Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse, as mentioned by WHO.

Infertility affects millions of people of reproductive age worldwide – and has an impact on their families and communities. Estimates suggest that between 48 million couples and 186 million individuals live with infertility globally.

What causes infertility among male and females?

In the male reproductive system, infertility is most commonly caused by problems in the ejection of semen, absence or low levels of sperm, or abnormal shape (morphology) and movement (motility) of the sperm.

In the female reproductive system, infertility may be caused by a range of abnormalities of the ovaries, uterus, fallopian tubes, and the endocrine system, among others.

What are types of infertility?

Infertility can be primary or secondary. Primary infertility is when a pregnancy has never been achieved by a person, and secondary infertility is when at least one prior pregnancy has been achieved.

Fertility care encompasses the prevention, diagnosis and treatment of infertility. Equal and equitable access to fertility care remains a challenge in most countries; particularly in low and middle-income countries. Fertility care is rarely prioritized in national universal health coverage benefit packages.

What causes infertility?

Infertility may be caused by a number of different factors, in either the male or female reproductive systems. However, it is sometimes not possible to explain the causes of infertility.

In the female reproductive system, infertility may be caused by:

1. Tubal disorders such as blocked fallopian tubes, which are in turn caused by untreated sexually transmitted infections (STIs) or complications of unsafe abortion, postpartum sepsis or abdominal/pelvic surgery;

2. Uterine disorders which could be inflammatory in nature (such as such endometriosis), congenital in nature (such as septate uterus), or benign in nature (such as fibroids); disorders of the ovaries, such as polycystic ovarian syndrome and other follicular disorders;

3. Disorders of the endocrine system causing imbalances of reproductive hormones. The endocrine system includes hypothalamus and the pituitary glands. Examples of common disorders affecting this system include pituitary cancers and hypopituitarism.

Photo-Bio modulation therapy in treating Infertility

Ovarian reserve (actively witnessed via, increased AMH and decreased FSH) are intimately tied to optimising fertility by increasing egg quality. There is preliminary evidence for the effectiveness of low level laser therapy in treating Infertility, a study that was performed in an IVF center in Japan used LLLT in women with low or undetectable AMH levels, out of 188 patients treated almost 56% reported pregnancy & 38% reported live births. This study was conducted from April 2010 to Nov. 2015 on patients with low or undetectable AMH level.

They were administered with LLLT for the neck and the abdominal lumbar regions. For better understanding out of 13 patients with an AMH level of 0.1, 6 patients were found to achieve a clinical pregnancy and 5 patients gave birth. An extension of this study showed 50% pregnancy rates.

A study in Denmark showed a 60% pregnancy rate in women who had struggled with infertility of 4 or more years with failure of ART procedures.   

Although there are only a few studies on the effectiveness of LLLT several case studies have been reported that LLLT is effective in ovarian age reversal and thus can be used effectively to treat infertility especially in the patients with low AMH levels. More clinical research is needed, although the preliminary studies show high potential for LLLT to be a valuable method in optimizing fertility in women undergoing natural or artificial conception.

Specific patients who would most benefit from photo bio modulation therapies, for natural conception or in combination with assisted reproductive technologies (IVF)

• Women with low ovarian reserves.
• Women of advanced maternal age.
• Men with low sperm count or quality.
• Women who have been through multiple cycles of IVF with high retrieval rates but low blastocyst rates.
• Women with PCOS ovarian cysts or fibroids.
• Women with endometriosis.
• Women with poor egg quality.
• Women with poor implantation rates repeat pregnancy loss or chemical pregnancies.

Scientific Back-Up

All our cells are powered by little structures called mitochondria. Ovum/ Eggs have about 200 times more mitochondria than any other Cell.

When eggs are developing they use a tremendous amount of energy and early embryo division and implantation requires lots of energy.

After 35yrs the mitochondria wear down, at age 40, 9 out of 10 eggs are normal.

LLLT to the acupressure points, activates ATP in cells, which in-turn increases the quality of cell and reduces oxidative damage. Thus researchers prove there is a significant role of laser therapy in enhancing the fertility of the individual and restoring fertility quality of life.

Dr.  Rekha Krishna Ayachit

Life positive Change Clinic

No 4013, KR road,  Banashankari 2nd stage

Bengaluru-560070

Mob:80881 32477 / 99456 38763

www.lifepositivechange.in 

The post Infertility : Why it is increasing among male and females? appeared first on Health Vision.

SHAPEUP INDIA was formed 17 years back by a group of expert doctors and healthcare professionals to promote targeted Nutrition, Regenerative Medicine, Anti-aging and Preventive care at community and corporate levels.

So far in the country there were no affordable products and no company with a proper revenue model to implement across the length and breadth of this country.

Emergence of a few  companies with an intention of preventive care, targeted and tailored Nutritional products to combat micronutrient malnutrition, many cell based products services with good regenerative/anti-aging solutions  and a suitable revenue model to consumers, has enabled Shapeup India to take a real shape and to form NATIONAL CONSUMER FORUM (NCF).

