Keywords
Cornual block, Salpingitis, salpingostomy, ICSI, Bilateral Ostia
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Gajabe G, More A, Dutta S and Chaudhari N. Case Report: The effect of Kumari Taila Uttar Basti treatment on a patient diagnosed with bilateral cornual blockage in the Fallopian tube [version 1; peer review: awaiting peer review]. F1000Research 2023, 12:873 (https://doi.org/10.12688/f1000research.138851.1)
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Case Report
Case Report: The effect of Kumari Taila Uttar Basti treatment on a patient diagnosed with bilateral cornual blockage in the Fallopian tube
[version 1; peer review: awaiting peer review]
PUBLISHED 24 Jul 2023
OPEN PEER REVIEW
REVIEWER STATUS
This article is included in the Datta Meghe Institute of Higher Education and Research collection.
Abstract
Corresponding author:
Akash More
Competing interests:
No competing interests were disclosed.
Grant information:
The author(s) declared that no grants were involved in supporting this work.
Copyright:
© 2023 Gajabe G et al.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Gajabe G, More A, Dutta S and Chaudhari N. Case Report: The effect of Kumari Taila Uttar Basti treatment on a patient diagnosed with bilateral cornual blockage in the Fallopian tube [version 1; peer review: awaiting peer review]. F1000Research 2023, 12:873 (https://doi.org/10.12688/f1000research.138851.1)
First published: 24 Jul 2023, 12:873 (https://doi.org/10.12688/f1000research.138851.1)
Latest published: 24 Jul 2023, 12:873 (https://doi.org/10.12688/f1000research.138851.1)
Introduction
Various bacteria, viruses, and fungi cause infections in the fallopian tubes, which may be acute or a chronic disease of the Fallopian tube, also called salpingitis. A couple is deemed “infertile” when they cannot become pregnant following unprotected intercourse for a year or more.1 Infertility is a failure for many couples, and it causes them to have serious physical, social, mental, and sexual issues.2 Primary care is defined by the World Health Organization (WHO). The terms “infertility” and “secondary infertility” respectively refer to conditions when a woman has never been able to conceive3 There are numerous potential reasons that either a male or female spouse, or both partners, may be infertile. Infertility in women can result from one or more causes, including hormonal imbalance, thyroid dysfunction, polycystic ovary syndrome, endometriosis, fallopian tube blockage, genital tract infection, and congenital disorder.4
The association of fallopian tubes in the uterus is called cornua (uterine horns). The cornua may get blocked due to infection, leading to a cornual block. It can be a primary or secondary infertility cause. It can be due to the small inflammation of the fallopian tubes known as salpingitis, commonly caused by bacteria or microorganisms sexually transmitted to the female partner from the male partner.5 Bilateral cornual block results in the inflammation of the fallopian tubes appearing in approximately 1/1000 women. It is caused mostly in the age of 13 to 17 or in adult women.6 It is least seen in sexually inactive females and generally occur with genitourinary infections like UTIs. Cornual block of the fallopian tubes causes a cornual contraction or spasm. It approximately covers 75% of the fallopian tubes. Because of cornual block, the fallopian tubes get blocked, and it restricts the entry of sperm into the fallopian tube so that the ovum cannot be fertilized, which causes infertility in women. Approximately 70% of women with infertility suffer from tubal problems.7
The hysterosalpingography technique is used for the detection of abnormalities in uterine and fallopian tubes. Using this technique, one can easily find the tubal abnormalities that can cause infertility in women.8
Case presentation
Patient-specific information
A 40-year-old female had suffered from infertility problems for around two years since her marital relation. She had started her treatment in Janurary 2020. Her menstrual cycle was normal for 28 days. The male partner had normal sperm parameters. The male partner worked as a businessman and neither of the couple reportedly had a history of drugs, tobacco, alcohol, or cigarette use.
Couple’s medical history
The patient, after hysterosalpingography, went through hysteroscopy and laparoscopy, and was finally diagnosed with bilateral cornual block abnormalities showing inflammation in the fallopian tubes. Bilateral ostia in scanty endometrium were observed, and estrogen deficiency was present in the laparoscopy. The semen analysis of the male partner was normal.
They had no family history of any conditions like blood pressure, thyroid disorder, or diabetes. However the patient had polio in her right limb at seven years old. She got married at the age of 36 years old. They were married for three years, and her infertility duration was two years. In 2022 she visited the Wardha test tube baby centre. A IUI (intrauterine insemination) had been performed on the patient. The Wardha Test Tube Baby Centre collected the sample from the male partner and processed the sample, then injected the processed sample via IUI. However, because of the cornual block in the fallopian tubes, it could not fertilize the ovum, and the IUI failed.
