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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 12  |  Issue : 4  |  Page : 231-239

Effect of individualised Homoeopathy in the treatment of infertility


Dr. Anjali Chatterjee Regional Research Institute for Homoeopathy, Kolkata, West Bengal, India

Date of Submission25-May-2018
Date of Acceptance26-Dec-2018
Date of Web Publication08-Feb-2019

Correspondence Address:
Dr. Suraia Parveen
Dr. Anjali Chatterjee Regional Research Institute for Homoeopathy, 50, Rajendra Chatterjee Road, Kolkata - 700 035, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijrh.ijrh_33_18

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  Abstract 


A 37-year-old woman, being married for 6 years, presented to the homoeopathic outpatient department, after treatment of infertility by a gynaecologist for few years. She had a past history of emergency ovarian cystectomy for endometriosis 1 year after her marriage. Her subsequent infertility workup revealed hydrosalpinx with one-sided tubal block along with the evidence of poor ovarian reserve. Her husband's semen analysis was normal and was advised for donor-ovum in vitro fertilisation. At this point, she was treated with constitutional homoeopathic medicine following the miasmatic analysis with the holistic concept of Homoeopathy over 6 months. Treatment started with Silicea and later switched to Syphilinum. She conceived normally after that and subsequently delivered a healthy baby at full term. This case shows the positive role of classical homoeopathic treatment on subfertility.

Keywords: Endometriosis, Homoeopathy, Infertility, Poor ovarian reserve, Silicea, Syphilinum


How to cite this article:
Parveen S, Bhaumik H. Effect of individualised Homoeopathy in the treatment of infertility. Indian J Res Homoeopathy 2018;12:231-9

How to cite this URL:
Parveen S, Bhaumik H. Effect of individualised Homoeopathy in the treatment of infertility. Indian J Res Homoeopathy [serial online] 2018 [cited 2019 May 20];12:231-9. Available from: http://www.ijrh.org/text.asp?2018/12/4/231/251915




  Introduction Top


The World Health Organization has defined infertility as a disease of the reproductive system characterised by the failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. Infertility may be broadly subdivided into primary and secondary infertility. Primary infertility is infertility in a couple who never had a child, whereas secondary infertility is failure to conceive following previous live birth of a child.[1],[2]

Data from population-based studies suggest that 10%–15% of couples in the world experience infertility. Infertility may be due to specific pathology in male (20%–30%) and/or female reproductive system (20%–35%); however, often, the cause is multifactorial (25%–40%) or remains unexplained (10%–20%).[3] However, literature reviews failed to reveal any Indian demographic data. Among female pathology, there may be either ovulatory dysfunction or structural problems in  Fallopian tube More Detailss and other reproductive system or combined pathology in an almost equal proportion. Ovulatory dysfunctions may be caused by either problems in ovaries such as oophoritis, ovarian tumours, decreased/poor ovarian reserve (POR) and corpus luteum insufficiency or systemic metabolic/endocrine disorders such as polycystic ovarian syndrome, hypothyroidism, hyperthyroidism and hyperprolactinaemia. Reproductive structural problems may be caused by pelvic inflammatory diseases, endometriosis, fibroids or congenital problems.[4]

Endometriosis is an enigmatic gynaecological pathology defined by the presence of tissue similar to uterine endometrium at places other than physiologically appropriate area, i.e., uterine endometrial cavity. There are two classical, well-differentiated types of endometriosis in both clinical manifestations and aetiopathogenesis, namely (1) adenomyosis or internal endometriosis where ectopic endometrial foci infiltrate the outer muscular walls of the uterus and (2) external endometriosis or simply endometriosis where ectopic endometrial foci infiltrate in the pelvic cavity commonly, or distantly at abdominal cavity or even outside. Usually, the common symptoms of endometriosis are dysmenorrhoea, deep dyspareunia and chronic pelvic pain.[5],[6] There may be infertility in 30% of cases of endometriosis. Infertility in endometriosis is usually caused by tubal blockage or interference with implantation.[7] Severe endometriosis in the ovary may lead to chocolate cyst, tubo-ovarian mass with adhesion of the fallopian tubes or acute ovarian-torsion requiring surgery.[8] Ovarian reserve (OR) determines the capacity of the ovary to provide oocytes that are capable of fertilisation resulting in a healthy and successful pregnancy. During menstrual cycle, certain hormones such as follicle-stimulating hormone (FSH), anti-Mullerian hormone (AMH) and estradiol (E2) are used to assess the reproductive quality of the oocytes parallel to the antral follicle count (AFC). Increasing maternal age affects ovarian function both in quality and quantity of oocytes by which, with increasing age, a woman gradually progresses from infertility to menopause. While menopause occurring before the age of 40 years is called premature ovarian failure (POF), subfertility with preserved menstruation in younger women is considered as POR or early ovarian ageing.[9] Since AMH is solely produced in the growing ovarian follicles, its serum level is used as a marker for OR or the quality of the ovarian follicle pool.[10] FSH helps in the maturation of ovarian follicles and in decreased growing follicle in the ovary; the serum FSH level goes higher indirectly as a compensatory mechanism of the brain and the women who ovulate early may have elevated.[11] E2 levels above 80 pg/mL will mask an elevated FSH level.[12] Thus, decreased AMH, decreased E2 and raised FSH on days 2–4 of menstrual cycle indicate POR in a female. The primary and prominent indication for egg donation was originally for women with POF, but, in recent years, for women with POR. Females with decreased AMH and raised FSH on days 2–4 of menstrual cycle when fail to show progress in growing AFC on optimum hormonal ovarian stimulation are finally the candidates for in vitro fertilisation (IVF) with egg donation.[13]

