Female Infertility as per Ayurveda
Vandhyata is the Ayurveda term used to describe infertility or the failure to conceive a child even after regular sexual intercourse without the use of contraceptive measures. Mritvatsa or repeated still births, Garbha Srava or repeated abortions are also included in the types of infertility. Major problems for infertility in present day is unhealthy diet habits, sedentary lifestyle, late marriages and increased stress.
Ayurvedic Stages of Womanhood
Ayurveda text books explain three stages in the lifespan of a female – childhood, adulthood (active reproductive period) and old age. There are anatomical and physiological variations in each of these stages. The different periods in a woman’s life are explained below.
Balavastha (Childhood period from birth upto 16 years)
Bala – Birth till 10 years of age
Kumari – 10 to 12 years, pre-menarche period
Rajomati – 12 to 16 years, puberty period
Madhyamavastha (Adulthood / Active reproductive period from 16 to 60 years)
Yuvati – 16 to 40 years
Praudha – 40 to 50 years
Adhirooda – 50 to 60 years
Now a days, because of the modernization and changes in diet & lifestyle, active reproductive period has been reduced to 45 to 50 years.
Vriddhavastha (Old age / the period above 60 years)
Vriddha – Above 60 years of age, indicated the post-menopausal period.
Childhood period is the Kapha Dominating phase where the bodily tissues are still immature.
Adulthood period is governed by Pitta Dosha. The metabolic activities are high, bodily tissues including reproductive tissue is fully developed and mature and menstrual cycles are regular. It is active reproductive phase of the life which is chiefly concerned with pregnancy and child birth. A young, immature plant does not give flowers or fruits. Just as the plant grows and when appropriate time comes, the fruit gets formed from the flower, similarly Rajas or menstrual blood appears at the time of menarche which is between 12 to 16 years. This is time when there is sexual maturity. Physical and psychological changes in the body can be noted during this period as the body gets prepared for becoming an adult. Puberty or adolescence period is a transition between childhood and adulthood. Actually, it is a joint phase at which these two very different stages of women’s life meet. Therefore, this period is a specific stage at which Kapha of childhood period is declining while Pitta of adulthood starts achieving its heights.
Peri-menopausal period begins from 45 years of age and continues for 2 to 5 years or even longer. Initially there is imbalance of Pitta Dosha leading to hot flushes, night sweats, changes in menstrual cycle and bleeding pattern, etc. As the women approaches menopause, when there is complete cessation of menstrual cycle for upto one year, Vata Dosha becomes dominant and continues to be dominant in the post-menopausal phase too. There is decline of the bodily tissues, especially the quantity and quality of ovum and decrease of sexual hormones. The genitals get atrophied, vagina becomes narrow and uterus markedly reduces in size and ovaries shrinks to become denser.
Menstrual cycle is the extra season of women which makes them more special. Just like all our body functions governed by three Doshas, the menstrual cycle is also governed by the three Doshas, Vata, Pitta and Kapha. Complex changes occur rhythmically in the body of an adult woman which prepare the body for pregnancy. After puberty, the menstrual cycle and hormones are released at regular intervals which is responsible for menstrual and ovarian cycle. Just as the tree begins to bear flowers and fruits when it matures, an adult female is able to bear the child when the reproductive tissues mature. The flowers contain the seeds which become fruits on maturity, the same way seeds / ovum is present in the female but only when time comes, ovum is able to fertilize.
Menstrual phase is governed by Vata Dosha, which is followed by dominance of Kapha Dosha during the ovulation period. Post ovulation until the menstruation occurs, Pitta Dosha dominates.
Middle age is the most fertile period in a female. This period starts after puberty and ends by pre-menopausal time. According to Ayurveda, the body has 7 Tissues, Shukra Dhatu (Reproductive Tissue) is the seventh tissue which is responsible for reproduction. Garbha (Embryo) is formed by the union of Sperm (Male gamete) and Stri Bija (Female gamete) (Ref Sloka 1). Ovum is produced in the Ovary and the sub-type of Vata, Apana Vata governs the production of matured ovum, its secretion by ovulation and movement through the fallopian tubes. Hence imbalance of Apana Vata can result in compromised quality or quantity of ovum.
