AbijithSen
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A Case Of Pcos With Infertility Treated Effectively With Homeopathic Constitutional Treatment( Hct)

Polycystic Ovarian Syndrome (PCOS) is one of common female gynecological disorders
which is also linked with endocrinological diseases. About 6-9 % of women of
reproductive age (Lunisten et al 2014) suffers from PCOS. Demographical distribution –
it is common among people of South Asian origin. The clinical manifestations of PCOS
are variable both in type of presenting symptoms as well as their intensity. Presence of 2
out of the following 3 signifies to be PCOS: 1) presence of multiple cysts in ovary 2)
Symptomatic features like Hirsutism, acne, oligomenorrhea to amenorrhea owing to
absence of ovulation and infertility are most common presenting features. And 3) Raised
androgen (Testosterone) (Aziz R et al 2006). PCOS is thought to be a metabolic disorders
owing to hormonal imbalance associated with raised Insulin but with Insulin resistance.
Obesity, Hyperlipidemia, fatty liver and Insulin resistance diabetes (Type IINIDDM)
especially gestational diabetes are common complication in association to
gynecological problems. More recently, increased incidences of fatty liver have been
reported in patients with PCOS (Kelley 2014). Non Alcoholic Fatty Liver
Disease (NAFLD) is a common association with PCOS; about 15%- 55% women
(depending on diagnostic criteria) suffering from PCOS have NAFLD. NAFLD occurs
in cases of PCOS owing to increased accumulation of Triglyceride in liver cells which in
turn causes inflammation and damage of liver cells.

In cases of PCOS, the increased risk of insulin resistance, type II diabetes and visceral
obesity increases patients’ risk for cardiovascular diseases especially intolerance,
inflammation and procoagulation (Manerras et al,2011). These all in association with
anovulation contribute to poor pregnancy rates for women in reproductive age.
Moreover, pregnant women with PCOS would develop gestational diabetes, increased
risk for pre-eclampsia and preterm parturition (DeFreme et al 2014).
Due to poor fertility rate and adverse outcomes of pregnancy in women with PCOS, it is
desirable to optimally manage these complex endocrinological and reproductive disorders
in order to have uncomplicated pregnancy. There are different approaches to treat
infertility found in women with PCOS. Lifestyle managements, weight reduction, etc.
Some nonspecific pharmaceutical drugs; invasive methods such as laparoscopic ovarian
drilling and assisted reproductive techniques etc. (Tziomalos, 2013). These methods have
little or no effect. Invasive methods and in vitro fertilization are too expensive as well.
Furthermore, cases of PCOS with NAFLD may not be suitable for pharmaceutical
medications due to impaired liver function. In this report I am presenting a complex
case of PCOS with Non Alcoholic Fatty Liver and infertility treated successfully with
Homeopathic constitutional therapy, subsequently she had uncomplicated pregnancy and
delivered healthy male full term child.

Case in Detail:

The 24 year-old girl visited my clinic for treatment of infertility. She was married for
more than 5 years but was not able to conceive. In earlier days of her marriage she
used to use oral contraceptive pills and after 2 yrs of their marriage, they (she & her
husband) planned for child with no result. They consulted a gynecologist who first
diagnosed her as a case of PCOS. Relevant investigations were Ultra Sonographical
diagnosis and abnormal hormonal assay. Reports pertaining to her diagnosis were as
following:

1) Anti Mullerian Hormone: 9.79 ng/ml. (mild raised as per age specific value)
2) Prolactin: 18.3 ng/ml ( within normal limit)
3) TSH: 3.25 mU/L ( within Normal Limit); free T4 – 0.91 nG/dl ( within Normal Limit)
4) USG: Ovaries: Multiple peripheral tiny cysts in both ovaries with features suggesting
chronic anovulation and associated with diffusely increased echotexture of liver
suggestive of fatty liver.
5) FSH: 6.66 mIU/ml (mid luteal) moderately raised.
6) Semen Analysis of her husband shows 90million/ml sperm count with 65% motility
after 1 hr. ( within Normal Limit)

[ Copies of reports are provided at the end. Patient’s identification were removed owing
to confidentiality issue.

Discussion of report: AMH is liberated from sertoli cells of fetal male and granulosa of
primary follicle of adult females; High AMH is indicative of PCOS, as well as AMH also
indicates of high follicular reserve (Pub Med, 2016)
Prolactin hormone analysis has no direct relation in diagnosing PCOS but it is usually
done to rule out any other possible cause of menstrual disturbance or association of any
other abnormality.