Clinical findings
The decreased value of anti mullerian hormone (AMH) was also considered as a reason the female partner could not be conceived. The value of AMH is described as average: 1.0 ng/mL - 3.0 ng/mL; low: below 1.0 ng/mL; deficient: 0.4 ng/mL.9 Her AHM value was 0.16 ng/mL, i.e., her antral follicle count (AFC) was poor. An imbalance in thyroid levels could also cause infertility in female patients. Her thyroid hormone levels (TSH) were average, i.e., in the following ranges: triiodothyronine (T3) 1.2-2.8 nmol/L, thyroxine (T4) 77 nmol/L to 155 nmol/L, and thyroid stimulating hormone (TSH) 0.3-4 mU/l.10
The patient was diagnosed with bilateral cornual block as the reason for her infertility. Her AMH value was poor, which is known to affect follicles quality. The patient provided consent for the treatment. The thickness of follicles increased with time (days), which helped adequately implant an embryo. The patient was started with Uttar Basti treatment. Uttar Basti exhibited a dark red colour, a fragrant odour, a dark look, and a thick consistency based on organoleptic characteristics. The results were 0.25%, 1.454%, 0.522%, 9.986 weight per weight, 192.95 weight per weight, and 92.50 weight per weight, respectively, for the physicochemical parameters of loss on drying, refractive index, specific gravity, acid value, saponification value, and iodine value.11 On her first menstrual cycle, her medication was started for six days with a three-day gap. After the treatment, we performed a hysterosalpingogram and laparoscopy, and we observed that around 80% of the cornual block was cured. We planned ovum collection along with ICSI (intrcytoplasmic sperm injection) for the next cycle. Follicles were observed from day 1 to day 9. On day 10, ovulation was triggered with hormonal injection (HCG-Human chronionic gonadotrophin), and the patient was ready for the ovum collection after two days, i.e. day 12. For the ovum pickup method, an ovum needle was inserted via the vagina and then inserted into the ovary. Upon visualization of follicular sac, oocytes were retrieved. On day 5, embryos were formed and frozen. The patient was counselled for frozen embryo transfer. Embryos were thawed with the help of a worldwide accepted thawing kit. After 1-2 hours, her first frozen embryos were transferred. Two day 5 embryos (blastocysts) were transferred. Her serum βhCG was tested after 14 days of embryo transfer.
Important follow-up and outcomes
A regular follow-up was conducted after 14 days of embryo transfer. It should be checked whether the medication that was given to the patient was appropriately taken or not. After 14 days from embryo transfer, a blood sample was collected from the patient for a βhCG test. The patient’s report showed a positive result. One of the day 5 embryos had implanted.
Discussion
For couples trying to conceive, assisted reproductive technology (ART) is becoming more developed. Infertility management for couples has seen a substantial increase in the use of technology. Secondary infertility accounts for about 30% of infertility and can manifest in various ways, including ectopic pregnancies, abortion, and miscarriages.12 Secondary infertility and gynaecological surgery history are connected.13 The primary cause of infertility include tubal infections, male sperm parameter parameters (oligozoospermia, asthenozoospermia, teratozoospermia) abnormalities, and ovarian dysfunction. Approximately 70% of females experiences tubal infertility.14 A patient with a tubal infection can be evaluated with the help of hysteroscopy and laparoscopy.15 In male patients, abnormalities in sperm parameters can be treated with gonadotropins, intrauterine insemination, among others. In this case report, the patient took infertility treatment (Uttar Basti) for two years. The patient’s first IUI failed. There could be various reason for the failure of IUI although the patient’s partner had normal sperm parameters.
Hysterosalpingography (HSG) is the X-ray examination that evaluates the structure of the uterus and fallopian tubes. In the case of continued miscarriages, doctors advised HSG to assess whether or not the fallopian tubes were open.16 In HSG, a contrast material fluid is injected into the uterus. After performing a pharmacognostic analysis of the raw materials, the medication was created using the procedure. We treated the patient with a suitable ayurvedic treatment named Uttar Basti medicine. The patient was comfortable taking ayurvedic treatment, and the treatment was successful; the patient was also happy when around 80% of the cornual block was cured. Along with being beneficial to the patient, it is also cost-effective and non-invasive as compared to conventional treatments available. After the treatment, she achieved pregnancy by intracytoplasmic sperm injection (ICSI).
Conclusions
This case report presented the effect of ayurvedic treatment for bilateral cornual block in the fallopian tube after the failure of a one-time IUI; the treatment and ICSI were successful. The patient with bilateral cornual block or inflammation in the fallopian tube got positive clinical pregnancy reports with the help of ICSI.
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how to cite this article
Gajabe G, More A, Dutta S and Chaudhari N. Case Report: The effect of Kumari Taila Uttar Basti treatment on a patient diagnosed with bilateral cornual blockage in the Fallopian tube [version 1; peer review: awaiting peer review]. F1000Research 2023, 12:873 (https://doi.org/10.12688/f1000research.138851.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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