Diet and lifestyle followed during menstrual period plays a major role in obtaining a healthy progeny. Adopting healthy diet & lifestyle regimen as mentioned in Ayurveda texts will help in purification of the uterus and fallopian tubes, also will help in production of healthy ovum. The woman in ovulation period is called Ritumati. She possesses healthy vagina, uterus and ovum and is capable of conceiving. The ovulation period is called Ritukala which lasts for about 12 to 16 days. According to Ayurveda Acharyas, fertilization of sperm and ovum takes place only during the Ritukala. The uterus will not accept the sperm during the post ovulatory period just like lotus closing its petals after sunset. During ovulatory period, when the male and female gametes unite, it forms embryo. Just like the paddy sown after the appropriate season possess less or inferior properties (fragile and having low nutritive values), if impregnation occurs after the ovulatory period, the health of the fetus and its development may be affected.
Healthy fetus is formed from healthy sperm and ovum, healthy diet and lifestyle of the mother and wisdom and support from family. It is just like plant growth from a seed. Seed germinates and sprouts, later transforms into sapling and grows into a plant or tree. For a healthy plant, we need seed which is devoid of any defects, proper soil conducive to the growth of the plant (White pine grows in clay soil whereas red pine grows in sandy soil), timely plantation of seed in suitable season or climate (onions and mint are planted in spring or fall whereas peppers are sown in later winter or spring), watering the seed regularly and use of manures for nurturing the growth of the plant. The four factors responsible for conception and for proper growth of healthy fetus are as follows (Ref Sloka 2).
For conception and healthy growth of fetus
For germination and growth of plant
Uterus and other reproductive organs
Nourishing substances such as diet of the pregnant lady;
Amniotic fluid, placenta
Water & Manure
Healthy sperm and ovum
Hence, Ayurveda prescribes specific nutritional measures for the growth and protection of the woman to keep her vital and pure.
Age as a Factor for Infertility
Now a days, people want to achieve their goals and become well settled in their career paths, hence plan for late marriages or postpone conception with the use of contraceptive measures. However, Ayurveda states that there is noticeable decline in the quality and quantity of ovum after the age of 35 in females, especially in our fast-paced lifestyle because of reduction in intake of healthy fats, increased intake of fast food / fried food / ready to eat food, eating hurriedly, staying awake late at nights for work or parties, Vata Dosha increases in our body which in turn decreases the quantity of eggs and its quality too. Ayurveda explains predominance of Kapha Dosha in the body as conducive to conception. Also, in young age, the bodily tissues are fully developed and the strength of the body is superior which leads to increased rate of conception.
Ayurveda says that very young and old woman should not be impregnated because even if conceived it will lead to intrauterine death of foetus or if the child is born, the life span of the child will be short and it will have low immunity. Female before 18 years and above 40 years should not attempt for achievement of conception. The period between 18 and 40 years is the fully mature period, physically and physiologically, hence ideal for conception.
Ayurveda classification of Infertility
Most Ayurveda texts have classified Vandhya or Infertile women into three types, they are as follows.
Vandhya: It is absolute sterility (Ref Sloka 3). This type is mostly difficult to treat because sterility occurs due to Bija Dosha or congenital chromosomal abnormalities.
Apraja: It is primary infertility or unsuccessful conception. This condition is treatable with Ayurveda herbs and therapies.
Sapraja: This is secondary infertility, that is infertility occurs after successful conception and giving birth to one or more children.
Acharya Harita in his treatise has explained six types of classification based on causative factor or clinical features which are as follows.
Garbha kosh bhanga – Injury to uterus, uterine prolapse or any other pathology of uterus leads to malnourishment of the reproductive tissues.