NCF is designed to be an innovative community and consumer driven project aimed to achieve SMART HEALTH and a well- planned economic redistribution at grass root levels leading to SMART NATION.  We are equally inspired by the Nation’s slogan “ATHMA NIRBHAR BHARATH”

Health Vision Spoke to Dr. Srinivas Murthy –  senior consultant clinical sports and nutrition Shape up India on his vision to make the society clean and healthy.

Is it a fact that many people in society are suffering from many diseases due to regular use of commercially sold household products?

Dr. Murthy:  In this regard let us not think of spurious products. Let us talk about only daily use products sold through media support. Just take normal bath soap and toothpaste. Nobody is bothered about the required parameters for bath soap. Now a days some companies are talking about T F M (Total Fatty Material). It should be a minimum of 75% TFM . But majority of available brands have around or less than 70%TFM.

Next toothpaste. As per Central Education and Research Society majority of our toothpastes have high fluoride content. People use high end water filters to filter fluoride in water but consume fluoride while brushing teeth on daily basis. Children in fact eat half of the paste. Fluorosis leads to dental caries, osteoporosis and nerves disorders. If we consider edible and cooking oils it is a major health concern.

According to you which are the false perceptions people have while maintaining their health?

Dr Murthy: From the point of maintaining good health there are many good developments. By looking at walking crowds in the mornings, number of fitness centers everywhere and business of nutritional products speak about the public concern to health.  Like that public have many misconceptions about health. Let me cover just a couple.

As per W H O every 8 minutes one cervical cancer is recorded. In addition PCOD and infertility issues are increasing day by day. As per few surveys it is due to use of Sanitary pads, it is learnt. You chose any best brand in the market and examine they will have plastic and synthetic layers and they have poor absorption and causes itching, irritation and discolouration. In addition the heat generated produces DIOXIN which is the leading cause of all problems.

You mean one has to quit sanitary pads and use clothes like olden days?

Dr murthy: Not like that. The main intention of Shapeup! India is to introduce economical, natural and nutritional products to the society. In this regard we are introducing one international standard smart sanitary pads. These pads have only pure cotton in all layers with max absorption capacity. In Addition it has ACTIVE OXYGEN, NEGATIVE ION, F I R, MAGNETIC and NANOSILVER based chip. Which does many things. Please google and check.

In addition we provide free vaginal test kit with each and every packet. And cost of this kit in market is Rs.175. By using this test kit one can avoid visiting gynecologist frequently by testing themselves. Complete demo of this Pads is available in video format.

Any other false perception People are in?

Dr Murthy: Next Protein Consumption by public is another concern. Since 20 years there are many companies promoting different kinds of proteins at different levels. Big containers with crude concentrates are sold in bazaar in the name of protein. People buy blindly. Many company Reps come to us with preparations less than 30% proteins.

In addition we come across people in parks and public places offering free checkups and saying that if we use their products one can melt like wax in three months and can get away from all other metabolic disorders freely. Many do not know how weight is lost. Weight loss is just based on calorie management. Weight or inches are lost by calories we do not consume and calories we burn by exercise. But not by any secret ingredients as people presume.

Normal general convalescent drinks have around 30% protein. Athletes and sports people need 45-60% protein; Body builders Need 80% protein. In addition almost all general issues by public and for all age related cases one needs PROTEIN RICH IN GLYCINE AMINO ACID. But majority are not aware of this.

What is the solution for this? What kind of preparation SHAPEUPINDIA recommends?

Dr Murthy: People should consult nutritionists before using Protein preparations. One should use protein preparation rich in 65% Glycine. It is present prominently in Muscles, joint cartilages, ligaments, Skin, Heart and nerves. Hence all body builders, sports people, weight Management, neurological, Ortho and Cardiac conditions we need Glycine rich protein.

In addition in all metabolic conditions and age related diseases there is high level of Homocysteine in blood. Only Glycine can break down Homocysteine into methionine and cysteine.

If so where this Glycine rich Protein is available?

Dr Murthy: Shapeup! India has formed National Consumer Forum. Here any one can register from any part of the country and buy products and do social marketing. Courier service is available throughout the country.

Distributors will have all the following benefits-

1. Retail profits
2. Wholesale profits
3. Incentives & bonuses
4. Life time BUY ONE GET ONE FREE
5. International travel opportunities
6. Life time income opportunities for generations
7. BANK LOAN FACILITY for business expansion.
8. Nutritional seminars by experts.
9. Digital marketing support
10. TV and Print media support.

Shape up! India provides

• Info on importance of nutrition and preventive health care in day to day life
• Promotes economical safe natural and nutritional & daily use FMCG products for preventive care purposes.
• Promotes cellular or stem cell therapy to many incurable chronic degenerative conditions including many auto immune disorders and deadly cancerous conditions
• Promotes excellent anti- aging products and stem cell serums soon in Indian market
• Complete ecommerce portal services along with razor pay payment gateway processes are in pipeline.
• World class logistic services throughout the country from well renowned company Ship rocket.
• To unleash dynamic entrepreneurship among the community and corporate members
• Regular online meetings on different health issues by medical and other healthcare experts
• Digital marketing services
• Print and TV media ads

We promote Social marketing through

• women empowerment
• Second career to senior citizens & Unemployed youth

• We have taken steps to provide microfinance through banks to eligible candidates who want to take up marketing.

