Clinical Evaluation of Virechana Followed by Uttarabasti in the Management of Anovulatory Infertility: Impact on Ovulation and Fertility Outcomes - A Case Series

Abstract

Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.[1] WHO estimates that infertility affects approximately 1 in 6 people globally during their lifetime. In women, ovulatory dysfunction constitutes a principal cause of infertility, accounting for approximately 25–40% of cases. Common etiologies[2] include Polyendocrine metabolic ovarian syndrome, Hyperprolactinemia, Primary Ovarian Insufficiency, hypothalamic anovulation, luteinized unruptured follicle syndrome, and luteal phase deficiency. Additionally, altered serum anti-Mullerian hormone (AMH) levels serve as an important indicator of ovarian reserve and are widely used in the assessment of female reproductive function and infertility. Polyendocrine metabolic ovarian syndrome (PMOS) is the most prevalent endocrine–metabolic disorder among women of reproductive age and represents a major cause of anovulatory infertility, with a particularly high burden in India. According to Acharya Kashyapa, Pushpaghni is a condition characterized by regular menstruation despite infertility and is often associated with clinical features such as hirsutism and obesity. Case Report: Two cases of infertility associated with anovulation were managed by Virechana and Uttarabasti. The first case involved a 23-year-old female with a four-year history of primary infertility, while the second case was a 25-year-old female presenting with irregular menstrual cycles and secondary infertility. In both cases, transvaginal sonography (TVS) confirmed anovulation, with the radiological impression of bilateral immature follicles. Based on the clinical presentation, both patients exhibited the above-mentioned Lakshanas, indicating Vata-Pradhana Tridosha Vikriti with the involvement of Rasa, Rakta, and Artava Dhatus. They were treated with Virechana followed by Uttarabasti. Following the intervention, both the patients demonstrated significant clinical improvement in terms of regularization of cycle, duration of cycle and achieved conception. Urine pregnancy test was positive in both cases by march 2026.