Kakavandhya – Secondary infertility, occurs after giving birth to one child.
Anapatya – Primary infertility or unsuccessful conception.
Garbhasravi – Repeated abortions leading to unsuccessful pregnancies.
Mrutvatsa - Infertility characterized by unsuccessful pregnancies due to intrauterine death, repeated still births.
Balakshaya – Loss of bodily strength (tissue weakness) (Ref Sloka 4)
Thus, not only non-achievement of pregnancy but failure of successful continuation of pregnancy leading to birth of live child is also termed as Vandhyata (Infertility).
Causative Factors of Infertility
The menstrual and ovarian cycle can be adversely affected by many factors such as diet, lifestyle, emotional instability, physical and mental over strain. Common causative factors are listed below.
Aharaja Nidana (Dietetic Factors)
Katu – Shita – Ruksha Ahara Sevana: Excess and prolonged intake of spicy food, cold food and drinks, dry food items increase Vata Dosha in the body. As Vata Dosha increases, it naturally dries up the Kapha Dosha which is responsible for conception or fertility. Also, excess use of processed food, refined sugar, etc. hampers the digestive fire and leads to imbalance in hormones. Thus malnutrition, vitamin deficiencies can be considered as dietetic factors.
Viharaja Nidana (Lifestyle Factors)
Ratri Jagarana: Staying awake late at night
Vega Dharana: Suppression of natural urges, especially of urine, flatus and faeces
Ahita Vyavaya: Incompatible intercourse or intercourse in inappropriate times or implantation in late hours. In long distance relationships, when the husband and wife stay in different cities intimacy during appropriate period is difficult.
Present day lifestyle, working in shifts, travelling long distances for work, frequent travels cause physical and mental stress which leads to increase of Vata Dosha in the body thereby affecting tissue nourishment.
Balakshaya (Loss of strength)
Rogajanya: In debilitating diseases such as tuberculosis, there is emaciation and loss of tissue strength leading to improper development of tissues.
Ati Vyayama: Excess exercise or long working hours leads to depletion of body strength and increase of Vata Dosha in the body leading to infertility issues.
Daiva Prakopa (Divine factors)
Ayurveda believes that fruitful actions from the past life and blessings from God play an important role in health including fertility.
Atma Dosha (Failed union of soul factor)
Union of male and female gametes in the uterus along with the entry of Atma or Soul is called Garbha or Embryo. Slowly it develops into foetus and the presence of soul becomes evident because of the actions of foetal heart. But sometimes in pregnancy, the foetal heart is not evident because of failed union of soul factor and it can lead to miscarriage or missed miscarriage where D&C will be planned.
Manasika Dosha (Psychological stress)
Stress in the family, target-based jobs, long working jobs, etc. lead to emotional disturbances or psychological stress which are also the causes of infertility.
Anya Nidana (Other factors)
Ovulation Disorders: As ovulation is essential factor for pregnancy, different conditions like Anovulatory Cycles, PCOS, Thyroid problems, Premature Ovarian Insufficiency, etc. These are common in present day fast paced lifestyle where we consume more processed food and follow a sedentary lifestyle. Also underlying genetic problems or autoimmune diseases or elevated prolactin, increase of stress and anxiety because of jobs or family are predisposing factors for the anovulatory infertility. Prolonged use of Non-steroidal Anti-inflammatory drugs, Antipsychotic medicines, Chemotherapy are also causative factors. In all these conditions, the ovaries producing insufficient oestrogen and progesterone, stop releasing ovums regularly and the menstrual cycle becomes irregular or delayed. These are common during menopausal period but if these occur below 45 years of age, then it is a disorder which has to be treated.
Tubal Factors: As ovum descends through the fallopian tube and fertilization takes place in the outer end of the fallopian tube, any anatomical or functional alterations of the tubes such as fallopian tube blockage or hydrosalpinx are associated with infertility.
