Fertility is an existential necessity and as such has assumed over whelming importance from time immemorial. However, not all couples who desire a pregnancy will achieve one spontaneously and a proportion of couples will need medical help to resolve underlying fertility problems. Infertility has been recognized as a public health issue world wide by the World Health Organization. Infertility severely affects the couples psychologically, sexually and socially. Anovulation accounts for 25 - 40% of the female infertility. Ayurveda offers several potent combinations in such a condition. The aim of the present paper is to address this problem by studying the efficacy of Ashvagandha Ksheerapaka in the induction of ovulation

Dr. Vishwesh B. N

Rajani Kagga

English

Journal of Ayurveda and Integrated Medical Sciences (JAIMS)

   ISSN: 2456-3110                                                    ORIGINAL ARTICLE May-June 2017  Journal of Ayurveda and Integrated Medical Sciences | May - June 2017 | Vol. 2 | Issue 3 34  A Clinical Study on the efficacy of Ashvagandha Ksheerapaka in Stree Vandhyatva w.s.r. to Anovulation  Rajani Kagga,1 Vishwesh B.N.2    1Assistant Professor, Department of Prasutitantra and Striroga, Sri Sri College of Ayurvedic Science and Research, Bangalore, Karnataka. 2Associate Professor, Department of Prasutitantra and Striroga, Shri Krishna Ayurvedic Medical College, Cholapur, Varanasi, India.               INTRODUCTION Infertility is a condition in women’s life which indicates inability to procreate. Conception depends on multiple factors, ovulation being one among them. A remarkable decline in human fertility is observed beyond the age of 30 years due to reduction in quality and number of healthy ovum. Anovulation is reported to be one of the major cause for female infertility ranging up to 25 - 40% of infertile women.[1] If the menstrual cycles followed by ovulation are related to an   outside    influence    like   nutrition    or   lifestyle, Address for correspondence:  Dr. Vishwesh B. N. Associate Professor, Department of Prasutitantra and Striroga,  Shri Krishna Ayurvedic Medical College Cholapur, Varanasi, India. E-mail: vishweshbn@gmail.com Submission Date : 04/05/2017 Accepted Date: 24/05/2017 Access this article online Quick Response Code Website: www.jaims.in  DOI: 10.21760/jaims.v2i3.8206 effective treatments will include regulating eating habits and moderating physical activities. Making changes to one’s weight (gaining or losing weight) may also be enough to jump-start stalled ovulation. Sometimes internal imbalances are the reason and in such cases, medications are to be prescribed for fertility. These medications are designed to combat the cause of a woman’s infertility. There are drugs designed to ripen the follicles, increase estrogen and help the ovaries release an egg.[2] In Ayurveda, four Garbha Sambhava Samagri are enumerated as Ritu, Kshetra, Ambu and Beeja. Any abnormalities in any of these affect the formation and development of Garbha. According to Shabdakalpadhruma, a women who has hindrance of any kind, in the normal process of conception is termed as Vandhya. Infertility according to Ayurveda is not only limited to non-achievement of conception but also includes failure to continue it till viability and birth of a healthy live child. In this Pumbheeja (Shukra) and Streebheeja (Artava) are very much important.[3] Artavanasha is due to Avarana in Artavavaha Srotas.[4] Ashvagandha is mentioned in A B S T R A C T  Fertility is an existential necessity and as such has assumed over whelming importance from time immemorial. However, not all couples who desire a pregnancy will achieve one spontaneously and a proportion of couples will need medical help to resolve underlying fertility problems. Infertility has been recognized as a public health issue world wide by the World Health Organization. Infertility severely affects the couples psychologically, sexually and socially. Anovulation accounts for 25 - 40% of the female infertility. Ayurveda offers several potent combinations in such a condition. The aim of the present paper is to address this problem by studying the efficacy of Ashvagandha Ksheerapaka in the induction of ovulation. Key words: Ashvagandha Ksheerapaka, Vandhyatva, Anovulation. Rajani Kagga et. al. A Clinical Study on the efficacy of Ashvagandha Ksheerapaka in Stree Vandhyatva.     