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Introduction

Motherhood is ultimate and cherish desire of every women. The woman in whom there is a hindrance of any kind to normal process of conception is Vandhya. Nowadays infertility is an developing as a major disorder due to changing lifestyle and increasing stress affecting the social and physiological aspect of women.

Infertility: - Inability of couple to conceive after one year of insecure coitus.

Primary infertility: If conception has never occurred. Secondary infertility: Patient fails to conceive after having achieved a previous conception. Conception depends upon fertility potential of both male and female.

AIM AND OBJECTIVE:

1. To do conceptual study related to vandhyatwa.
2. To study different treatment modalities in ayurveda.

Disease Review:

Types Accourding to various Acharyas :

1.Harit [1] :  Failure to achieve child rather than pregnancy because he has included

a) Garbhastavi (Having repeated abortions)

       b­­) Mrutavatsa (Having repeated still birth)

      c) Unexplained:  Infertility due to Idiopathic cause.

      d)Kakavandhya: Women have one child but second time she is not conceived.

     e)Anapatya:  The woman who has no child or primary infertility.

     f) Balakshya: Infertility due to loss of Bala.

2.Sushrut[2]:He has explained vandhya under 20 gynaecological disorders i.e      yonivyapat.  Vandhya –Nashtartava (Primary infertility)  

3.Kashyap- He has explained Jatharinis, one of the kinds is Pushpaghni (Having useless pushpa) and certain other characterised with repeated expulsion of foetuses of different gestational age [3].

4.Charak- Vandhyatwa is explain as beejadushti leading to congenital absence of garbhashya and Aartava. [4]

 

ESSENTIAL FACTORS FOR CONCEPTION:[5]

Acharya Sushrut has described four essential factors to achieve conception as follow:

1.Ritu- Raja samaya

2.Kshetra- Garabhashaya

3.Ambu- Ambu punah aaharpakaja vyapi Rasadhatu

4.Beeja- Purusha beeja- Shukra-  Stree beeja-Artava

According to Ayurveda important factor for conception are Ritu (fertile period), kshetra (uterus and reproductive organs), Ambu (proper nutrient fluid), beeja (shukra and shonita) and normalcy of hridya (psychology). Presence of any abnormality in any above factor may cause “vandhyatwa”. Because of some Aaharatmak or viharatmak or janmajat dosha any of the factors get vitiated causes Vandhyatwa.

Etiological factors: [6]

1. Yonipradosh (abnormality of reproductive organs)

-Yonivyapad

-Garbhakoshabhanga

-Bhaga sankoch

-Sphalit mutratwa

-Injury to artavavaha srotus

1. Abnormality in garbhotpadak samagri
2. Abnormality in garbhotpadak shadabhavas
3. Coitus with ati bala, ati vrudha, or rogi Stree
4. Coitus in nubjya or parshwa stithi (as shukra falls on sameerana nadi )
5. Complication of Artava vyapada leading to beeja dushti.
6. Dhatukshya
7. Virrudha ahar, ahit vihar
8. Vegavarodha
9. Akaal yoga
10. Loss of bala
11. Teekshna panchakarma in mrudu vyakti.
12. Sthoulya
13. Idiopathic (fate/curse)

MATERIAL AND METHOD:

Treatment modalities

Treatment principles include evaluating and treating the causes accordingly like vandhyatwa chikitsa / Garbhashay balya chikitsa / Beejadosh chikitsa / aartav dushti chikitsa / vrushya aushadhi chikitsa / shodhan chikitsa.

Panchakarma:

1. Vaman:It is cleansing procedure intended mainly for expulsion of vitiated kapha.  It enhance agni and regulate bowel habits thus improves rasadhatwagni. As Raja/ Artava is updhatu of Rasa, and rasadhatwagni if working properly it ultimately results in normalacy of Artava uttapati. It maintains balance in hormonal system. It reduces sr.cholesterol  due to its kaphahar action hence reduces some disorders like thyroidisum, PCOS, and also removes some obstructing pathology like granthi.
2. Virechan: It decrease ushna guna and maintain the sheeta guna in proper proportion, which is beneficial to produce shukra dhatu which enhance fertility. Agni which gets vitiated by pitta is corrected by virechana.

c) Basti:

1. Anuvasan/ Niruha basti

Vata is main factor i.e Apana vayu vaigunya lead to vandhyatwa, hence basti is main chikitsa for vatashaman which helps in conception.

In Kashyapa samhita, Anuvasana basti is indicated in women having conditions like Alpapushpa (less amount of artava), Nashtapushpa, Nashtabeeja, Yonishool, Udavarta. Women who is unable to conceive due to some vata vyadhi, in such conditions anuvasana  basti plays a crucial role.[7]

Niruha basti is indicated in Rajakshay, Anartava and having good results in such conditions.[7]

2. Uttar basti

It is considered to be superior basti because of its administration and its action on vitiated vatadosha. Improves chances of conception. It prepares endometrial bed for healthy implantation. Helps in asthir garbhawastha as it strengthens garbhashay – garbhashaya balya, Rajodosh nashak. In Charak samhita, in Yonivyapat chikitsa adhyaya, there are many conditions which causes vandhyatwa are treated by shodhana karma. Out of which uttarbasti plays a vital role in improving  those conditions. Such as Kashmarya , Kutaja sidha ghrita uttarbasti is useful in conditions like  Arjaska, Raktayoni and Putraghni yonivyapat.[8]

1. Nasya

It occupies shungatak marma as well as all channels in head and  removes adherent doshas. It is hypothetical to state that hypothalamus and pituitary glands are located in head which is functional area of nasya. Thus it helps to regulate normal function of hypothalano pituitary ovarian axis.  Apart from these karma sthanik karama also plays vital role .

