Polycystic ovarian syndrome is a disorder of the endocrine system caused by hormonal imbalance. It is characterized by excess androgen production by ovaries or adrenals which interferes growth of ovarian follicles. It consists of three diagnostic criteria – chronic anovulation hyperandrogenism and polycystic ovaries. It is the leading cause of infertility. 5-10 % of child bearing age women have PCOS.

Poly Cystic Ovarian Syndrome is a condition that has cysts on the ovaries that prevent the ovaries from performing normally. Symptoms of Poly Cystic Ovarian Syndrome include Amenorrhea or infrequent menstruation, irregular bleeding, infrequent or no ovulation, multiple immature follicles, increased levels of male hormones, male pattern baldness or thinning hair, excess facial and body hair growth, acne, oily skin or dandruff, dark coloured patches of skin specially on neck, groin, underarms, chronic pelvic pain, increased weight or obesity, diabetes, lipid abnormalities and high blood pressure [1].

Fertility problems experienced by women with Poly Cystic Ovarian Syndrome may be related to the elevated hormone, insulin or glucose levels, all of which can interfere with implantation as well as development of the embryo. Increased Leutenizing hormone reduces the chance of conception and increase miscarriage. Additionally, abnormal insulin levels may also contribute to poor egg quality, making conception more difficult [1].

The conventional treatment for PCOS with infertility is metformin, OC pills and ovulation induction drugs. Long term use of these drugs can cause side effects like GIT symptoms, ovarian hyperstimulation syndrome and hepato toxicity also. But PCOS should be treated for infertility as well as menstrual disorders and to prevent long standing metabolic diseases. 

In Ayurveda PCOS is not described as a separate disease. The clinical features, etio pathogenesis can be correlated to different gynaecological disorders. In Ayurveda all gynaecological disorders are incorporated in Yonivyapadas and Aartavadushti. Based on these principles PCOS and infertility can be considered as Rasa, Rakta, dushti, Vata dushti predominantly, associated Kapha or Pitta dushti and Dhatavagni mandya. As all female reproductive organs lie in pelvic area the Apana vayu governs all the physiological functions. So the management in PCOS should be targeted at Agni deepana, Pachana, Vatanulomona and Rasarakta prasadana.

Case Report

A female of 30 years came to our Out-Patient Department (OPD) of Patanjali Ayurveda Hospital on 27.02.2021 with primary infertility and willing for conception. Her married life was 3.5 years. She was taking allopathy treatment for last 3 years with ovulation induction drugs, laproscopic ovarian drilling and failed to conceive. 

• Her Other Complaints: Constipation frequently, P/V white discharge, Anxiety

• Menstrual History: 3-4/50-60 days, irregular cycle, moderate flow sometimes with clots, dysmenorrhea Personal history: No allergies, occupation: housewife. Diet: Irregular timings, Sleep: disturbed, insomnia sometimes, Psychological aspects: disturbed, stressed, anxious, irritable Clinical examination: Patient well conscious, oriented

• O/E: P -76/min, BP -100/60, Ht.-152cm, Wt.-54.5 kg, motion - sometimes constipation, urine- WNL, P/A – soft, non -tender, P/V- uterus-AVAF, fx clear, cervical motion non tender. P/S –Cervix healthy

• Prakriti: Vata pittaja, Jaran Shakti (digestive power) –Madhyam, Agni dushti

Treatment

The treatment was carried out with Virechan Karma along with following medicines (Table 1 and 2). During this period the patient was advised to take Samayaka ahara (nutritive diet like milk, fresh fruits and vegetables, almonds etc.) and avoid Amla, Lavana,Vidahi (Spicy) and Snigdha (oily) ahara. After the treatment, the sonography report on 27/04/2021 showed early intra uterine pregnancy with normal cardiac activity.

Table 1: Medicines used for Virechan Karma

 *Before Snehapana, Agnitundii Vati (2 tds) + Panchakola phanta (15ml bd) is given for three days (for improving Agni-Deepna and Pachana property of patient)

Table 2: Shamana Yoga

*Twice daily

The patient had followed the Ahara and drug restriction strictly. The finding of sonography after treatment is data.

Figure 1: Ultrasound Report Showing Pelvic and Abdominal Findings

Figure 2: Transvaginal Ultrasonography Report Showing Single Live Intrauterine Pregnancy

1. Dutta D.C. “Textbook of gynaecology.” Textbook of Gynaecology, 4th ed., New Central Book Agency Ltd., Calcutta, pp. 421, 431, 523, 549, 558.

2. Shastri A.D. “Sushruta Samhita, sutra sthana 2/33.” Sushruta Samhita, Chaukhambha Sanskrit Sansthan, Varanasi, reprint ed., 2012.

3. Tripathi R.D. “Charaka Samhita, sharir sthana 4/30.” Charaka Samhita, Chaukhamba Sanskrit Pratishthan, Delhi, reprint ed., 2009.

4. Sharma P.H. “The Kashyap Samhita, kalpa sthana 27/29.” Kashyap Samhita, Chaukhambha Sanskrit Samsthan, Varanasi, 2013.

5. Bhaskurani S. “Management of vandhyatva with chitrakadi ghrutam and phala ghrutam.” International Journal of Ayurveda Medicine, 2013.

6. Sharma R. “Role of virechan in infertility: case report.” Journal of Ayurvedic and Herbal Medicine, 2017.

7. Anonymous. “Rasatarangini, parishishta.” Rasatarangini, p. 766.

8. Anonymous. “Rasa tantra sara siddha prayoga sangraha.” Rasa Tantra Sara Siddha Prayoga Sangraha, Krishnagopal Ayurveda Bhavan, Rajasthan, part 1, p. 288.