High FSH in a woman of reproductive age is indicative of PCOS but it’s alone increment
has less diagnostics value. Raised FSH and increased LH level with ratio of 1:3 is very
indicative of PCOS. (Pub Med, 2016)
The USG report showed multiple cyst in ovaries, which could be indicative of PCOS but
not diagnostics, but presence of multiple cysts in ovaries along with fatty liver definitely
indicates towards PCOS with complication.
TSH: Thyroid hormonal assay is not directly related to PCOS but it was probably done to
rule out hypothyroid as a cause for disturbance in menstruation and infertility.]
The patient came with her husband on 17 .08. 2015. She appeared to be fatty, flabby
and fair complexioned girl. She was visibly tensed and worried. On presenting
symptoms they informed me about their great concern for not being pregnant even after 5
years of marriage. Her husband was also checked by the same gynecologist and the
gynecologist confirmed that her husband had no apparent pathology for not having a
child of his own. The woman was a full term vaginally delivered child with no history
of birth anomaly; in childhood she used to suffer from repeated tonsillitis (which used to
be treated with antimicrobial therapy), she had early menarche (at the age of 10 yrs.) with
history of irregular menses associated with severe dysmenorrhoea; she also had headache
during menses, it was throbbing in type, occasionally associated with vomiting, used to
get relieved on rest. She developed weight gain in late adolescence with strong desire of
taking junk and unhealthy fatty and fried food. Her thirst was fair with strong desire for
freeze cold water; She was chilly but used to sweat a lot specially from covered area
( foul smelling – told by her husband); Her seasonal preference was not very
characteristic as well as her diurnal variations. Psychologically she was weak, timid and
she had weeping disposition, of late she developed great aversion to work specially on
exertion. She expressed to me that not having pregnancy made her scared about her
future especially about her relation with her husband. Her husband told me that she had
been losing her psychological strength and abilities since the day she heard that she won’t
be pregnant naturally and in vitro fertilization is the only alternative to it( by their
gynecologist). She became forgetful, had been getting anxious without any specific
reason. She hates to take dairy products but likes to have eggs. Eggs were her favorite
and she was fond of spicy and rich food.

On Physical examination she was fair, flabby with a Body Mass Index (BMI) of 28.5
kg/m². She had moderate hirsutism (fairly prominent mustache line and more than
normal body hair on her fore arms, wrists and legs) and scars of old acne on face. There
were no clinically detectable anemia, jaundice, cyanosis, clubbing and no palpable lymph
nodes; there was non pitting edema (over her tibial tuborosity) Her Vitals were:- BP
130/78mmHg, Pulse 66 bpm, Respiratory Rate- 18/min and body temp was within acceptable
limit.

Systemic examination revealed lower abdominal obesity, moderately tender gastric area.
Based on her presenting symptoms I made her totality of symptoms: 1) Apprehensive of
suffering from critical disease. 2) Anxiety about her future 3) Forgetfulness 4) Excessive
sweats and sour or foul smelling 5) Aversion to dairy products 6) Desire for eggs, spicy
rich food 7) early menarche. 8) Profuse menstruation and prolonged menstruation with
severe dysmenorrhoea and headache during menstruation. These symptoms were
arranged according to their importance. It can be seen that the highest importance was
assigned to mentals [psychological features may alter the neuro hyphophysial balance
and might have caused the disruption of intricately balanced endocrinological
system.(Saalam Ranbir & K Reetu, 2011); endocrinological homeostasis is a basic
requirement of healthy pregnancy; Moreover, majority of her mental symptoms
developed after she was pronounced that she cannot have pregnancy without artificial
method ( by the gynecologist)]

Rubrics used for repertorization were: ( Kent’s repertory was used and page numbers of
respective rubrics are mentioned alongside of rubrics )

1) MIND: Fear disease, of impending( page #44)
2) MIND: Anxiety, future, about ( Page # 7)
3) MIND: Forgetful ( Page # 48)
4) PERSPIRATION: Profuse (Page 3# 1299)
5) STOMACH, aversion, milk (Page # 481)
6) STOMACH, Desires eggs ( Page # 481)
7) GENITALIA FEMALE: Menses, frequent, too early, too soon ( Page #726)
8) HEAD: Pain, menses, during ( Page # 142)

After repertorization major drugs came out were Calcarea Carb, Phosphorus, Baryta
Carb and Graphites. Amongst them Calcarea Carb was most indicated, especially her
physical makeup, typical mental features, generalities as well as her female reproductive
symptoms were indicative of Calcarea Carb (Kent’s Materia Medica). Her aversion to
dairy products and special liking of eggs and spicy rich food were other additional
indicative symptoms suggesting Calcarea Cab (Boricke’s Materia Medica).
I started her treatment with LM potency. As the case was slow in onset over a period of
time, I decided to start her treatment with LM2. In addition to Calcarea Carb I also gave
her Jenosia Asoka in Homeopathic tincture form. Jenosia Ashoka was given to tonify
female reproductive system and to assist endometrial bed. The girl was asked to come
after a fortnight.

On 2nd visit the woman’s husband told me that she was showing some (not very
prominent) improvements. Her mental features were markedly improved her
forgetfulness, apprehensive features were disappeared. Though her female reproductive
system’s features were not markedly changed; she looked much assertive about her
prognosis.