Uterine Factors: Conditions such as fibroid uterus, uterine polyps, adenomyosis, endometriosis or any other abnormal uterine conditions can lead to obstruction of the uterus. Also, septate uterus which is a congenital abnormality may lead to recurrent miscarriages or inability to conceive.
Ayurvedic Treatment Approach
Treatment of the underlying causative factor such as fibroids or PCOS or any other pathology should be done first. After which herbs, therapies, diet and lifestyle for nourishment of the body, strengthening the immune system, balance of the three Doshas, nourishment of the tissues, especially reproductive tissue and stress relief is administered according to one’s constitution and health status. The following line of treatment is suggested.
Ama Pachana: Removal of endotoxins from the system
Agni Dipana: Restoring the Digestive and Metabolic fire
Dosha Shamana Chikitsa: Pacification therapies for balancing the Doshas
Vata Anulomana: Restoring downward movement of Vata Dosha
Shodhana Chikitsa: Detoxification Therapies
Aushadha Prayoga: Administration of Ayurveda herbs
Pathya Ahara Vihara: Adopting wholesome diet and lifestyle
Ama Pachana & Agni Dipana
Due to low digestive and metabolic fire, endotoxins are formed which clog the reproductive system thereby affecting the normal movement of Vata Dosha and affecting tissue health. Hence, they should be removed from the body for restoring tissue health, balancing digestive and metabolic fire and bringing normalcy of Vata Dosha. This can be achieved by intake of light to digest food such as Mung soup, Kitchari (Rice cooked with lentils and spices), intake of warm water, ginger infusion and avoidance of heavy to digest food, milk products and refined sugar. Regular exercise will also help in removing endotoxins. Herbal compounds such as Avipathikar churna, Trikatu churna, Chitrakadi vati are also beneficial in removal of endotoxins and regulating digestive and metabolic fire. Healthy Agni will improve immunity and tissue strength.
Dosha Shamana Chikitsa
As all the Doshas are inter-related, increase of one Dosha will lead to increase of other Doshas as well. Hence the primarily vitiated Dosha should be brought to normalcy first and other Dosha balance should also be achieved later by suitable herbs, therapies, diet and lifestyle.
As Vata is the main Dosha involved in gynecological problems and pathogenesis of infertility, measures to pacify Vata Dosha are very important in the management of infertility. The perineum and pelvic floor are the seat of Apana Vata, a subtype of Vata Dosha. Basti (Therapeutic enema) is the main treatment to balance Vata Dosha. Different types of Basti such as Anuvasana Basti (Oil enema), Niruha Basti (Cleansing enema) and Uttarabasti (Intra-urethral administration of enema) are beneficial in pacification of Vata Dosha. Also herbs such as Haritaki (Terminalia chebula), Sunthi (Zingiber officinale), Ashwagandha (Withania somnifera) help in balancing Vata Dosha. Spices such as asafetida, cumin, ginger, garlic, turmeric help in balancing Vata Dosha. Timely meals, regular exercise and timely sleep will help in balancing Vata Dosha.
Detoxification procedures help to remove toxins from the body, clear any obstruction in the channels of circulation, improve circulation to the reproductive organs, helps restore balance of ovarian, tubular and uterine functioning which is essential for conception. Snehana (Oleation) and Swedana (Sudation) are done prior to main Panchakarma procedures which are Vamana (Therapeutic emesis), Virechana (Therapeutic purgation), Basti (Ayurvedic enema) and Nasya (Nasal cleansing).
The physician after careful examination and detailed consultation, decides Vamana or Virechana based on the condition of the patient. Vamana is beneficial in Kapha dominant conditions whereas Virechana is beneficial in Pitta dominant conditions. Ayurveda massage using herbal oils such as Dashmool oil, Kshirabala oil, etc and herbal steam bath are followed by oral administration of Ayurvedic ghee such as Phala ghrita, Shatavari ghrita, etc based on one’s constitution and health status. These procedures are done for 3, 5 or 7 days based on health needs. After that, in case of therapeutic emesis, suitable herbs such as Yashtimadhu decoction, mixture of Madanaphala and other herbs are given. Where if therapeutic purgation is planned, then Eranda oil, Avipathikar churna or Trivrit Lehya are given. After Vamana or Virechana, suitable Post-Panchakarma diet such as Mung soups or supernatant liquid of cooked rice is administered for 3, 5 or 7 days based on the outcome of Panchakarma.
