Treatment of the Infertility

MODERN APPROACH-for the treatment of the Infertility


The concept

Assisted reproductive techniques include in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), and zygote intrafallopian tube transfer (ZIFT). These are usually used after other techniques to treat infertility have failed.

In vitro fertilization involves the use of a drug to induce the simultaneous release of many eggs from the female's ovaries, which are retrieved surgically. Meanwhile, several semen samples are obtained from the male partner, and a sperm concentrate is prepared. The ova and sperm are then combined in a laboratory, where several of the ova may be fertilized. Cell division is allowed to take place up to the embryo stage. While this takes place, the female may be given drugs to ensure that her uterus is ready to receive an embryo. Three or four of the embryos are transferred to the female's uterus, and the wait begins to see if any or all of them implant and result in an actual pregnancy.

Success rates of IVF are still rather low. Most centers report pregnancy rates between 10-20%. Since most IVF procedures put more than one embryo into the uterus, the chance for a multiple birth (twins or more) is greatly increased in couples undergoing IVF.

GIFT involves retrieval of both multiple ova and semen, and the mechanical placement of both within the female partner's fallopian tubes, where one hopes that fertilization will occur. ZIFT involves the same retrieval of ova and semen, and fertilization and growth in the laboratory up to the zygote stage, at which point the zygotes are placed in the fallopian tubes. Both GIFT and ZIFT seem to have higher success rates than IVF. 



Details
  • Fertility medication which stimulates the ovaries to "ripen" and release eggs (e.g. clomifene citrate, which stimulates ovulation)
  • Surgery to restore patency of obstructed fallopian tubes
  • Donor insemination which involves the woman being artificially inseminated with donor sperm.
  • In vitro fertilization (IVF) in which eggs are removed from the woman, fertilized and then placed in the woman's uterus, bypassing the fallopian tubes. Variations on IVF include:
    • Use of donor eggs and/or sperm in IVF. This happens when a couple's eggs and/or sperm are unusable, or to avoid passing on a genetic disease.
    • Intracytoplasmic sperm injection (ICSI) in which a single sperm is injected directly into an egg; the fertilized egg is then placed in the woman's uterus as in IVF.
    • Zygote intrafallopian transfer (ZIFT) in which eggs are removed from the woman, fertilized and then placed in the woman's fallopian tubes rather than the uterus.
    • Gamete intrafallopian transfer (GIFT) in which eggs are removed from the woman, and placed in one of the fallopian tubes, along with the man's sperm. This allows fertilization to take place inside the woman's body.
  • Other assisted reproductive technology (ART):
    • Assisted hatching
    • Fertility preservation
    • Freezing (cryopreservation) of sperm, eggs, & reproductive tissue
    • Frozen embryo transfer (FET)

AYURVEDIC APPROACH- for the treatment of the Infertility

CHIKITSA

According to the Ayurvedic principles the process by which dhatu and dosha comes in balanced state is called Chikitsa.(Ch. Su. 10/34)

In Ayurveda, three types of Chikitsa have been mentioned.

  1. Daiva vyapashraya (Spiritual or beyond logical explanation faith, metaphysics etc.)
  2. Satvavajaya(Psychological measurements)
  3. Yuktivyapashraya(Logical principles based treatment-Dosha Dhatu Chikitsa)

It is again of two types – Samshodhana and Shamana

Samshodhana Chikitsa : It is most beneficial in any disease under this panchakarma is advised vikara treated by samshodhana cannot reoccur again. In various Gynaecological disorders panchkarma procedures has been advised –

Shamana chikitsa - The drug, which are used for the treatment of Vandhyatva should be used.



The principle of Shamana Chikitsa of Vandhyatva –

Keeping all these benefits in mind. In my research work, I have selected uttarbasti. So derail of uttarbasti has been given as follows:

Treatment of specific causes responsible for infertility such as all gynecological disorders, disease of Sukra and Artava should be done (Ch. Chi. 30/125)

In Ayurveda, three types of Chikitsa have been mentioned.

Other etiological factors should be avoided such as abnormal diet, life, coitus etc.