For video demos and further details whatsapp

94068 49406 /80732 37833

Or visit

Shapeupindia

714, 3rd floor, GIOSTAR-USA hospital building

714, MOdi hospital Road

Rajajinagar, Bangalore-560079

www.shapeupindia.in

The post SHAPEUP INDIA – A project aimed to achieve SMART HEALTH appeared first on Health Vision.

 A clinical case report

ABSTRACT

PCOS, Fallopian Tubal Blockage, Repeated Spontaneous Abortions are some of the causes of female infertility.  Hormonal treatment or drilling of ovaries, micro-surgery of fallopian tubes, IVF are some of the treatment. In Ayurveda it is named as Vandhyatva. Garbhasrava, Beeja Dushti and Mithya Ahara Vihara are some of the causes mentioned by our Acharyas. We are reporting a case of infertility due to PCOS with a surgical history of emergency laparoscopic right sided salpingectomy for ectopic pregnancy. And medical history of tab methotrixate for left side ectopic pregnancy, consequently for second time & left sided hydrosalpinx. As per the classical reference treatment was planned for four- karma (virechana karma, kala basthi and marsha nasya karma, and Uttara basthi karma) along with music therapy and yoga chikitsa, accompanied by rasayana chikitsa, to achieve shuddha garbha sambhava samagri (pure factors of fertilization & conception). Treatment plan was successful with intra uterine pregnancy and she has delivered a healthy female baby through caesarian section.

 INTRODUCTION

According to the World Health Organization (WHO), infertility can be described as the inability to become pregnant, maintain a pregnancy, or carry a pregnancy to live birth.⁽¹⁾ A clinical definition of infertility by the WHO and ICMART is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.” ⁽²⁾ Infertility can further be broken down into primary and secondary infertility. Primary infertility refers to the inability to give birth either because of not being able to become pregnant, or carry a child to live birth, which may include miscarriage or a stillborn child. ⁽³⁾⁽⁴⁾

PCOS – Poly Cystic Ovarian Syndrome is a set of symptoms due to elevated androgens (male hormones) in females.⁽⁵⁾⁽⁶⁾ Signs and symptoms of PCOS include irregular or no  menstrual periods, heavy periods, excess body and facial hair, acne, pelvic pain, difficulty getting pregnant, and patches of thick, darker, mood disorders, velvety skin.⁽⁷⁾

PCOS is the most common endocrine disorder among women between the ages of 18 and 44.⁽⁸⁾ It affects approximately 2% to 20% of this age group depending on how it is defined.^(9)(10) When someone is infertile due to lack of ovulation, PCOS is the most common cause.⁽⁵⁾

PCOS is due to a combination of genetic and environmental factors .^(11)(12)(13) Risk factors include obesity, a lack of physical exercise, and a family history of someone with the condition.⁽¹⁴⁾ Diagnosis is based on two of the following three findings: no ovulation, high androgen levels, and ovarian cysts.⁽¹⁵⁾ Cysts may be detectable by ultrasound.⁽¹⁶⁾

 Figure of pcod

PCOS has no cure.⁽¹⁷⁾ Treatment may involve lifestyle changes such as weight loss and exercise.^(18)(19) Birth control pills may help with improving the regularity of periods, excess hair growth, and acne.⁽²⁰⁾ Metformin and anti-androgens may also help.⁽²⁰⁾ Other typical acne treatments and hair removal techniques may be used.⁽²⁰⁾ Efforts to improve fertility include weight loss, clomiphene, or metformin.⁽²¹⁾ In vitro fertilization is used by some in whom other measures are not effective.⁽²¹⁾

Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus.⁽²²⁾.

Causes of tubal pregnancy

Any sexually active woman of childbearing age is at risk of an ectopic pregnancy and often the reason for the ectopic pregnancy will never be determined. Tubal pregnancy is when the egg is implanted in the fallopian tubes. Hair-like cilia located on the internal surface of the fallopian tubes carry the fertilized egg to the uterus. Fallopian cilia are sometimes seen in reduced numbers subsequent to an ectopic pregnancy, leading to a hypothesis that cilia damage in the fallopian tubes is likely to lead to an ectopic pregnancy.⁽²³⁾ Women who smoke have a higher chance of an ectopic pregnancy in the fallopian tubes. Smoking leads to risk factors of damaging and killing cilia.⁽²³⁾ As cilia degenerate, the amount of time it takes for the fertilized egg to reach the uterus will increase. The fertilized egg, if it doesn’t reach the uterus in time, will hatch from the non-adhesive zona pellucida and implant itself inside the fallopian tube, thus causing the pregnancy.⁽²³⁾ Women with pelvic inflammatory disease (PID) have a high occurrence of ectopic pregnancy.⁽²⁴⁾ This results from the build-up of scar tissue in the fallopian tubes, causing damage to cilia ⁽²⁵⁾.  If however both tubes were completely blocked, so that sperm and egg were physically unable to meet, then fertilization of the egg would naturally be impossible, and neither normal pregnancy nor ectopic pregnancy could occur.⁽²⁵⁾

A history of a tubal pregnancy increases the risk of future occurrences to about 10%.⁽²⁵⁾ This risk is not reduced by removing the affected tube, even if the other tube appears normal.  Fertility following ectopic pregnancy depends upon several factors, the most important of which is a prior history of infertility.