Here, we presented a case of successful homoeopathic treatment of primary infertility in a female who was long been treated for endometriosis, undergone emergency laparotomy with removal of tubo-ovarian mass, finally diagnosed as a case of decreased OR/POR and advised for IVF with donated egg.


  Case Report Top


A 37-year-old, Hindu, married woman from low-middle socioeconomic status family presented at Dr. Anjali Chatterjee Regional Research Institute for Homoeopathy (DACRRIH), Kolkata, in July 2015, with a complaint of having no child since 6 years of her marriage despite long-term treatment by gynaecologists and fertility specialists. Her husband's semen analysis report was normal. Her menstrual cycle was irregular, with moderate flow lasting for 2–3 days with associated dysmenorrhoea.

She got married in 2009 and used to suffer from dyspareunia and recurrent pain in the lower abdomen. In June 2010, she was admitted to a nursing home with acute pain abdomen and diagnosed with a large space-occupying lesion is modified to-a large cystic SOL (space-occupying lesion) (4.3 cm × 4.0 cm × 4.1 cm) in the right ovary/adnexa. There was a history of recurrent appendicitis. On 14 June 2010, right ovarian cystectomy and appendicectomy were done. In 2011, she was worked up by a gynaecologist for the treatment of infertility. On 30 March 2011, hysteroscopy revealed a congested uterus, hyperplasic with both ostia seen. On laparoscopy, right ovary and right fallopian tube were not visualised but showed extensive endometriosis surrounding the left ovary and the left tube was looking healthy but with no spillage. After that, she continued her endeavour for natural conception along with on-off treatment by different gynaecologists over the next few years. Finally, being unsuccessful, she went to a fertility specialist in January 2015. She underwent thorough investigation such as hysterosalpingogram (HSG), transvaginal ultrasonography (TVS USG), serum for AMH, FSH and serial folliculometry with hormonal ovulation induction. After complete evaluation, the fertility specialist suggested her for IVF with donor ovum. The patient did not have financial ability for bearing the expenses of IVF, so she finally landed up at DACRRI for homoeopathic treatment for her infertility.

There was a history of typhoid at 7 years of age and tonsillectomy at the age of 12 years. Currently, she has an additional morbidity of small fibroadenoma in the left breast for 1 year.

As for her family, there was a history of chronic obstructive pulmonary disease in her father, osteoporosis and lumbar spondylosis in her mother, unspecified mental illness in her maternal uncle at old age and her maternal grandfather died from liver cancer.

Homoeopathic generalities

Mental expressions, physical makeup, physical generals, etc., were considered for totality of symptoms as follows:

Mental generals

She was extremely anxious for her issue. She was usually sad, depressed and frustrated in life because of ending of hope to conceive. She prefers being alone and a quiet environment. She is very much irritable and angered easily, and small things would affect her. She has also obsessive behaviour, i.e., washing habit and always busy to clean home. She is also forgetful, indecisive and hesitated to take decision with lack of self-confidence.

Physical generals

She was dark complexioned, emaciated with pointed forehead and looked older than age. Her menses were usually painful, irregular, late, scanty flow, dark and clotted, offensive and pain occurs before and during menses. She has leucorrhoea – thick, acrid mucus < after menses, with itching in vagina and vulva pudenda. She also had decreased appetite, moderate thirst with recurrent ulceration of mouth and tongue, caries teeth with decayed edges and disturbed sleep < first night. She has the tendency of constipation from childhood, with passing dry, hard, stool, at 2–3 days' interval. She was also thermally ambithermic, She craves spicy food+++ and cold food+++ and dislikes bread+. Moreover, she has profuse sweat in all over the body, offensive, more on the palm and sole.

