VANDYATVA (INFERTILITY)

🔺 CASE STUDY : VANDYATVA (INFERTILITY)

🔺 NIDANAM (ETIOLOGY / CAUSES)

• Beeja dosha – Defects in sperm or ovum

• Artava dushti – Menstrual irregularities; vitiation of female reproductive tissues

• Garbhashaya dushti – Anatomical or functional abnormalities of the uterus

• Aharaja nidana – Excessive intake of Ruksha, Katu, Tikta foods

• Viharaja nidana – Over-exercise, suppression of natural urges, late nights

• Manasika nidana – Stress, anxiety, depression affecting hormonal balance

• Daiva (Karmaja) – Destiny-related or past-life karmic causes

• Improper Garbhadhana factors –

  • Ritu (time)

  • Kshetra (uterus)

  • Ambu (nutrition)

  • Beeja (gamete)
    (Ref: Charaka Sharira Sthana 2/4, 8/33; Sushruta Sharira Sthana 2/3)

🔺 PURVAROOPAM (PRODROMAL SYMPTOMS)

• Irregular menstruation (interval, flow, duration)

• Scanty or excessive vaginal discharge

• General debility, fatigue

• Low libido

• Hormonal disturbances like PCOS signs
  (Related symptoms from Artava Kshaya and Yoni Vyapad in classical texts)

🔺 LAKSHANA (SYMPTOMS)

• Inability to conceive despite regular, unprotected intercourse

• Menstrual abnormalities: painful, irregular, or absent menses

• Physical and mental weakness

• Signs of ovulatory failure or poor semen quality
  (Ref: Sushruta Sharira 2/35, Charaka Sharira 8/33)

🔺 GENERAL EXAMINATION

• Vitals: BP, Pulse, Temperature, Respiration

• BMI: Underweight or obese – both affect fertility

• Signs of hormonal imbalance:

  • Hirsutism

  • Acne

  • Acanthosis nigricans

  • Galactorrhea

• Thyroid examination: Check for goitre, nodules

• Secondary sexual characters: Development of breast, axillary and pubic hair

• Pelvic exam (Female): Uterine size, tenderness, masses

• Testicular exam (Male): Size, texture, varicocele, hydrocele

🔺 SYSTEMIC EXAMINATION

• Endocrine System: Thyroid, pituitary, adrenal status

• Reproductive System:

  • PCOS, uterine abnormalities in females

  • Testicular volume, spermatic cord in males

• Neurological: Pituitary adenoma symptoms (e.g., visual field defects)

• Metabolic Disorders: Signs of insulin resistance, obesity, diabetes

🔺 LABORATORY INVESTIGATIONS

FOR FEMALES:

• Hormonal Profile:

  • FSH, LH

  • AMH (ovarian reserve)

  • Prolactin

  • TSH, T3, T4

  • Estradiol, Testosterone

• Blood Glucose Profile: FBS, PPBS, HbA1c

• Pelvic USG: For PCOS, fibroids, ovarian reserve, endometrial thickness

• Hysterosalpingography (HSG): Tubal patency

• Laparoscopy: If endometriosis or adhesions are suspected

• Cervical mucus test / Endometrial biopsy (if required)

FOR MALES:

• Semen Analysis: Volume, count, motility, morphology

• Hormonal Profile: FSH, LH, Testosterone, Prolactin, TSH

• Scrotal USG: Varicocele, hydrocele

• Genetic Testing: Karyotyping, Y-chromosome microdeletions

• Sperm DNA Fragmentation Index (DFI)

• Anti-sperm antibody test (if unexplained infertility)

🔺 DIFFERENTIAL DIAGNOSIS (DD)

FEMALE FACTORS:

• Ovulatory disorders: PCOS, premature ovarian failure

• Tubal causes: PID, TB, Hydrosalpinx

• Uterine causes: Fibroids, polyps, congenital anomalies

• Cervical factors: Stenosis, hostile mucus

• Endometriosis

• Thyroid dysfunction

• Unexplained infertility

MALE FACTORS:

• Oligospermia, Azoospermia, Asthenospermia, Teratospermia

• Varicocele

• Obstructive causes: Blocked vas deferens

• Hypogonadism, thyroid issues

• Genetic causes: Klinefelter syndrome, Y deletions

• Lifestyle: Smoking, alcohol, stress, obesity

• Sexual dysfunctions: Erectile, ejaculatory

🔺 SAMPRAPTI (PATHOGENESIS)

• Primary Dosha: Apana Vata vitiation

• Involvement of Pitta and Kapha depending on nidana

• Beeja dosha – Faulty ovum/sperm

• Artava or Shukra dushti – Reproductive fluid defects

• Kshetra dushti – Uterine abnormalities

• Ritu (timing), Ambu (nutrition), Beeja (gamete), Kshetra (uterus) malfunction

• Leads to failure of Garbhadhana (fertilization/implantation)
  (Ref: Charaka Sharira 8/33; Sushruta Sharira 2/3)

🔺 SAMANYA CHIKITSA (GENERAL TREATMENT)

• Nidana Parivarjana – Avoid causative and lifestyle factors

• Agni Deepana & Ama Pachana – Improve digestive fire

• Vata Shamana – Regulate Apana Vata functions

• Rasayana Therapy – Enhance reproductive dhatu (Beeja, Artava)

• Manasika Chikitsa – Stress relief, counseling

🔺 UPASHAYA (PALLIATIVE MEASURES)

• Use of ghee, milk, and nourishing food

• Brimhana and Snigdha therapies

• Observing Ritukala (fertile period)

• Sleep hygiene, yoga, meditation

• Regular oil massage and warm fomentation

🔺 ANUPASHAYA (AGGRAVATING FACTORS)

• Fasting, excessive dieting

• Intake of Katu, Tikta, Ruksha Ahara

• Day sleep, night awakening

• Chronic stress

• Over-exercise or sedentary lifestyle

• Suppression of natural urges

🔺 VISHESHA CHIKITSA (SPECIFIC TREATMENT)

✔ SHODHANA THERAPIES:

• Vamana: In Kapha dominant patients

• Virechana: For Pitta and Rakta dushti

• Basti (Uttara Basti):

  • Primary treatment for Vandhyatva

  • Cleanses uterus and regulates Apana Vata
    (Ref: Charaka Chikitsa 30/139; Ashtanga Hridaya Uttara Tantra 38)

✔ SHAMANA & RASAYANA THERAPIES:

✔ PATHYA-AHAR & VIHAR (DIET & LIFESTYLE):

• Balanced, nutritious diet with milk, ghee, fruits, and whole grains

• Avoid spicy, sour, and processed food

• Maintain moderate weight

• Exercise: Moderate yoga, walking

• Mental wellness: Meditation, avoiding stress

• Observe Ritukala properly