CASE PRESENTATION

A lady with married life of 6yrs from Bidadi in Banglore, presented with amenorrhoea -1 & ½ month, with history of irregular, scanty, painful menstruation. Her past medical history revealed twice tubal ectopic pregnancy.

Timeline

Lady had developed irregular, scanty, painful menstruation after undergoing IVF (In-Vitro-Fertilization) in one of the Hospital at Banglore in 2017. However, IVF was not successful. Ultra-sonography of the abdomen & pelvis revealed bilateral PCOD (Poly Cystic Ovarian Disease). She was treated with oral hormonal pills for 6moths. During the course of oral hormonal treatment she had regular but painful menstruation. But she did not conceive. Later she visited Ayurveda clinic in Mysore for her problems. Later in June 2018 she consulted our hospital. She underwent ultra-sonography of abdomen & pelvis (August 2018). This report also revealed as bilateral PCOD.

In 2013, she had undergone emergency laparoscopic right sided salpingectomy under spinal anaesthesia, as she was diagnosed very late with right sided ruptured tubal ectopic pregnancy.

In 2015, she had conceived second time, however, again it was left tubal pregnancy, as it was diagnosed early at 5wks, it was terminated by oral pills & was treated with medicine Methotrixate.

After that she underwent HSG (Hystero-Salpingography) & the report showed,

Left tube –hydrosalpinx in ampullary region, fimbrial end clumped. However, free spill was seen.

After this event she did not conceive.

In 2017, once she underwent IVF (In-Vitro-Fertilization) in Milan Hospital Banglore. However, it was not successful. Since then she developed irregular menstruation & diagnosed with PCOD (Poly Cystic Ovarian Disease) in ultrasonography report.

In June 2018, she came to SDM Institute of Ayurveda & Hospital Banglore. From august 2018 she was regular in taking medicine and councelling.

Menstruation was found to be irregular (50- 90 days usually gets after taking hormonal pills she used to get her menstruation), scanty, painful, 3 – 4 days -dark blackish red, more clots than liquid bleeding & required 1 pad/day, but she changed 2pads/day to maintain hygiene. Her inner garment used to get stained during menstruation.

 Diagnostic focus and Assessment

Per Vaginal Examination revealed – Uterus- AVNS, vagina was bathed in yellowish – white discharge.

Per Speculum Examination revealed – Cervical erosions all over the cervix with severe yellowish- white discharge adhered to the cervix & vagina.

HSG (Hystero-Salpingography) in 2015 – Left tube –hydrosalpinx in ampullary region, fimbrial end clumped. However, free spill was seen.

After analyzing, with the ayurvedic principles, it was diagnosed as,

‘Vandhyatva’ ‘Secondary Infertility’ due to PCOS ( PCOD, Pimples, Hair loss)

In this case, the six causative factors (Ashuddha garbha sambhava samagri (impure factors of fertilization & conception) & manasika shalyas ) for vandhyatva are explained as follows,

• Beeja dushti – Anovulation due to PCOD,
• Rutu dushti – Irregular menstrual cycle,
• Kshetra dushti – Hydrosalpinx in the ampullary region of the left fallopian tube, right sided – salpingectomy done, cervical erosion.
• Arthava dushti (Arthavakshaya,Athyarthava,Kashtarthava) – irregular menstruation, sometimes amenorhoea and other time meno-metrorrhgia/oligomenorrhoea, dysmenorrhoea.
• Ambu dushti – Body fluids -All the doshas vitiated (in bhedhavastha of shad kriyakala) and ama (free radicals) produced also vitiates body fluids. Her vyadhi kshamatva (immunity) decreased (often she gets rhinitis, cough). Homeostasis was disturbed in the body.
•  Shalyas – Stressful factors (manaha shareera bhadhakarani iti shalyani.) were present in her. As she was, physically, mentally, emotionally & socially stressed out, due to medical history. This leads to disturbance in homeostasis. Lady had entered into flight mode due to stress.

Therapeutic focus and Assessment

Chikitsa was aimed at objectives ‘A’ and ‘B’

Objectives ‘A’

1. Ashuddh garbha sambhava samagri – impure factors of fertilization & conception-rutu (ovulation & menstruation), kshetra (female reproductive system), ambu (body fluids), beeja (ovum, sperm & zygote), in order to achieve shuddha garbha sambhava samagri (pure factors of fertilization & conception).
2.  Arthava dushti irregular menstruation, sometimes amenorhoea and other time meno-metrorrhgia/oligomenorrhoea, dysmenorrhoea, in order to achieve shuddha arthava (purity & alignment in menstrual cycle & endocrinal co-ordination).
3. Shalyas -Physical, Mental, Emotional & social Stressful factors, in order to attain prassannatmendriya mana (satiation of body, mind & spiritual).

 Objectives ‘B’

1.  To attain health in mother at all levels (physical, mental, emotional, spiritual and social).
2. To obtain healthy progeny.

The chikitsa (treatment) schedule planned as below,

Deepana Pachana chikitsa – digestive & assimilative medicine-is given prior to shodhana chikitsa.