As per the principles of Homoeopathy, to construct the totality, detailed case taking and evaluation of the characteristic symptoms were done. Using the RADAR 10 software (Synthesis, Repertorium Homeopathicum Syntheticum 9.1 version), Archibel Homoeopathic Software, Belgium, 2009,[14],[15] repertorial analysis was done [Table 1]. The following characteristic symptoms were considered for repertorisation:
Table 1: Repertorisation chart

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  • Sadness and depressed
  • Despair and frustrated in life
  • Irritable easily and affected by small things
  • Indecisive, lack of self confidence
  • Forgetful, cannot remind things where kept
  • Washing habit, always busy to clean home
  • Infertility
  • Hydrosalpinx
  • Menses irregular, mostly late
  • Menses – Scanty, dark, clotted, offensive
  • Painful, dysmenorrhoeal < before menses
  • Leucorrhoea – thick, mucus, acrid, with itching in vagina and vulva pudenda
  • Desire for spicy foods+++
  • Desire for cold food+++
  • Disturbed sleep < first night for thinking
  • Profuse offensive perspiration on the palm and sole
  • Recurrent ulceration of the mouth and tongue with irregular patches
  • Caries in teeth with decayed at edged
  • Tumour/fibroadenoma in the left breast
  • Constipation – Hard and dry stool.


Clinical findings and diagnostic assessment

On previous clinical findings and investigations, it was found to be a case of gross endometriosis with a history of right ovarian cystectomy on 14 June 2010 with primary subfertility. On 30 March 2011, hysteroscopy revealed a hyperplastic congested uterus with both ostia seen; laparoscopy revealed extensive endometriosis surrounding the left ovary and healthy looking left fallopian tube [Figure 1]. Furthermore, HSG revealed right-sided fallopian tubal block with patent left-sided fallopian tube with spillage [Figure 2]. In 2015, reproductive hormonal profile revealed decreased AMH and increased FSH that suggested decreased OR. Decreased OR refers reduced production of quality ovum from the maturing follicle during menstrual cycle. On 9 March 2015, TVS USG [Figure 3] also revealed right hydrosalpinx. It was found that it was subfertility with dual pathology of poor Ovarian Reserve along with one-sided tubal blockage (h/o right hydrosalpinx). She had taken treatment for natural conception along with on-off treatment by gynaecologists and obstetricians from 2011 to 2015 by gynaecologists and fertility specialists. Finally, she was advised for a course of normal treatment with dehydroepiandrosteridione for 6 months with a hope to stimulate the ovarian function, but there was no improvement for subsequent level of AMH (<1, indicates POR) and FSH (increased, 16.25) [Figure 4]. There was failure of normal conception; ultimately, the fertility specialist advised her for IVF with donor ovum [Figure 5], for which the patient was unable to afford the expenses.
Figure 1: Ultrasonography of the lower abdomen (before treatment)

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Figure 2: HSG report (before treatment)

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Figure 3: Ultrasonography (transvaginal) of the pelvis (before treatment)

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Figure 4: Hormone profile (before treatment)

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Figure 5: Advice from fertility specialist for in vitro fertilisation with donor ovum

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Based on detailed workup by different gynaecologists and therapist's clinical evaluation, this was found to be a case of subfertility due to dual pathology of severe endometriosis and POR. There were associated fibroadenoma breast and depression with obsessive behaviour.

Therapeutic intervention, follow-up and outcome

Homoeopathic medicines were procured from Hahnemann Publishing Company Pvt. Ltd. (Good Manufacturing Practice certified ISO 9001:2008 unit) and dispensed from DACRRI (H) dispensary. The homoeopathic Similimum was prescribed on the basis of individualisation, symptom totality and miasmatic analysis with the holistic concept of Homoeopathy. Treatment was started with constitutional homoeopathic medicine Silicea with increasing potencies (200C, 1M, 10M). Further, through miasmatic analysis, Syphilinum was prescribed as an inter-current remedy.