ISSN: 2456-3110                                                    ORIGINAL ARTICLE May-June 2017  Journal of Ayurveda and Integrated Medical Sciences | May - June 2017 | Vol. 2 | Issue 3 35  the treatment of Stree Vandhyatva.[5] Studies on Ashvagandha shows significant increase in ovarian function and folliculogenesis.[6] This paper intends to describe the efficacy of Ashvagandha Ksheerapaka in Stree Vandhyatva w.s.r. to anovulation. MATERIALS AND METHODS  Total 30 women fulfilling the inclusion criteria were selected from outpatient and inpatient department of P.G. Studies in Prasuti Tantra and Stree Roga, S.D.M. College of Ayurveda and Hospital, Hassan in a single group and were studied. The drug Ashvagandha Choorna was obtained from the pharmacy of SDM Centre for Research in Ayurveda and Allied Sciences, Udupi for the present study. The Ethical Clearance for the study was obtained from Institutional ethical committee. The informed and written consent along with specially designed Case Proforma for the study was prepared.  Inclusion Criteria 1. Females of age group of 20 - 35 years.  2. Females with normally developed secondary sexual characters, ovary and uterus.  3. Women who are diagnosed with anovulatory cycles and single or multiple cyst in either of the ovaries.  4. Patients who were ready to sign in the informed consent form.  Exclusion Criteria 1. Known case of genetic abnormalities.  2. Known case of chronic systemic disorders (diabetes mellitus, hypertension, tuberculosis) and endocrinal disorders. (thyroid dysfunction). Criteria for diagnosis 1. Female patients of primary and secondary infertility were assessed for Anovulation.  2. Anovulation was confirmed by USG - Follicular study.  Drug - Ashvagandha Ksheerapaka (Sharangadhara method 1:4:8 ratio) in a dose 100ml twice a day before food administered Orally. Duration - Consecutive 3 cycle (from 5th day after cessation of menses till the commencement of next menstrual cycle)  Criteria for Assessment Sonological Parameters - Follicular study was repeated after completion of oral intake of Ashvagandha Ksheerapaka for three menstrual cycles. Efficacy of therapy was assessed on the basis of size of follicles, endometrial thickness and signs of ovulation.  Patients were divided to following categories for assessment of follicle development and size.   Grade 0 = < 12mm follicle  Grade 1 = 12 - 19mm follicle   Grade 2 = 19 - 23mm follicle  Grade 3 = ovulation Overall effect of treatment 1 Grade 3  Conceived  The patient conceived after the treatment.  2 Grade 2  Ovulated  Ovulation occurred  3 Grade 1 Improved  Ovulation not occurred but only improvement in the size of follicles i.e. 12-19 mm.  4 Grade 0  Unchanged  No change in the growth of the follicle  Follow up study was conducted every 15 days and also on 12th day of menstrual cycle for follicular study after completion of the treatment. OBSERVATION Total 30 subjects registered and all 30 patients completed the study. The data collected from the proforma was subjected to statistical methods using SPSS (version 16) with Friedman’s test and Wilcoxon’s signed rank test which were filled on the starting of the first day of the treatment. All patients in the present study were having proper development and proper fat distribution on pubis and vulva. Average vaginal discharge was observed in 76.7% of patients, while cervical erosion was found in 13.3% of patients. Rajani Kagga et. al. A Clinical Study on the efficacy of Ashvagandha Ksheerapaka in Stree Vandhyatva.     ISSN: 2456-3110                                                    ORIGINAL ARTICLE May-June 2017  Journal of Ayurveda and Integrated Medical Sciences | May - June 2017 | Vol. 2 | Issue 3 36  96.7% of patients were having nulliparous cervix. All of patients were having normal size uterus. 