Shodhana chikitsa – detoxification treatment

Virechana karma (detoxification- Medical purgation treatment),

Sarvanga Abhyanga & Swedana (medicated oil massage & steam).

Kala basthi karma (medicated enema),

Nasya karma (medicated nasal drops),

Uttara basthi (medicated intra-uterine treatment),

Music therapy councelling and yoga – mohana raga, surya namaskara, chinmudra pranayama & meditation, omkara recitation

Oral medicines

For cervical erosion –

Sthanika chikitsa per-vaginal treatment as follows,

Yoni prakshalana- medicated vaginal wash (vaginal douch)

Yoni dhoopana – medicated vaginal fumigation  

Yoni pichchu dharana- medicted vaginal tampoon

Regular councelling was planned as per the changes & feedback from the lady and her husband.

The treatments were carried out as scheduled in the Table 1,2,3,4.

 TREATMENT SCHEDULED.

From August 2018 to October 2018

Deepana – Pachana was done with Tablet Trikatu 1-1-1 continuously for 6months.

Councelling was done daily 1hour for 10 days, then once in week for 1month- 1hr, followed by once in a week for 1month-15min.

Yoga –Surya namaskara 6times 5days in a week, Chinmudra pranayam, Meditation & Omkara recitation for 15min twice daily.

Music therapy – Mohan raga music was done for 2hours, once in a week for 3months.

Prayer –Universal Prayer shloka was given in writing & advised to recite twice daily accompanied by her husband.

 Table 1 Oral medicine

 From last week of October 2018 to first week of November 2018

Table 2 Virechana karma  Sthanika chikitsa Sarvadaihika chikitsa

SP-Sneha Pana, SAAS-Sarvanga abhyanga and swedana, VK-Virechana karma, YP-Yoni prakshalana, YD – Yoni dhoopana, YPD – Yoni pichchu dharana, C – Councelling, Music therapy.

 From last week of November 2018 to first week of December 2018

Table 3 Kala Basthi karma Sarvadaihika chikitsa

ABK – Anuvasana Basthi Karma, NBK – Niruha Basthi Karma, SAAS-Sarvanga abhyanga and swedana, SN – Surya Namaskara, CM – Chin Mudra, MT – Music Therapy, C – Councelling.

 In first week of January 2019

Table 4 Nasya karma chikitsa

MNK – Marsha Nasya Karma, C – Councelling, MT – Music Therapy

 RESULTS

 After the virechana karma followed by kala basthi, she had her menstruation on 28/12/2018 (after 6 months of amenorrhoea). Menstruation was uneventful, that is she did not suffer with any pains and liquid part was more than the clots in menstrual bleeding. Color of menstrual bleeding was light blackish red. Her inner garments were not stained.  5 Days bleeding with less small clots was observed by the patient.  Her weight also increased by 2kg after the kala basthi (from 58kg to 60kg). By this time, pimples had reduced completely. She was happy as her face was clear & chubby cheeks.

After the sthanika chikitsa (local per-vaginal treatment) through vaginal route, cervical erosion healed and healthy cervix noted.

The two follow up examination showed- P/V- uterus –AVNS, no white discharge was seen. P/S- Cx –healthy.

She missed her menstruation on 28^thJanuary 2019. On 22^nd February 2019 urine test for pregnancy was positive.

It was confirmed as intra-uterine pregnancy with gestation sac & yolk sac, in ultra-sonography of abdomen & pelvis.

Repeat scan was done on 14/03/19 which showed CRL-1.95cm, yolk sac was seen, fetal heart pulsation seen 178beats/min. Intra-uterine pregnancy of 8wks 4days.

 Discussion:

Discussion is a detailed treatment of a topic in speech or writing, in order to reach a decision or to exchange ideas. Herewith I have tried to analyse the ayurvedic samprapthi & treatments for the infertility due to PCOS & ectopic pregnancy, with the help of our proud Acharya’s principles.

It has been explained in our samhitas, the purity of arthava (menstrual flow) is the primary unit for garbhotpatti (fertilization & conception). Our acharyas have highlighted that the menstrual blood does not leave any stain on the cloth. ⁽²⁶⁾ This is the sign of purity in menstrual blood & indicates the forthcoming ovulation.

It was noted that, after course of deepana, pachana,virechana karma & kala basthi karma, menstruation was uneventful, that is she did not suffer with any pains and liquid part was more than the clots in menstrual bleeding. Color of menstrual bleeding was light blackish red. Her inner garments were not stained.  5 Days bleeding with less small clots was observed by the patient.  This indicates the purity of the arthava menstrual bleeding.

Her weight also increased by 2kg after the kala basthi (from 58kg to 60kg). By this time, pimples had reduced completely. She was happy as her face was clear & chubby cheeks.

In Charaka Samhita Shareera Sthana 4^th chapter named Mahati garbhavakranthi, commentator of Charaka Samhitha, Acharya Chakrapani has explained that, garbha gradually enters garbhashaya. However, if there is vikara in garbha, by the time it reaches kukshi or garbhashaya, it may get destroyed (kukshau jayamana; kukshau vinasham prapnoti) & brings in death (katsnyernavinashyan iti marana gachchan) ⁽²⁷⁾.