Detailed follow-up is summarised in [Table 2].
Table 2: Timeline including follow-up of the case

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Although Silicea initiated the improvement, Syphilinum completed the cure, i.e., the patient became pregnant [Figure 6] - USG report of pregnancy] and gave birth to a healthy male baby [Figure 7], Birth registration Certificate].
Figure 6: Ultrasonography of pregnancy (after treatment)

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Figure 7: Birth registration certificate of the male child

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The final outcome and possible causal attribution of the changes in this case were assessed using the ‘Modified Naranjo Criteria’ as proposed by the HPUS Clinical data Working Group (December 2015) [Table 3].
Table 3: Assessment by Modified Naranjo Criteria score

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The total score of outcome as per the Modified Naranjo Criteria was 09, which was close to the maximum score of 13. This explicitly shows the positive causal attribution of the individualised homoeopathic treatment towards this case of infertility.[16]


  Discussion Top


This case report followed HOM-CASE guidelines for reporting the outcomes. This case was a confirmed case of subinfertility in an elderly primigravida with dual pathology, POR with one-sided tubal block along with decreased AMH and increased FSH. There was no chance of normal conception without IVF with donor ovum as per the fertility specialist or the gynaecologist and the obstetrician after their treatment from 2011 to 2015.

As per homoeopathic philosophy, pathology does not fully represent the expression of disease in a given case. The true pathognomic symptoms of a given case are those that cover the existing active miasm. Hahnemann says that the primitive disease evidently owed its existence to some chronic miasm. To reach the prima causa miasmatic prescription was based on the basic miasmatic symptoms of the case. In-depth understanding of dominant miasm of the patient through the totality of symptoms, individualisation, personal history and family and past histories can give insight to the morbid susceptibility and bring out cure.[17],[18],[19],[20],[21]

In this case, the miasmatic analysis was based on the dominant symptoms of the Syphilis miasm such as pathological symptoms (infertility, POR [premature degeneration, hydrosalpinx, history of endometriosis, delayed menses and acrid, excoriating leucorrhoea]; mental symptoms [sad, depressed, despair, irritability, aversion to speak, obsession such as washing habit]; physical symptoms [emaciated with swollen glabella with protruded forehead, desire for cold food and spicy foods, recurrent mouth ulcer with salivation and profuse offensive perspiration]; other symptoms [caries teeth, decayed at the edges, black and brittle nails, constipated with hard, dry stool] and family history of insanity, cancer and osteoporosis.[22],[23] In the female genitalia chapter of The Essential Synthesis Repertory under the rubric ‘Sterility’, Syphilinum is presented as the 2nd grade medicine. Therefore, Syphilinum (200, 1M) was prescribed as an anti-miasmatic drug to complete the treatment process in this patient, resulting a positive outcome i.e. the patient became pregnant and delivered a healthy male baby.

Kalampokas et al.[24] presented a case series of treated female infertility in the literature in which homoeopathic treatment showed positive/successful result on five female subfertility patients in a large obstetrics-gynaecology hospital in Athens, Greece. However, there is lack of any well-designed study to support the results of these case reports.

In the review article of ‘Homeopathic treatment of infertility: A medical and bioethical perspective’, the author has observed the homoeopathic approach and the bioethical implications to infertility and proposed that monitoring the effects of homoeopathic remedies on infertile women may be an effective method to assess the efficacy of this form of alternative medicine. Infertility is a popular area for homoeopathic applications as the complementary and alternative medicine.[25]


  Conclusion Top


  • Constitutional homoeopathic treatment has helped an elderly primi to conceive normally despite her established subfertility due to the dual pathology of endometriosis and decreased OR
  • It reconfirms the homoeopathic constitutional treatment on miasmatic analysis and holistic basis over clinical diagnosis
  • Well-designed studies are required for establishing the effectiveness and efficacy of Homoeopathy in treating infertility cases. It may provide the scientific validity on the medical benefits of Homoeopathy.


Acknowledgements

The author is grateful to Dr D. B. Sarkar, Assistant Director, DACRRI (H), Kolkata, for editing this case report. The author acknowledges the fertility specialist Dr Kousiki Roy, Department of Gynaecology, AMRI, Kolkata, for helping in the case study of literature review for this case report and valuable suggestions.

The author would also like to acknowledge the patient for her consent and co-operation in continuing the follow-up.

Informed consent

The patient willingly gave her informed consent for publication of this report.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

None declared.



