient Information Top


A 35-year-old married female patient residing in Delhi, having 18 years of married life visited Stree Roga Evum Prasuti Tantra OPD, in December 2019 with chief complaints of being unable to conceive even after trying for 18 years with adequate coital frequency.


  Clinical Findings Top


The patient got married in 2001 and her menstrual cycles were regular since menarche. She was regularly cohabiting with her husband. Initially, the couple did not worry much about conception but after 3 years of marriage, when she was unable to conceive; the couple consulted an allopathic doctor for the possibility of treatment. When the patient did not conceive after 1 year of treatment, she discontinued the treatment and visited to another hospital. She was advised with diagnostic investigations including follicular study, and hysterosalpingography. Both the investigations of the couple were found to be normal. Thus, the doctor counseled them and prescribed medicine to induce ovulation. However, there was no improvement. After all these efforts, the case was diagnosed as unexplained infertility and she was advised for IUI. The patient received three sittings of IUI with ovulation induction in 2010 and 2011 and also another cycle of IVF in 2011. Despite this, she was unable to conceive. As the couple did not conceive even after these efforts; they approached for Ayurvedic treatment in 2019.

The patient had no history of hypertension, diabetes mellitus, hypothyroidism, and any other medical illness. No previous surgical history was reported. The patient did not have a family history of infertility or any other chronic medical illness.

The patient had a history of chronic constipation and dysmenorrhea. The history revealed a normal menstruation cycle with three days along with an occasionally clotted bleeding pattern and interval of 25–28 days associated with moderate abdominal pain on the first day of menstruation. In personal history, the patient was homemaker. She is vegetarian; however, Vishamashana (~consuming less or more quantity of food at an improper time) is observed. Based on bowel habits, the patient had Krura koshta (~irregular bowels) and Vishamagni (~irregular state of Agni). She suffered from disturbed sleeping patterns since a long due to stress. The patient had a history of Mala (~stool) and Mutra (~urine) vegadharana (~suppression of natural urges). The Prakruti (~physical constituent) of the patient was Vata-Pitta. Sara (~excellence of Dushya or tissue elements) and Satva (psychic condition) were Avara (~low) and Abhyavarana shakti (~power of ingestion) of the patient was Madhyama (~moderate), but her Jarana shakti (~digestive power) was Avara (~low).


  Diagnostic Focus and Assessment Top


On general examination, the patient's pulse was 76/min and blood pressure was 114/70 mmHg. Her height was 5 feet 3 inches and her weight was 61 kg. On systemic examination, no abnormality was seen. On abdominal examination, no abnormality was detected. Per-speculum vaginal examination showed a healthy cervix without any abnormal vaginal discharges and per-vaginal examination revealed normal-sized anteverted uterus and clear fornices without cervical motion tenderness. All the hematological, biochemical reports, ultrasonography, hysterosalpingography, and semen analysis of the husband were found to be normal. Her follicular study reports were documented with proper ovulation in both ovaries.


  Timeline and Therapeutic Intervention Top


Considering the chronicity of the disease and Bala (~strength and ability) of the patient, Nitya virechana and IUI were planned for three cycles. The patient had faulty dietetic habits as mentioned in the patient information section, so the patient was advised to take easily digestible food such as Moong dal (~green gram), Khichadi (~porridge) and leafy vegetables along with Ushnodaka (~warm water) from the first visit. Considering the last menstrual cycle (on February 7, 2020) and after cessation of menses, 30 ml of Eranda Sneha (~castor oil) with an equal amount of milk was given on empty stomach in the morning from February 11 to 17, 2020. This treatment continued till the size of the ovarian follicle did not reach up to 17 mm. The patient attained maximum Lakshana of Samyak nitya virechana (~optimal therapeutic purgation), which were assessed based on Samyak virechana symptoms such as Laghuta (~lightness in the body), Agnidipti (~increase in power of Agni), Vata anulomana (~evacuation of the flatus), and Sroto shuddhi (~cleanliness of srotas).[5] In the first cycle of Nitya virechana, the patient had 5–6 Vega per day (~purgative bouts). After the size of the follicle attained to 17 mm, preovulatory IUI was done on February 18, 2020, and after ovulation, postovulatory IUI was done following all precautionary measures on February 20, 2020, with Husband's Semen at All India Institute of Ayurveda, New Delhi.