Our Acharyas have written in sutra form. While explaining the early growth of fertilized ovum, Acharya Charaka has used the term kheta bhuta which means shleshma sadrashya- slippery in nature⁽²⁸⁾, which is quiet similar to Zona pellucida-outer layer of the zygote. This layer helps the zygote, to slide down with its slippery nature, from fallopian tube to the intra-uterine cavity of the uterus for the implantation. One of the etiological factors for the tubal pregnancy is pre-mature loss of the layer zona-pellucida, loss of kheta bhuta can be compared to sthanika shleshma ksheena, when the fertilized ovum is in the ampulla part of the fallopian tube, as the fertilization occurs in the ampulla. Thus the zygote gets fixed to the fallopian tube, leading to rupture of the tube & destruction of the zygote if goes unnoticed by the medical faculty. Thus tubal pregnancy gets destroyed & increases the mortality rate of the mother.

Subserosa layer of the fallopian tube is composed of loose adventitious tissue, blood vessels, lymphatics, an outer longitudinal and inner circular smooth muscle coats. This layer is responsible for the peristaltic action of the fallopian tubes. In turn this peristaltic movement helps in the gliding movements of zygote towards the intra-uterine cavity of the uterus. These movements can be compared to apana-vata, which is present in shroni pradesh & is responsible for all the movements in the shroni. There is apana vata vigunata (improper function of apana vata). This is exhibited in the form of, irregular menstruation, sometimes meno-metrorragia other time oligomenorrhoea, dysmenorrhoea.

The inner layer of fallopian tube is a single layer of simple columnar epithelium. The columnar cells have microscopic hair-like filaments (cilia) predominantly throughout the tube, but are most numerous in the infundibulum and ampulla. Estrogen increases the production of cilia on these cells. Between the ciliated cells are peg cells, which contain apical granules and produce the tubular fluid. This fluid contains nutrients for spermatozoa, oocytes, and zygotes. This can be compared to shleshma, rasadhatu. Tubal fluid flows against the action of the cilia, toward the fimbrial end. The fertilized ovum, now a zygote, travels towards the uterus aided by activity of tubal cilia and activity of the tubal muscle. Again these movements are responsibility of apana-vata.

The early embryo requires critical development in the fallopian tube. After about five days the new embryo enters the uterine cavity and on about the sixth day implants on the wall of the uterus, which is again co-ordinate activity of vata-kapha-pitta in shroni & minute srotas in shroni.

Fallopian tube obstruction is associated with infertility and ectopic pregnancy. Risk factors for ectopic pregnancy include: pelvic inflammatory disease, often due to chlamydia infection, tobacco smoking, prior tubal surgery, a history of infertility, and the use of assisted reproductive technology. Those who have previously had an ectopic pregnancy are at much higher risk of having another one. Most ectopic pregnancies (90%) occur in the fallopian tube, which are known as tubal pregnancies (29).

Presence of multiple pimples, heavy perspiration in palms and soles, often suffering from cold, constipation, irregular menstruation (more often amenorrhoea), anxiety and depression indicates the reduced immunity, accumulation of free-radicals in the body, disturbances at mental, emotional, spiritual and social levels due to loss of zygote in twice ectopic tubal pregnancies and unsuccessful IVF.

Our acharyas have highlighted the importance of shuddh garbha sambhava samagri (pure sperm, ovum, uterus and bod fluids) to obtain a healthy garbha. And shuddhata of shareera & manas (pure body & mind) is also equally important.

Acharya Sushruta while explaining swastha laxana, has given equal importance to equilibrium at physical level-shareera (samadhosha, samagni, samadhatu, sama mala & kriyas of dosha-agni-dhatu-mala), spiritual level -prasannata of atma (satiation or brahmananda), mental level -prasannata of mana (happiness in all situations), emotional level -prasannata of indriyas (liveliness jnyanendriyas & karmendriyas).

In jathaharini adhyaya, it has been mentioned that, to get a healthy progeny, the couple have to follow ‘Dharma palana ( Dharanath dharmaha)’that is good conduct to maintain health at physical, mental, emotional, spiritual and social levels.

By considering the above mentioned etiological factors, the exclusive treatment schedule was planned to target health at physical, mental, emotional, spiritual and social level. The plan is shown in the following table 5.

Table 5 Treatment plan

      After the Deepana Pachana for 2months, virechana karma was done after the samyak snigdha laxana with trivruth leha & gandharva hasthadi taila respectively on 9^th & 10^th day.

On 15^th day follow up after the virechana karma, her pimples had subsided. Sweating in palms and soles had reduced completely. Sneezing, running nose, cold had been subsided completely. Up to 1month same health was maintained.

In second course, kala basthi karma as follows,

Anuvasana basthi- was done with Phala ghrita 75ml- for 9 days. On 6^th 12^th day of kala basthi karma, Gandharva hasthadi taila 50 ml- for 2days was used for Anuvasana basthi karma.

Niruha basthi- was done with Honey 50ml+ Saindhava lavana10gms+ Shatapushpa churna10gms+ Phala ghrita75ml+ Eranda mula churna kashaya-300ml-for 5days.

