Introduction

Infertility is inability to achieve pregnancy after a reasonable time of sexual intercourse without taking contraceptive measures. There are many reasons why a couple may not be able to conceive, or may not be able to conceive without medical assistance. Infertility affects millions of people of reproductive age worldwide – and has an impact on their families and communities. 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. In Ayurveda various types of infertility are mentioned such as Vandhya (sterility), Apraja (curable and women can achieve pregnancy) and Sapraja (female becomes infertile after conceiving for one or more times). Six type of Vandhyatva are depicted in Table. 1. Female infertility can occur due to some defects in movement of egg from ovary to uterus; less production of eggs; defective embryo formation and survival of embryo when it is attached to the lining of uterus.

Management of Infertility : Ayurveda considers two types of Chikitsa i.e. Shamana (medicinal treatment) and Shodhana Chikitsa (purification). Ayurvedic classics have given a lot of importance to Sthanic Chikitsa. The gynecology Sthanic Chikitsa deals mainly with Tryavarta Yoni (layers of vagina). Yoniroga and Artava Vikara are caused due to vitiation of Vata dosha. Pitta and Kapha’s functions are dependent of Vata dosha. Panchkarma helps in curing many disorders of the body.

Dietary Management : In sedentary life diet plays a vital role in the prevention and cure of diseases and in maintenance of good health. "Annam Brahmam" - Food has been compared to God, in the ancient Indian scriptures since it is the main factor for sustaining and nourishing life. Dietary management involves strict compliance and adherence to foods that increase Ojus (an intersection factor of physical, mental and spiritual health of the body, responsible for overall health, energy and liveliness) and to avoid the substances which diminish the Ojas. This is important to regulate ovulation and enhances fertilization. Eating whole foods provides all nutrients for the health of the body in addition to the fibres that influences hormonal levels of the body. Foods such as processed carbohydrates, excess starch, antibiotic and hormone laden meat and milk and canned produce destroy fertility.

Ojas building food include as milk, ghee, nuts, sesame seeds, dates, pumpkin seeds, honey, saffron and avocados, fresh organic fruits and vegetables, protein from plant sources like beans, and peas, sweet, whole grains, spices such as ajwain powder, turmeric (improves the interaction between hormones and targeted tissues), cumin (purifies the uterus in women and the genitourinary tract in men) and black cumin boost fertility. Diet should be free from Trans-fats as they block arteries, threaten fertility and harm the heart and blood vessels and therefore, must be avoided. Foods containing preservatives and other chemicals, like artificial sweeteners, Monosodium Glutamate (MSG), diet high in fat and other artificial flavouring and colouring, excess alcohol and caffeine, tobacco, soda, smoking, red meat, refined carbohydrates, such as pasta, white bread, rice etc can exacerbate the problem of infertility.

Treatment principles of Infertility in Ayurveda

1. Agni deepana and Ama pachana
   Ama formation (toxins created when undigested food forms in the stomach) by the imbalance in Agni (the power of digestion) lead to many diseases. Therefore, the treatment of Ama must always include the treatment of Agni, including the use of digestive and carminative Ayurvedic formulations, eating meals at proper time following an appropriate schedule. Panchakarma treatments help to eliminate Ama thus corrects Agni. Healthy Agni will also contribute to healthy Ojas.
2. Vatanulomana
   The main dosha involved in infertility is Vata. So Vatanulomana (correcting the functions of Vata) is very important in the treatment of infertility. Ayurvedic formulations, following routine exercises and strict diet schedule will help in Vatanulomana.
3. Sodhana
   Suitable sneha-swedas are done prior to shodhana. Then treatment modalities like Vamana (emesis), Virechana (puragation), Vasti (medicated enema) and Utharavasti special enema administered through urethral or vaginal routes) are done as per the condition of the patient. The patient has to follow peyadi krama (strict dietary regimen to be followed after Sodhana). This detoxification therapy helps in the expulsion of the toxins from the body. These therapies help to correct ovarian, tubular and uterine problems causing infertility.
4. Shaman chikitsa : Shaman Chikitsa also plays an important role in management of infertility.

1) Taila – Narayana Taila, Shatpushpa Taila,Lashuna Taila.