1. Yonipichu:

It ensures the constant delivery of drug in micro quantities in reproductive tract and nourishes it.It helps in vatashaman and strengthens the loose tissues, acts as antisagging, acts as uterine tonic mainly acts on Asthi and Mams dhatu. Acharya charaka has explained Tampoon in Udumbar tail improves chronic yonivikara like Pcchila yoni, vivruta yoni, Kaladushta yoni within week and increases chances of conception.[9] Similarly Shallakyadi sidha tail pichu is usuful in Vipluta yonivyapada.[10]

Rasayan chikitsa

‘Labhopayo hi shastanam Rasadina Rasayanam’ [11] Acharya Charaka has explained a unique kind i.e. ‘Aachar Rasayan’ it’s very important to follow and practice because only physically and mentally healthy person can yield the benefit of Rasayan therapy.

Abhyantar chikitsa:

A) Simple herbs:-  Endri, Brahmi, Durva, Ashoka, Ashwagandha, Shatavari, Guduchi, Putranjeeva, Jeevanti, etc. [12]

B) Various yog:-

1) Kwath- Maharasnadi qwath

2) Ghrita- Phala ghrita,Dadimadya ghrit, Kalyanak ghrit

3) Tail- Shatapushpa tail, Sahacharadi tail.

4) Choorna-Chandanadi choorna, pushyanug choorna.

5) Modak- Mahakalyanak gud.

6) Avaleha- Kushmandavleha.

7) Other kalpa- Laghumalini vasant, Mahayogaraj guggul.

Yoga: [13]

In Yogasutra acharya Patanjali has explained various kinds of Aasanas, by regular practicing  Aasanas reproductive organs get strengthen and co-ordination get improve. Some are explained below-

1.Padmasana= Strengthen garbhashaya.

Helpful in excessive menstrual problems

          2.Viparitkarini mudra-=

Tendency and possibility of displacement of  uterus is considerably reduced.

Keep reproductive oragans optimally elastic.

3.Kapalbhati and Bhastrika=

Breathing exercise mainly acts on autonomic nervous system, so it prevent and                cure conditions such as disruption in homeostatic state of ANS like obesity, HTN,              DM .thus it is also helpful in menstrual abnormalities and in PCOS.

Important factors which must be taken into attention:

• Samatvagat  veerya (proper age of both partrners)
• Atulya gotra vivaha (marriage should not be consingious)
• Garbhadhan vidhi must be followed.
• Adaption of proper Dincharya, Rutucharya, Rajawala paricharya, sound state of mind is most crucial factor to achieve conception.

Aahar:-

1. Ksheer and ghrita prolong fertile period.
2. During  garbhadhan samskar male should take saumya aahar like milk where as   female should take Aganeya and Aartava vardhak aahar like tail and Masha.
3. Aganeya aahar in rutu kaal; snigdha, madhur aahar in rutuvyatit kaal helpful in ovulation defect.
4. Madhur , snigdh, dravyas helps in gabhasthapana.
5. Vatapittavardhak, ati katu,lavan,abhishyandi dravyas are contraindicated.

Vihar :- Excessive work, prolong sitting or standing, deewaswap, ratroujagaran, vegavarodha,               all these affects apan vayu, which results in menstrual abnormalities and ultimately in infertility.

Discussion

Vandhytwa (female Infertility) is explained in Ayurved in very wide sense including nidana and chikitsa. Though as per modern science, in Ayurveda no specific treatment has explained over a specific factor like Rutu, Kshetra ,Ambu, Beeja . But treatment has been mentioned according to cause i.e yonivyapada , artava dosh etc. So, its very important to rule out the cause which is responsible for infertility. Therefore, considering all factors we have to choose Shaman, Shodhana, Rasayana etc. Chikitsa. As per the state or factors affected, we can choose kind of therapy singale or in combination.

As per chikitsa sutra of vandhyatwa, snehana , swedana, vamana, virechana, asthapana basti, anuvasana basti and uttar basti are indicated. With administration of Shodhana therapy attempts are made to cleanse all the vikrut doshas in body and and brings tridosha to normalacy. Where as shaman therapy is mainly palliative in nature. Hence here, we have to think about all roots of Vandhyatwa. Considering various states of vandhyatwa as explained by various Acharyas and choose treatment accordingly. Apart from Shodhana and shaman treatment one must adviced yoga, meditation, proper ahara and vihara and proper ritucharya, dinacharya which has explained by Acharyas.

Conclusion

Our prime role is to evaluate the root factor and applies various chikitsa like Shodhana chikitsa, Dhatuposhana, Rasayana chikitsa, with proper counselling of couple. It also includes Yoga, Pranayama and Manovaha chikitsa explained in Ayurveda. So that one can achieved prime aim “ Prajasthapana.”