After the completion of kala basthi karma, lady had her menstruation (after 6months of amenorrhoea) on 28^th December 2018.  Lady reported that, her menstruation was uneventful, without any pains. Consistency wise liquid part was more than the clots in menstrual bleeding. The colour of menstrual bleeding was light blackish red. 5 Days bleeding with less small clots was observed by the patient. 3pads/day changed by the lady. Arthava (menstrual bleeding) highlights about homeostasis in the body, as arthava is the upadhatu (sub-part) of rasa dhatu. Homeostasis was attained. It also indicates the forthcoming ovulation.

Activeness, good healthy raport with family and friends, involvement in her daily chores and smiling face throughout the day in lady (observed by her husband, friend and in follow up check-up). This indicates the stress free body, mind, emotions, spiritual and social well being in lady. Music therapy, surya namaskara, chinmudra pranayama are the parts of rasayana chikitsa. They have succeeded in returning her regular dinacharya. Music and yoga are the part and parcel of our daily work. For manasika shalya harsha chikitsa is indicated.

From 8^th day of menstruation that is on 5^th January 2019, marsha nasya karma was started with anu-taila. The nasya treatment was done up to 11^th January 2019. Councelling and music therapy were carried out on 5^th and 11^th January 2019.

She missed her menstruation in January 2019. On 22^nd February 2019 urine test for pregnancy was done at home by patient herself, which was positive for pregnancy. It was confirmed as intra-uterine pregnancy with gestation sac & yolk sac, in ultra-sonography of abdomen & pelvis.

Repeat scan was done on 14/03/19 which showed CRL-1.95cm, yolk sac was seen, fetal heart pulsation seen 178beats/min. Intra-uterine pregnancy of 8wks 4days.

 Patient consent:

 Informed consent regarding documentation and publication of the case study was obtained from the lady & her husband. Her husband has written about this case in review column in SDMIAH.   

Conclusion:

Quality of life was hampered in lady due to irregularity in consuming food, sleep pattern, stress in day today life.

Emotional stress had taken over her completely. Hampered quality life had negative effect on shuddha garbha sambhava samagri, leading to ashuddha garbha sambhava samagri (impure factors of fertilization), irregular menstrual cycles & irregular flow, scanty flow.

She was unable to conceive child. She had history of bilateral ectopic tubal pregnancy & losing one tube in salpingectomy and the other tube with hydrosalpinx.

Ayuveda has played very impotant role through dinacharya, virechana karma, kala basthi and marsha nasya karma, music therapy, yoga and pranayama, in obtaining shuddha garbha sambhava samagri (pure factors of fertilization) in the form of delivering a healthy female child through elective caesarian section. The aim and objects which was planned before starting the treatment, has been reached successfully.

So, the term has been used as ‘tapas by the couple’ to get a healthy child.

So the saying ‘Child by choice & not by chance’ should be taught to our people.

Aviruddhe Dhruvam Daive Kale Yukthasya Karmanaha.

 Financial support & sponsorship

Lady and her husband have taken care of financial situation. No other support or sponsorship was given for this case throughout the treatment courses.

Conflicts of Interest

Author has no competing interest, as this case study was done with exclusive interest to make the lady to conceive naturally and healthy progeny.

 SARVESHAM AROGYAM BHAVATU

Dr. Bharathi D. Anvekar BAMS, MS, PhD
Professor and Consultant,
Dept of Shalya tantra, Prasuthi Tantra & Stree-Roga
S. D. M. Institute of Ayurveda & Hospital,
Banglore-74 Ph:080-22718025 Mob:98864 10690 

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26. शुक्रशोणितशुद्धिशारीरं तत्र शुक्रशोणितयोः शुद्धयोरेव शुद्धिर्दुष्टदोषासम्पर्कता||१-२|| यदार्तवं वासः- स्थितं शुष्कमुदकप्रक्षालितं वासो न विरञ्जयेत् रागोपेतं वस्त्रं न कुर्यात् तत् प्रशंसन्ति, ‘गर्भजननाय’ इति शेषः||१७||
27. शारीरस्थानम् – २. शुक्रशोणितशुद्धिशारीरम् निबन्धसङ्ग्रह व्याख्या (डल्हण कृत )
28. Charaka samhitha shareera sthana 4^th chapter kukshau jayamana; kukshau vinasham prapnoti) & brings in death (katsnyernavinashyan iti marana gachchan) यतश्च जायमानःकुक्षौ विनाशं प्राप्नोति, यतश्च कार्त्स्न्येनाविनश्यन् विकृतिमापद्यते, तदनुव्याख्यास्यामः||३|| 
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An environment is a complex of surrounding circumstances, conditions, or influences in which a thing is situated or is developed, or in which a person or organism lives, modifying and determining its life or character. The natural environment is such an environment that is relatively unaffected by human activity. Soil, Sky, Heat (Sun), Air and Water (Panchaboothas); they together made an environment that is fit for our existence.

Environment motivates to react:  We are miserable when are in desert and delighted when we are in lush garden. In a hospital we are in different mood and in disco different. Environment motivates us to change our mood and reaction is in accordance.