Basti regulates the normal functioning of Vata Dosha, strengthens the reproductive tissue, improves the quality of ovum, facilitates timely release of ovum and improves the chances of conception. Yoga Basti for 8 days or Kala Basti for 15 days is beneficial. Here the procedure begins with Anuvasana Basti (Oil enema) alternating with Niruha Basti (Cleansing enema) and ends with Anuvasana Basti. Basti is administered following massage and steam. Anuvasana Basti is administered with lukewarm Kshirabala oil, Narayana oil, Shatapushpa oil, Trivrit ghrita or Lasunadi oil. Niruha Basti is administered with lukewarm concoction of Dashmool decoction or Musta decoction, honey, rock salt, Bala oil, paste of Shatapushpa, Musta, etc. Uttara Basti is intra urethral administration of small quantity of Apamarga Kshara oil or Phala Ghrita or Shatavari Ghrita following local massage and steam on the hips, lower back and abdomen under aseptic precautions. Uttara Basti is done for a period of 3 days consecutive days after menstrual cycle and is done for 3 to 6 consecutive cycles. This procedure helps to maintain alkaline pH of vagina, helps in rupturing of follicles, improves the quality of ovum, nourishes the endometrium and helps in implantation of fertilized ovum.
Nasya is a procedure where lukewarm Ayurveda oil is used for massaging the scalp and face. Then steam inhalation is done and 3 to 6 drops of herbal juice or oil is administered into each nostril and inhaled gently. Gargling with warm saline water is done 2 to 3 times to clear the throat. And herbal smoke inhalation is administered for 9 times in each nostril, where smoke is inhaled through the nose and exhaled through the mouth each time. Nasya therapy stimulates the hypothalamus thereby regularizing Gonadotropin Releasing Hormone secretion and leading to ovulation.
Abhyanga (Ayurveda Massage) and Shirodhara (Pouring of lukewarm medicated oil on the forehead) calms the nerves and relaxes the mind. Stress is a major cause of infertility especially in females because of tremendous family pressure. This in turn causes hormonal imbalance because of disturbance of Vata Dosha. Thus Abhyanga and Shirodhara activates the pituitary gland and helps maintain hormonal balance.
Ayurveda herbs useful in female infertility are explained below.
Vati or Pill: Chandraprabha vati, Kanchanara guggulu, Triphala guggulu
Churna or Compound powder: Avipathikar churna, Pushyanuga churna, Triphala, Dashmool
Dravya or Single herbs: Guduchi (Tinospora cordifolia), Punarnava (Boerhavia diffusa), Ashoka (Saraca asoca), Gokshura (Tribulus terrestris), Shatavari (Asparagus racemosus), Jivanti (Leptadenia reticulata), Kumari (Aloe vera), Draksha (Vitis vinifera), Bala (Sida cordifolia), Atibala (Abutilon indicum), Vata (Ficus bengalensis), Madhuka (Madhuca longifolia), Guggulu (Comiphora mukul), Shatapushpa (Anethum graveolens), Ashwagandha (Withania somnifera), Manjishta (Rubia cordifolia), Ushira (Vetiveria zizanioides), Shankhapushpi (Convolvulus pluricaulis), Amalaki (Emblica officinalis)
Kashayam or Concentrated Decoction: Sukumaram Kashayam, Varanadi Kashayam
Asava / Arishta or Fermented Liquid Preparations: Ashokarishta, Dashmoolarishta, Kumaryasava
Medicated Ghee: Shatavari ghrita, Phala sarpi
Lehya or Linctus: Shatavari gulam
As explained earlier, the four factors for conception are Ritu, Kshetra, Ambu and Bija. Their health is important to conceive. Below are the suggestions for healthy maintenance of the four factors.