 2) Basti – Shatpaka Taila Basti, Traivrutta Snehabasti, Bala Taila Basti,

3) Taila Pana - Narayana Taila, Shatavari Taila, Bala Taila, Shatpushpa Taila.

 4) Ghrita – Laghupahala Ghrita, Phala Ghrita,Shitkalyana Ghrita, Brihat Shatavari.

5) Arishta – Dashmularishta.

6) Rasa - Khandakadya Lauha.

7) Paka – Pugapaka.

 8) Churna - Shweta punarnava churna

Some herbs used in the treatment for infertility:

• Ovulation disorder - Ashoka, Dashmoola, Shatavari, Aloe vera, Guggulu etc.
• Premature ovarian failure (POF) - Ashoka, Dashmoola, Shatavari, Guduchi, Jeevanti etc.
• Blocked fallopian tubes, adhesions (scar tissue) and pelvic inflammatory disease - Guduchi, Punarnava etc.

1. Ayurveda chikitsa help in releasing tension and removing impurities from the body. They nourish the body, revitalize the mind and strengthen the immune system. They are beneficial in reducing stress, nourishing all dhatus of the body and pacifying Vata.

The right combination of herbs helps in regulating menstrual cycles, enhancing general health and wellness, revitalizing sperm (enhancing a man's sperm count, morphology and motility), reducing stress, enhancing sleep, controlling anxiety and increasing energy level, balancing the endocrine system and improving blood flow in pelvic cavity, thereby promoting fertility.

Material and Methods : Various Ayurvedic texts related with Infertility& Compendia, Various journals, e-material, published studies, articles.

Management of Infertility : Ayurveda considers two types of Chikitsa i.e. Shamana (medicinal treatment) and Shodhana Chikitsa (purification). Ayurvedic classics have given a lot of importance to Sthanic Chikitsa. The gynecology Sthanic Chikitsa deals mainly with Tryavarta Yoni (layers of vagina). Yoniroga and Artava Vikara are caused due to vitiation of Vata dosha. Pitta and Kapha’s functions are dependent of Vata dosha. Panchkarma helps in curing many disorders of the body.

Dietary Management : In sedentary life diet plays a vital role in the prevention and cure of diseases and in maintenance of good health. "Annam Brahmam" - Food has been compared to God, in the ancient Indian scriptures since it is the main factor for sustaining and nourishing life. Dietary management involves strict compliance and adherence to foods that increase Ojus (an intersection factor of physical, mental and spiritual health of the body, responsible for overall health, energy and liveliness) and to avoid the substances which diminish the Ojas. This is important to regulate ovulation and enhances fertilization. Eating whole foods provides all nutrients for the health of the body in addition to the fibres that influences hormonal levels of the body. Foods such as processed carbohydrates, excess starch, antibiotic and hormone laden meat and milk and canned produce destroy fertility.

Ojas building food include as milk, ghee, nuts, sesame seeds, dates, pumpkin seeds, honey, saffron and avocados, fresh organic fruits and vegetables, protein from plant sources like beans, and peas, sweet, whole grains, spices such as ajwain powder, turmeric (improves the interaction between hormones and targeted tissues), cumin (purifies the uterus in women and the genitourinary tract in men) and black cumin boost fertility. Diet should be free from Trans-fats as they block arteries, threaten fertility and harm the heart and blood vessels and therefore, must be avoided. Foods containing preservatives and other chemicals, like artificial sweeteners, Monosodium Glutamate (MSG), diet high in fat and other artificial flavouring and colouring, excess alcohol and caffeine, tobacco, soda, smoking, red meat, refined carbohydrates, such as pasta, white bread, rice etc can exacerbate the problem of infertility.