Pollution:

Pollution is the release of environmental contaminants. The act or process of polluting or the state of being polluted, especially the contamination of soil, water, or the atmosphere by the discharge of harmful substances.

1. Soil pollution

Soil pollution is defined as the build-up in soils of persistent toxic compounds, chemicals, salts, radioactive materials, or disease causing agents, which have adverse effects on plant growth and animal health.

2. Water pollution:

Water pollution occurs when undesirable foreign substances are introduced into natural water. The substances may be chemical or biological in nature. Common pollutants include human or animal waste; disease-producing organisms; radioactive materials; toxic metals such as lead or mercury; agricultural chemicals such as pesticides, herbicides, or fertilizers; acid rain, Industrial discharge of chemical wastes and byproducts, Discharge of poorly-treated or untreated sewage, petroleum products, and high-temperature water discharged from power plants, often called “thermal pollution.”  Pollutants in water are dangerous for human or animal consumption and harm crops.

3. Air pollution

Air pollution is the presence of any chemical, physical (e.g. particulate matter), or biological agent that modifies the natural characteristics of the atmosphere. The atmosphere is a complex, dynamic natural gaseous system that is essential to support life on planet earth.

Air pollution is composed of many environmental factors. They include carbon monoxide, nitrates, sulfur dioxide, ozone, lead, secondhand tobacco smoke and particulate matter. Factory emissions, vehicle emissions cause air pollution.

4. Noise Pollution

Any unwanted man-made sound that penetrates the environment is noise pollution. In general noise pollution refers to any noise irritating to one’s ear which comes from an external source.

 Noise pollution can be caused by many sources including highways, vehicles, factories, concerts, air-conditioners, engines, machine, aircraft, helicopters, alarms, public address systems, industrial development and construction work.

Effect of Pollution on Health:

1. Pollutants can cause disease, including cancer, lupus, immune diseases, allergies, and asthma.

2. Adverse air quality can kill many organisms including humans. Worldwide air pollution is responsible for large numbers of deaths and cases of respiratory disease.

3. Ozone pollution can cause respiratory disease, cardiovascular disease, throat inflammation, chest pain and congestion.

4. Water-borne diseases are infectious diseases spread primarily through contaminated water. Water pollution causes approximately 14,000 deaths per day, mostly due to contamination of drinking water by untreated sewage in developing countries. Cholera, Hepatitis, Dysentery and Typhoid are the more common water-borne diseases.

5. Oil spills can cause skin irritations and rashes.

6. Noise pollution can cause hearing loss, high blood pressure, stress, sleep disturbance, and High noise levels can contribute to cardiovascular effects.

Pollution and Fertility:

Environmental factors contribute to the severity of infertility, and that this may worsen the effects of pre-existing genetic or medical risk factors. Stress and environmental pollution are two of the main causes of growing infertility among urban couples.

Worldwide, one in every six couples has difficulty in conceiving. About 50 percent of the infertility problems are contributed by the male factor. But stress and environmental pollution are considered two key factors for childlessness among couples now.

An increasing number of reports suggest that chemical and physical agents in the environment, introduced and spread by human activity may affect fertility in humans. Stress and environmental pollution reduce the sperm count in males. While a couple is considered infertile if after one year of adequate unprotected intercourse the woman fails to conceive, the problem in our society becomes more social.

There are fears that industrial and agricultural chemicals and heavy metal pollutants are disrupting the reproductive biology animals and may also be affecting human fertility and fetal development.

Steps to taken to control Environment Pollution:

1. Encourage Afforestation: Afforestation is the process of converting open land into a forest by planting trees or their seeds.

2. Stop Deforestation: Deforestation results from removal of trees without sufficient reforestation; however, even with reforestation, significant biodiversity loss may occur.

3. Practice proper Waste management: is the collection, transport, processing (waste treatment), recycling or disposal of waste materials, usually ones produced by human activity, in an effort to reduce their effect on human health.

4. Proper management (Proper disposable) of Industrial wastes, chemicals, sewage, Pesticides & Fungicides, Poisonous chemicals should be done before disposed them into environment reservoirs.

5. Hospital wastes, syringes, needles etc should be properly treated before disposed. Syringes and needles tips should be cut down before disposed them into garbage so that one cannot reuse those materials.

6. Emission test to each vehicles should be done frequently.

Environmental Education:

Environmental education is a learning process that increases people’s knowledge and awareness about the environment and associated challenges, develops the necessary skills and expertise to address the challenges, and fosters attitudes, motivations, and commitments to make informed decisions and take responsible action

Since the industrial revolution many countries have experienced centuries of deforestation, and governments and Non-governmental organisations (NGO’s) should take up the programs of reafforestation (the restocking of existing forests and woodlands which have been depleted, with native tree stock) and also in supporting private and semi-private enterprise in programs of afforestation.

It is the duty of every one of us to preserve our environment in the best interest of our own health. It is also our duty to hand over a better environment to a next generation.

Dr. C. SHARATH KUMAR

 Director and Chief Fertility Surgeon

Mediwave I.V.F & Fertility Research Hospital, City X-Ray Complex, Sayyaji Rao Road

Mysore-570 001     Phone: 0821-2444441, 4255019

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