Ritu: Season or Time
Sexual intercourse is recommended between 10th and 20th day of the menstrual cycle.
Also, early part of night is the best time for coitus.
Winter and Spring seasons are the best weather for conception as Kapha Dosha is predominant during these two seasons.
If there is previous history of miscarriage, then conception should be planned atleast 3 months after miscarriage. Also undergoing Panchakarma is beneficial before planning for conception.
Kshetra or Female reproductive tract
In Endometriosis or Adenomyosis conditions, Vata Anulomana treatment is beneficial. Chirawilwadi Kashaya, Balaguluchyadi Kashaya are suggested.
In hydrosalpinx, Avipathikar churna is beneficial.
In atrophy conditions, premature ovarian failure, Ayurvedic phytoestrogens such as Shatavari (Asparagus racemosus), Shatapushpa (Anethum graveolens), Rasona (Allium sativum) and Phala ghrita are beneficial.
In vaginal morbidity conditions, Virechana is suggested followed by vaginal douche or tampons with Triphala decoction and internal administration of Chandraprabha vati and Triphala guggulu is suggested.
In obesity, Tiktaka Kashaya, Kalyanaka Kashaya, Varanadi Kashaya are suggested.
Ambu or Liquid factor related to female reproductive system
Vaginal pH variation or vaginitis will affect sperm motility. Sitz bath with Triphala decoction is beneficial. Maharasnadi Kashaya is given orally and later vaginal tampons using Bala taila or Jatyadi taila are beneficial. Repeated urinary tract infections may cause salpingitis because of constriction of vulva and vagina. Gokshuradi guggulu, Chandraprabha vati, Vilwadi tablet, Nirgundyadi Kashaya, Saribadyasava are beneficial.
In Pelvic inflammatory disease and vaginal discharges, Pushyanuga churna and Triphala guggulu are beneficial. Also, vaginal wash with purified borax powder or fenugreek infusion is suggested.
To control breast discharges or high serum prolactin levels, Siddhartaka Taila is suggested.
In Bija Dosha or defects in ovum, Panchakarma (Detoxification) mainly Basti or Virechana, and Rasayana (Rejuvenation) are beneficial. The diminution in quality and quantity of ovum can be treated by Ayurveda below the age of 45 years.
Pathya Ahara Vihara
Along with taking Ayurveda herbs and therapies, wholesome diet and lifestyle should be followed by the woman for treatment of infertility. Diet and lifestyle enhance the effect of herbs and therapies.
Diet to Favor
Diet to Avoid
Natural sweet taste
Fresh fruits and vegetables especially root vegetables
Grapes, Pomegranate, Asparagus
Sesame seeds, Pumpkin seeds
Spices – Turmeric as it improves interaction between hormones and targeted tissues, Cumin as it is a uterine cleanser
Small and regular meals, preferably freshly prepared.
Spicy, Salty, Sour tastes
Raw vegetables in excess
Coffee, tea, carbonated drinks
Food high in fat like red meat
Refined carbohydrates such as white bread, pasta
Food containing preservatives and artificial sweeteners
Lifestyle to Favor
Lifestyle to Avoid
Moderate amount of exercise or walk
Yogasana especially Sarvangasana (Shoulder stand), Padahastasana (Hand to foot pose), Paschimottanasana (Sitting forward bend), Halasana (Plough pose)
Suppression of Natural Urges
Staying awake late at night
Thus, Ayurveda helps to treat the cause of infertility and increases the chance of conception.
Ref Sloka 1 (C.S.Sh.St. 4/5)
Ref Sloka 2
Ref Sloka 3 (B.P.Ch.St. 70/6)
Ref Sloka 4 (C.S.Sh.St 2/7)
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Ayurveda stads for extensive and elaborate clinical examination to understand thenature of the disease