In the first cycle of IUI (February 2020), the patient did not achieve conception. Hence, the second cycle of IUI was planned in March 2020. In March 2020, the patient's last menstrual period was March 4, 2020. Similar to the previous month, Ushnodaka and Laghu aahara were advised to the patient and after cessation of menses, Nitya virechana was administrated with the Eranda sneha from March 8 to 15, 2020. During this time, the patient had 3–4 Vega/day. On March 16, 2020, the size of follicles was 16.4 mm × 12.8 mm and 18.5 mm × 13.4 mm in the right and left ovary, respectively. The endometrium thickness was 8.8 mm. Hence, preovulatory IUI was done on March 16, 2020. After ovulation, postovulatory IUI was done on March 17, 2020. On March 17, the endometrium thickness was 9.5 mm.


  Follow-Up and Outcome Top


In April 2020, the patient missed her period and UPT was positive on April 7, 2020. Beta-Human chorionic gonadotropin was 5305.09 mIU/ml on April 10, 2020. After conception, the patient has been in regular follow-up. On May 28, 2020, her ultrasonography report had shown 11 weeks 3 days of single intrauterine pregnancy. She continued her pregnancy till term and delivered a healthy male baby on November 18, 2020.

Pathya_Apathya (wholesome-unwholesome) during Nitya virechana

After Aushadha jeerna lakshana (~symptoms of digestion of drug), the patient was advised to take hot, liquid light diet, and lukewarm water for drinking and for all purposes. She was also advised to avoid day sleep, excessive walking, excessive traveling, exposure to cold wind, Guru bhojana (~heavy diet), junk food, and coitus.


  Discussion Top


Ayurveda believed in Karya-karana bhava (~cause and effect relationship). This theory postulates that Karya (~any event) cannot take place without Karana (~causative factor). Hence according to Ayurveda, if diagnostic tests do not show any pathology it does not mean that there is no deformity and in the case of unexplained infertility, it indirectly indicates insufficiency of essential factors. Virechana is mentioned in all Yoni roga chikitsa.[6] Acharya Kashyap quoted that Garbhashya remains in good condition and seed becomes efficacious by Samyak virechana.[4] Nitya virechana is a component of Virechana karma, which gives similar benefits of Virechana karma. Aacharya Charaka said that when the amount of morbid Dosha is high in weak patients then, Doshas should be eliminated by repeated use of Mridu virechana drug.[7] In general, females being Sukumara (~delicate) in nature, and in this study, patient's Sara (~excellence of Dushya or tissue elements) and Satwa (~psycic condition) were Avara (~less) and Koshtha (~nature of bowel) was Krura (~irregular or constipated bowel nature). Thus, Nitya virechana with Eranda sneha was planned before IUI.

Vandhyatva is a Vata dominant Vyadhi and Mridu sansodhana is mentioned in Vata dosha chikitsa.[8] The patient had a history of chronic constipation and dysmenorrhea which suggests Apana vata dushti. Along with that, the patient also has a history of Vegadharana and disturbed sleep (~Alpa nidra) which indicates the vitiated Vata dosha.

Eranda sneha due to its Ushna (~hot) Tikshna (~sharp), Deepana (~appetizer), and Sroto shodhana (~purifies the channels) properties[9] is highly used in Nitya virechana. Acharya Sushruta has mentioned that Eranda Sneha has Srotoshodhana and Vrushya (~aphrodisiac) properties and it helps in maintaining physiological functions of the reproductive system, alleviating Vata-Kapha, and eliminating impurities.[9] Castor oil is described as the best oil in all types of oil for Virechana.[10]

The purgative nature of Eranda sneha facilitated the Vata anulomana karma, which initiates the proper function of vitiated Vata dosha, especially Apana vayu. Its Sukshma guna makes its entry easy to Sukshma srotas level, by which it removed Srotorodha and do Srotoshodhana karma which finally leads to Yoni vishodhana (~cleanses the Yoni marga). Medhya (~intellect power) and Smritikara (~improving memory) properties[9] of Eranda sneha might act on Manovaha srotas (~channels which carries impulses of thoughts and emotions) in controlling the hypothalamus-pituitary-ovarian axis. Hence, Eranda sneha possibly influenced the IUI outcome and enhances its acceptance by Nitya virechana.