Treatment principles of Infertility in Ayurveda

1. Agni deepana and Ama pachana
   Ama formation (toxins created when undigested food forms in the stomach) by the imbalance in Agni (the power of digestion) lead to many diseases. Therefore, the treatment of Ama must always include the treatment of Agni, including the use of digestive and carminative Ayurvedic formulations, eating meals at proper time following an appropriate schedule. Panchakarma treatments help to eliminate Ama thus corrects Agni. Healthy Agni will also contribute to healthy Ojas.
2. Vatanulomana
   The main dosha involved in infertility is Vata. So Vatanulomana (correcting the functions of Vata) is very important in the treatment of infertility. Ayurvedic formulations, following routine exercises and strict diet schedule will help in Vatanulomana.
3. Sodhana
   Suitable sneha-swedas are done prior to shodhana. Then treatment modalities like Vamana (emesis), Virechana (puragation), Vasti (medicated enema) and Utharavasti special enema administered through urethral or vaginal routes) are done as per the condition of the patient. The patient has to follow peyadi krama (strict dietary regimen to be followed after Sodhana). This detoxification therapy helps in the expulsion of the toxins from the body. These therapies help to correct ovarian, tubular and uterine problems causing infertility.
4. Shaman chikitsa : Shaman Chikitsa also plays an important role in management of infertility.

1) Taila – Narayana Taila, Shatpushpa Taila,Lashuna Taila.

 2) Basti – Shatpaka Taila Basti, Traivrutta Snehabasti, Bala Taila Basti,

3) Taila Pana - Narayana Taila, Shatavari Taila, Bala Taila, Shatpushpa Taila.

 4) Ghrita – Laghupahala Ghrita, Phala Ghrita,Shitkalyana Ghrita, Brihat Shatavari.

5) Arishta – Dashmularishta.

6) Rasa - Khandakadya Lauha.

7) Paka – Pugapaka.

 8) Churna - Shweta punarnava churna

Some herbs used in the treatment for infertility:

• Ovulation disorder - Ashoka, Dashmoola, Shatavari, Aloe vera, Guggulu etc.
• Premature ovarian failure (POF) - Ashoka, Dashmoola, Shatavari, Guduchi, Jeevanti etc.
• Blocked fallopian tubes, adhesions (scar tissue) and pelvic inflammatory disease - Guduchi, Punarnava etc.

1. Ayurveda chikitsa help in releasing tension and removing impurities from the body. They nourish the body, revitalize the mind and strengthen the immune system. They are beneficial in reducing stress, nourishing all dhatus of the body and pacifying Vata.

The right combination of herbs helps in regulating menstrual cycles, enhancing general health and wellness, revitalizing sperm (enhancing a man's sperm count, morphology and motility), reducing stress, enhancing sleep, controlling anxiety and increasing energy level, balancing the endocrine system and improving blood flow in pelvic cavity, thereby promoting fertility.

Discussion

Agni Deepana and Ama Pachana.  healthy Ojas by detoxification.Panchakarma eliminate Ama thus corrects the Agni and healthy Agni .The treatment helps in Vatanulomana. The right combination of treatment helps in re gulating menstrual cycle,revitalizing sperm, reduces mental stress, enhances general health.These therapies help in releasing tension and removing impurities from the body. They nourish the body, revitilize the mind and strengthen the immune system.Shodhan chikitsa eliminating impurities, reducing symptoms, increasing resistance to disease, reducing worry, and increasing harmony in life.

Conclusion

Infertility has increased tremendously in the past decade and this is due to the result of a combination of social, environmental, psychological, and nutritional factors. Ayurveda pays attention to each individual body types, enhances the body systems participating in the process of fertilization and therefore serves as an excellent alternative for reaching fertilization. In Ayurveda, treatment is done on the basis of constitutional predominance of an individual. In light of infertility we look very closely to the reproductive system. Ayurveda emphasizes on both systemic and localized treatment. To treat Vata Dosha, Basti is always preferred. In modern world, due to the mismanagement in lifestyle, infertility problems are increasing. Ayurveda suggested Uttarbasti as line of treatment for Garbhashyagat Rogas since this approach facilitates absorption of drugs and helps to achieve target delivery of drugs to the affected organs. When Sukoshna (lukewarm) Sneha or Kwatha enters into the uterine cavity or urethra, Srotas can easily carry drugs towards the desired sites such as fallopian tubes and cervix etc. Thus this Chikitsa is considered as useful approach to treat disorders of genital/reproductive system.

Acknowledgement :- I would like to thank BMAM for motivating and providing the necessary help for writing this article.