 
  References Top

1.
World Health Organization (WHO-International Committee for Monitoring Assisted Reproductive Technology (ICMART), [Sexual and reproductive health], WHO; https://www.who.int/reproductivehealth/topics/infertility/definitions/en/. [Last accessed on 2017 Sep 16].  Back to cited text no. 1
    
2.
Infertility, Wikipedia; Available from: https://www. en.wikipedia.org/wiki/Infertility. [Last accessed on 2017 Sep 15].  Back to cited text no. 2
    
3.
Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: A systematic analysis of 277 health surveys. PLoS Med 2012;9:e1001356.  Back to cited text no. 3
    
4.
Olooto WE, Adeleye AO, Amballi AA, Banjo TA. A review of female infertility; important etiological factors and management. J Microbiol Biotechnol Res 2012;2:379-85.  Back to cited text no. 4
    
5.
Acién P, Velasco I. Endometriosis: A disease that remains enigmatic. ISRN Obstet Gynecol 2013;242149.  Back to cited text no. 5
    
6.
Koninckx PR, Martin DC. Deep endometriosis: A consequence of infiltration or retraction or possibly adenomyosis externa? Fertil Steril 1992;58:924-8.  Back to cited text no. 6
    
7.
Macer ML, Taylor HS. Endometriosis and infertility: A review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin North Am 2012;39:535-49.  Back to cited text no. 7
    
8.
Koninckx PR, Martin D. Treatment of deeply infiltrating endometriosis. Curr Opin Obstet Gynecol 1994;6:231-41.  Back to cited text no. 8
    
9.
Subrat P, Santa SA, Vandana J. The concepts and consequences of early ovarian ageing: A caveat to women's health. J Reprod Infertil 2013;14:3-7.  Back to cited text no. 9
    
10.
te Velde ER, Pearson PL. The variability of female reproductive ageing. Hum Reprod Update 2002;8:141-54.  Back to cited text no. 10
    
11.
Abdalla H, Thum MY. An elevated basal FSH reflects a quantitative rather than qualitative decline of the ovarian reserve. Hum Reprod 2004;19:893-8.  Back to cited text no. 11
    
12.
Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update 2006;12:685-718.  Back to cited text no. 12
    
13.
The National Infertility Association. (Family Building Options/Donor Options/Using Donor egg), NIA. Available from: . [Last accessed on 2017 Sep 16].  Back to cited text no. 13
    
14.
Schroyens F. RADAR 10, Synthesis Repertorium Homeopathicum Syntheticum, 9.1 version, Archibel Homoeopathic Software, Belgium 2009.  Back to cited text no. 14
    
15.
Schroyens F. The Essential Synthesis Repertory. 9.1 version. Rep. Indian Edition. New Delhi: B. Jain Publishers (P) Ltd.; 2012. p. 1050, 1089.  Back to cited text no. 15
    
16.
van Haselen RA. Homeopathic clinical case reports: Development of a supplement (HOM-CASE) to the CARE clinical case reporting guideline. Complement Ther Med 2016;25:78-85.  Back to cited text no. 16
    
17.
Boericke W. Pocket Manual of Homoeopathic Materia Medica and Repertory. 50th Impression. New Delhi: B. Jain Publishers (P) Ltd.; 2010. p. 590-4, 627-8.  Back to cited text no. 17
    
18.
Allen HC. Keynotes and Characteristics with Comparisons of Some of the Leading Remedies of the Materia medica with Bowel Nosodes. Rep ed. New Delhi: B. Jain Publishers (P) Ltd.; 2004. p. 264-7, 282-4.  Back to cited text no. 18
    
19.
Hahnemann S. Organon of Medicine. 6th ed. New Delhi: B. Jain Publishers (P) Ltd.; 2011.  Back to cited text no. 19
    
20.
Kent JT. Lectures on Homoeopathic Philosophy. New Delhi: B. Jain Publishers (P) Ltd.; 2011. p. 231-41.  Back to cited text no. 20
    
21.
Hahnemann S. The Chronic Diseases, their Peculiar Nature and their Homœopathic Cure. Rep ed. New Delhi: B. Jain Publishers (P) Ltd.; 1978. p. 1397-436.  Back to cited text no. 21
    
22.
Allen JH. The Chronic Miasms Psora and Pseudo-Psora. Rep ed., Vol. I & II. New Delhi: B. Jain Publishers (P) Ltd.; 2006. p. 51-277.  Back to cited text no. 22
    
23.
Speight P. A Comparison of the Chronic Miasms, Psora, Pseudopsora, Syphilis, Sycosis. Rep ed. New Delhi: B. Jain Publishers (P) Ltd.; 1998. p. 1-87.  Back to cited text no. 23
    
24.
Kalampokas T, Botis S, Kedikgianni-Antoniou A, Papamethodiou D, Kivellos S, Papadimitriou V, et al. Homeopathy for infertility treatment: A case series. Clin Exp Obstet Gynecol 2014;41:158-9.  Back to cited text no. 24
    
25.
Masiello DJ, Loike JD. Homeopathic Treatment of Infertility: A Medical and Bioethical Perspective. Int J Complement Alt Med 2017;5:00167.  Back to cited text no. 25
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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