  Conclusion Top


Nitya virechana is a type of Virechana karma, which is done on daily basis for Dosha nirharana in Alpamatra in Bahu dosha awastha condition, without Poorvakarma when the patient is Durbala or Sukumara. Vata anulomana is the therapeutic effect of Nitya virechana karma, which facilitates Sroto shodhana karma and by removing toxins, it maintains gut health. No side effects were noticed during the treatment period. Based on the observations of this case, it can be inferred that Nitya virechana, before IUI can be helpful in case of unexplained infertility.

Declaration of patient consent

Authors certify that they have obtained patient consent form, where the patient has given his consent for reporting the case along with the images and other clinical information in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Guzick DS, Sullivan MW, Adamson GD, Cedars MI, Falk RJ, Peterson EP, et al. Efficacy of treatment for unexplained infertility. Fertil Steril 1998;70:207-13.  Back to cited text no. 1
    
2.
Ahinko-Hakamaa K, Huhtala H, Tinkanen H. Success in intrauterine insemination: The role of etiology. Acta Obstet Gynecol Scand 2007;86:855-60.  Back to cited text no. 2
    
3.
Shastri KA, editor. Sushruta Samhita of Sushruta, Sharira Sthana. Ch. 2, Ver. 35. Varanasi: Chaukhambha Sanskrit Sansthan; 2014. p. 19.  Back to cited text no. 3
    
4.
Bhisagacharya S, editor. The Kasyapa Samhita by Vrddha Jivaka, Siddhi Sthana. Ch. 2, Ver. 7. Varanasi: Chaukhambha Sanskrit Sansthan; Reprint 2015. p. 225.  Back to cited text no. 4
    
5.
Shastri R, Upadhyaya Y, Pandeya GS, Gupta B, editors. The Charaka Samhita of Agnivesha, Sutra Sthana. Ch. 16, Ver. 5-6. Varanasi: Chaukhambha Bharati Academy; Reprint 2013. p. 320.  Back to cited text no. 5
    
6.
Shastri R, Upadhyaya Y, Pandeya GS, Gupta B, editors. The Charaka Samhita of Agnivesha, Siddhi Sthana. Ch. 2, Ver. 13. Varanasi: Chaukhambha Bharati Academy; Reprint 2013. p. 981.  Back to cited text no. 6
    
7.
Shastri R, Upadhyaya Y, Pandeya GS, Gupta B, editors. Charaka Samhita of Agnivesha, Kalpa Sthana. Ch. 12, Ver. 69. Varanasi: Chaukhambha Bharati Academy; Reprint 2013. p. 950.  Back to cited text no. 7
    
8.
Upadhyaya Y, editor. Astanga Hridayam, Sutra Sthana. Ch. 13, Ver. 1. Varanasi: Chaukhambha Prakashan, Reprint 2011. p. 130.  Back to cited text no. 8
    
9.
Shastri KA, editor. Sushruta Samhita of Sushruta, Sutra Sthana. Ch. 45. Ver. 114. Varanasi: Chaukhambha Sanskrit Sansthan; 2014. p. 230.  Back to cited text no. 9
    
10.
Shastri KA, editor. Susruta Samhita of Sushruta, Sutra Sthana. Ch. 44, Ver. 4. Varanasi: Chaukhambha Sanskrit Sansthan; 2014. p. 208.  Back to cited text no. 10
    




 

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Abstract
Introduction
Patient Information
Clinical Findings
Diagnostic Focus...
Timeline and The...
Follow-Up and Ou...
Discussion
Conclusion
References

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