100% of patients had freely mobile uterus and fornices were clear. After the treatment among 30 patients, in maximum 93.3% there was no change observed in the growth of the follicles, where as in 6.7%, there was slight improvement in follicular growth also the endometrial thickness, but it was not statistically significant. RESULTS Table 1: Showing USG - Follicular study reports of 30 patients. Factors No of patients % Right ovary BT < 12 mm follicle 19 63.3 12-19mm follicle 10 33.3 19-23mm follicle 01 3.3 Ovulated 00 00 AT < 12 mm follicle 19 63.3 12-19mm follicle 10 33.3 19-23mm follicle 01 3.3 Ovulated 00 00 Left ovary BT < 12 mm follicle 24 80.0 12-19mm follicle 03 10.0 19-23mm follicle 03 10.0 Ovulated 00 00 AT < 12 mm follicle 22 73.3 12-19mm follicle 05 16.7 19-23mm follicle 03 10.0 Ovulated 00 00 Endometrial thickness BT <6mm 10 33.3 6-8mm 19 63.3 >8mm 01 3.3 AT 6mm 08 26.7 6-8mm 22 73.3 >8mm 00 00 Free fluid in POD BT Present 00 00 AT Absent 30 100 Among 30 patients before treatment 63.3% patients had <12mm follicular size, 33.3% patients had follicular size in between 12 - 19 and 3.3% had 19 - 23mm follicle size in right ovary, in left ovary 80% had <12mm follicular size, 10% each had 12 - 19mm and 19 - 23mm sized follicle with ET 6 - 8mm in 63.3%, <6mm in 33.3% and >8mm in 3.3% with no free fluid in POD. Whereas after treatment 63.3% patients had <12mm follicular size, 33.3% patients had follicular size in between 12 - 19mm and 3.3% had 19 - 23mm follicle size in right ovary, in left ovary 73.3% had <12mm follicular size, 16.7% had 12 - 19mm and 10.0% had 19 - 23mm sized follicle with ET 6-8mm in 73.3%, <6mm in 26.7% with no free fluid in POD. Table 2: Showing Friedman Test  Parameter N X2(2) Df P value Remarks Right ovary 30 0.000 01 1.000 NS Left ovary 30 1.000 01 0.317 NS Endometrial thickness 30 0.077 01 0.782 NS Free fluid in POD 30 - 01 - NS Rajani Kagga et. al. A Clinical Study on the efficacy of Ashvagandha Ksheerapaka in Stree Vandhyatva.     ISSN: 2456-3110                                                    ORIGINAL ARTICLE May-June 2017  Journal of Ayurveda and Integrated Medical Sciences | May - June 2017 | Vol. 2 | Issue 3 37  Friedman’s test shows that the trial drug is not giving statistically significant result in induction of ovulation. Table 3: Showing Wilcoxon Signed Ranks Test. Parameter Negative ranks Positive ranks Ties Total Z value P value Remarks N MR SR N MR SR RO BT-AT 4 4.50 18.00 4 4.50 18.00 22 30 0.000 1.000 NS LO BT-AT 1 2.50 2.50 3 2.50 7.50 26 30 -1.000 0.317 NS ET BT-AT 6 7.00 42.00 7 7.00 49.00 17 30 -0.277 0.782 NS POD BT-AT 0 0.00 0.00 0 0.00 0.00 30 30 0.000 1.000 NS Bonferroni correction - 0.01, N - No., MR - Mean Rank, SR - Sum of Ranks Wilcoxon signed rank test shows that the trial drug is not giving statistically significant result in induction of ovulation. Among 30 patients maximum 93.3% there was no change observed in the growth of the follicles where as in 6.7% there is slight improvement in follicular growth also the endometrial thickness. But this is not statistically significant. CONCLUSION The present work was designed to study the efficacy of Ashvagandha Ksheerapaka in Stree Vandhyatva on anovulation. The effect of Ashvagandha Ksheerapaka is not clinically and statistically significant on ovulation. Better result may be achieved after Shodhana along with the administration of other Prajasthapanagana Dravya or Pumsavana Dravya or other compound medicine. Anyhow, no adverse drug reaction (ADR) and side effects were reported in the present study and the drug in the prescribed dose and the method used for the procedures proved safe.   REFERENCES 1. Taylor E. Anovulation, BMJ2003; 327;p.494-497. 2. Scorge OJ, Scoffer IJ, Halvorson LM, Hoffman, Bradshaw KP, Cunningham FG, Evaluation of infertile couple. Williams’s gynecology, Dallas: library of congress, 2008;p.426. 3. Tiwari PV. Streevandhyatwa, 2nd edition, PrasutiTantraevamstreeroga; Varanasi, chaukhambha orientalia2009:2;p.273 4. Sushruta, Dalhana, ShukraShonitashuddhi, Sushrutasamhita, Shastri KA, Edittion.6, Varanasi, Chaukhambha Sanskrit Sansthan:1985;p.13 5. Kumari A, Tiwari PV. Yonirogadhikara 1st edition Yogaratnakara: Varanasi. ChaukhambhaBharati Academy; 2010:2;p.1139. 6. Sabin’s M. Withania somnifera, Chemistry and Pharmacology of Ayurvedic Medicinal Plants, 1st edition; Varanasi. Chaukhambha Amarbharti Prakashan, 2006;p.383-391.    ******************************** How to cite this article: Rajani Kagga, Vishwesh B.N. A Clinical Study on the efficacy of Ashvagandha Ksheerapaka in Stree Vandhyatva w.s.r. to Anovulation. J Ayurveda Integr Med Sci 2017;3:34-37. http://dx.doi.org/10.21760/jaims.v2i3.8206  Source of Support: Nil, Conflict of Interest: None declared. 

A Clinical Study on the efficacy of Ashvagandha Ksheerapaka in Stree Vandhyatva w.s.r. to Anovulation

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A Clinical Study on the efficacy of Ashvagandha Ksheerapaka in Stree Vandhyatva w.s.r. to Anovulation

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