  • Use of Basti in infertility due to disease of vata is highly beneficial (Ch. Si. 1/34).
  • Niruha basti is like a nector to an infertile woman (Bhe. Sa. Si. 6).
  • In Charaka Siddhi Sthana 4/25, it is said that the woman having infertility due to abnormality of either of the partner conceives by use of anuwasana basti. (Ch. Si. 4/25)
  • In Kashyapa samhita siddhi sthana it is said that the woman having amenorrhoea scanty menses, useless ovulation or non-ovulation should be treated with Anuvasana basti. (Ka. Sa. Si. 7).
  • He has also explained that by the use of basti the yoni becomes healthy, even sterile women conceive. The basti is beneficial to the woman having repeated abortions short lived and weak children, who are delicate and indulge daily in coitus.(Ka. Si. 1)
  • Yapana basti are also useful in infertile woman.(Ch. Si. 12/22)

It is again of two types – Samshodhana and Shamana

Upashaya-Anupashaya :

The regimen which is favorable in destroying the disease is said to be upashaya of that particular diseaese. But for Vandhytwa no special upshaya is mentioned in our classics.

But it can be said that –

Coitus during(appropriate time)

Consumption of ghee milk and in the dietcan be used as upashaya for vandhyatva

Anupashaya Madhukosha, Mad. Ni.)

In the same way in its treatment both type of treatment is mentioned in Shodhana chikitsa if is said that it should be treated with uttarbasti. (Su. Sha. 2/12)

In Shamana Chikitsa it is said that yoga mentioned for Shukra Dosha can be used for Artava dosha also (Su. Sha. 2/15)

Some garbha sthapaka drugs were selected for oral yoga. These are - Ashwagandha, Vatshunga, Nagkesar, Kumkum, Bhimseni kapoor etc.

Ahar ,aushdhi and Vihar which aggravates the ailment is called Anupshayam of the concerned ailment.Hence the treatment which we envisage is the kind of Anupshayam for the Vandhyatwam

  1. Putrajeevak : Vata Kapha (Bha. Prk.)(Raj. Ni.) (Bha. Prk.)
  2. Vatashrunga : (Sodhal)
  3. Ashwagandha : (Sodhal Va. Chi.)
  4. Nagkesar : (Ra. Ma.)
  5. Kapas Moola : (Vaidya Manorama)
  6. Ashoka : (shodhal)


Our Modified approach

The causes of infertility according to Acharya Sushruta is lacking in one or more four essential factors required for fertilization.(Su. Sha. 2/34)

Those Four factors are :

1)Ritu, 2) Kshetra, 3) Ambu and 4) Beeja.

1. Ritu or the KAL :

Treatment of each factor related with infertility in the context of time are addressed ,i.e. age of the patient, delayed menstruation on the puberty, menopause, abnormal and short cycled or delayed cycled menses problems. We support astrology if it supports our principles .

Tridoshas , their KAL(time) is also considered.

2. KSHETRA or The body :

Male and female. The built .The life and living factors affecting human health related with reproduction. The physical exercises, sexual performance, sexual position are guided to the patients.

The mind .

The psychological factors. Male and female traits towards sex .The Libido the Orgasm are explained. Sexual misconceptions leading to infertility. The environment, the Dogmas. The attitude towards sexuality, the beliefs and other factors hindering conception are also considered. Rest and sleeping patterns of the patience are addressed. Sociological factors, Fast living style, hasty life, big family, privacy are also handled and helped which hinder in the conception.

3. AMBU the Nutrition the food :

The nutrition ,the consumption of food, the eating habits ,the kind of food, the fast food ,the junk food, tobacco ,alcohol drugs and other consumable items ; these are the factors which affect the health of the human body.Rather these factors are problems in getting pregnancy

4. BEEJ the Shukra and the Artava :

Male and female factors. Male semen and its related problems according to Ayurveda are treated. The quality and quantity of the semen is treated and continually monitored. Medicines according to Ayurveda prescribed. In the female problems related with the ovum, menses, ovulatory disorders I also treated according to Ayurvedic principles and medicines. More over other factors related with infertility are also addressed and treated.

Ahar ,aushdhi and Vihar which aggravates the ailment is called Anupshayam of the concerned ailment.Hence the treatment which we envisage is the kind of Anupshayam for the Vandhyatwam