Conception in a case of primary infertility with intra mural fibroid–A case report

Introduction

Infertility is defined by the failure to be pregnant after 12 months or more of regular unprotected sex. ^[1] Infertility affects millions of people worldwide. It affects their families. It is estimated that about 48 million couplesface problem of infertility worldwide. ^[2], ^[3], ^[4] In the males, infertility is most commonly attrtibuted to problems in the ejection of semen, ^[1] absence or low levels of sperm, or abnormal shape (morphology) and movement (motility) of the sperm. While in the females infertility may be due to abnormalities of the ovaries, uterus, fallopian tubes, and the endocrine system, among others. Infertility can be primary or secondary. Primary infertility is when a pregnancy has never been achieved by a person, and secondary infertility is when at least one prior pregnancy has been achieved.

Unani system of medicine infertility is termed as Uqr and unani physicians attribute Uqr (Infertility) to some defect in either of the couple.

Case Presentation

A married couple (23 years female partner & 28 years male partner) presented to OPD of Gynae OPD A&U Tibbia College,KarolBagh,New Delhi with the complaint of infertility issue. The couple had been married for 3years and since then has been trying to conceive and reported a high degree of stress related to their lack of success. Patient had regular menstrual cycle of 30-32 days with 6-7 days’ duration of flow of moderate amount. On examination P/A-soft and non –tender. P/S-vagina and cervix found healthy, P/V-uterus anteverted. On investigation- CBC – Hb-13.5,TLC-5500.DLC-66/32/ blood group of patient is A negative and her partner was positive, PRL-3.59 on 23.06.21. Patient had undergo diagnostic HCG in which both fallopian tubes were normal, and uterine cavity was also normal. USG revealed intramural fibroid of 1.7 and 1.9 cm in anterior wall. The patient attempted for IVI but failed. She had moderate built with no significant medical or surgical history. There was no history of family infertility on either side of partners. The patient was a housewife, belonged to middle socio economic group and had no history of STDs, smoking, alcohol or other drug. The patient’s partner also reported good health and no problems with erection, ejaculation or pain during intercourse. His seman analysis was normal. He worked in a private company and had no habits of smoking, alcoholism, drug abuse or self-medications.

Follow Up & End Result

Patient took the Unani medicine for two consecutive cycles. No response was observed in first cycle, and then she was counselled and advised to continue the same in the next cycle one medicine was added to the treatment. After receiving Unani medicine in second cycle, when she had missed her period & urine for pregnancy test was positive. This pregnant woman is having regular ANC.

Discussion

In this case a married couple (23 years female partner & 28 years male partner) presented to OPD of Gynae OPD A&U Tibbia College,KarolBagh,New Delhi with the complaint of infertility issue. The couple had been married for 3years and since then has been trying to conceive and reported a high degree of stress related to their lack of success. Patient had regular menstrual cycle of 30-32 days with 6-7 days’ duration of flow of moderate amount. On examination P/A-soft and non –tender. P/S-vagina and cervix found healthy, P/V-uterus anteverted. On investigation- CBC – Hb-13.5,TLC-5500.DLC-66/32/ blood group of patient is A negative and her partner was positive, PRL-3.59 on 23.06.21. Patient had undergo diagnostic HCG in which both fallopian tubes were normal, and uterine cavity was also normal. USG revealed intramural fibroid of 1.7 and 1.9 cm in anterior wall. The patient attempted for IVI but failed. She had moderate built with no significant medical or surgical history. There was no history of family infertility on either side of partners. The patient was a housewife, belonged to middle socio economic group and had no history of STDs, smoking, alcohol or other drug. The patient’s partner also reported good health and no problems with erection, ejaculation or pain during intercourse. His seman analysis was normal. He worked in a private company and had no habits of smoking, alcoholism, drug abuse or self-medications.

In first month patient was given Majoon Supari Pak 5gm BD, Itrifal Shahtra 5gm BD and Qurs Kafoor 2 BD. In second cycle Jwarish Amla sada 5gm BD was added and husband was given Majoon Ard Khorma 5gm in both cycles. Patient conceived in third cycle. Majoon Supari Pak helped in conception by being uterine tonic and Itrifal Shahtra and Qurs Kafoor were given for resolution of fibroid.Jwarish Alma sada was given because of its antioxidant property.

All the Unani medicines might have cumulative effect and helped in conception.Furthur studies are needed to establish the role of above mentioned medicines in conception.

Conclusion

Majoon Supari pak, Majoon Ard Khorma has been mentioned in the classical unani literature for the treatment of infertility. Based upon the above case study, it is further recommended to have a clinical trial on a larger sample size in order to prove its efficacy in treatment of an ovulatory infertility scientifically.

Acknowledgement

We are highly thankful to patient who had trust in Unani medicines and continued medicine for two cycles despite failures.

Conflict of Interest

None.

Source of Funding

None.