I repeated Calcarea Carb in next LM potency and also told her to continue Jenosia Asoka
as before and to report after a fortnight.
On 3rd visit the lady told me that she was feeling much better. She had menstruation and
this cycle seemed to be regular in duration, and amount of discharge; she also told me
that she experienced much less pain during this menstrual period.

I gave her Calc Carb LM4 (to take every alternate day) and told to continue all other
regimens as before. I counseled them about the healthy conjugal life and to plan for child
starting from a week after the last menstruation to a week preceding next menstruation
cycle.

On 4th visit the girl told me that she had the regular menstruation in this cycle as well.
She regained her confidence. Her relation with her husband revived and both of them
were psychologically confident of having a child.
I gave her Calc Carb LM5 (to take every alternate day) and to continue other regimens
as before. I advised them to continue their conjugal life as before and told her husband
to take her to any health resort and to maintain intimate conjugal relation for the middle 2
weeks of that menstrual cycle.

On the next visit the girl came to my clinic with highest pleasure. She reported me that
it was more than a week she missed her menstrual period. She was also having some
sorts of morning sickness.

I told her to do an Urine test for Hcg after one week and to come to me with the report
and advised her to stop all earlier medicines. I advised her to take Calc Phos 6DH
tablets/ 4 tablets twice in a day. To have absolute rest, not to exert any type of pressure
on abdomen.

On Feb 2016 her husband reported me with her Urine report, which was positive. He also
showed me an USG report (as per her gynecologist’s advice) which showed a viable fetus
of 6 weeks duration (approx.). He was visibly contended and highly joyous. I told
them to consult the Gynecologist for further treatment and management; and to continue
Calc. Phos 6DH for next 3 months (at least till the end of first trimester).
Homeopathy has been used successfully to treat many gynecological problems. . A
special feature of Homeopathy is that it utilizes the concept ‘Similia Similibus
Curenteur’ Like cures like. Calcarea Carb was the drug selected because in healthy
individual it can produce similar symptoms (like those presenting features of the girl).
Ashoka was given to tonify female uterus. Selection of potency could be justified with
the notion that the case was of chronic in nature and LM potency can affect both
functional as well as physical spheres of a patient with less / no aggravation.
During the tenure of the treatment, the patient’s menstrual cycle became almost regular
with less/ no pre-existing complications like dysmenorrhea. Pregnancy was also
achieved after 4 months of treatment with Homeopathic constitutional therapy. Then
the Homeopathic treatment was stopped after confirmation of pregnancy, with only
exception of taking Calc. Phos. Calc Phos is a biochemic medicine, supposed to
strengthen her physically. Most astonishingly she didn’t developed gestational diabetes
and had almost uncomplicated pregnancy with natural labor giving birth to a healthy
baby boy. This total episode (getting pregnant without any invasive method and having
uncomplicated pregnancy and uncomplicated labor) can be attributed to the uniqueness of
Homeopathic Constitutional Treatment and its long lasting or sustained effect.

Discussion:

This report details of the case of the woman of childbearing age had NAFLD and PCOS
contributing to an ovulatory infertility. For her complex disorders modern medicine had
no treatment apart from doing in vitro fertilization. On the other hand homeopathic
constitutional treatment was able to address this complex condition. The patient was
previously complied with lifestyle modifications, however had unsatisfactory results due
to the complexity and severity of her physical ailments. But Homeopathic constitutional
treatment (HCT) was able to solve her problem.
In pharmaceutical treatment of PCOS, oral contraceptive pill is often administered to
suppress androgens and to regulate the menstrual cycle (Srimans, 2014). However, this
treatment strategy was not suitable for patients who wants to be pregnant, because OCP
inhibits ovulation also resists sperm penetration. Moreover, Oral contraceptive pill cannot treat fatty liver and is associated with the side effect of weight gain which may further
aggravate PCOS and related symptoms. Management of PCOS with pharmaceutical
medications of metformin and clomiphene citrate has been well documented (Tziomalos,
2013). Clomiphene is used to increase ovarian stimulation to induce ovulation. However,
clomiphene has limited efficacy and is associated with various side effects as well as
hyper-ovarian stimulation (Diamond et al, 2014). Metformin is an insulin sensitizer that
may improve insulin resistance to ameliorate PCOS (Chavez, Bermudez, 2014); however,
metformin is not recommended because metformin may have a limited effect on
regulating menstruation.

In regards to Homeopathic treatment; Homeopathic constitutional treatment is supposed
to be safe, effective for many gynecological disorders, like irregular menstruation,
amenorrhea and PCOS with infertility etc. etc., provided there is strong symptoms
similarity. The advantage of Homeopathic treatment is that it considers the individual as
whole. Thus the homeopathic treatment achieved not only conception (pregnancy) but
also prevented other complications like gestational diabetes during the pregnancy of the
woman despite of multiple endocrinological and reproductive ailments. Homeopathic
constitutional treatment improved her ailments as a whole. It (Homeopathic
constitutional treatment) restored vital constitutional harmony of different systems. In
normal healthy state all systems of body work with optimum efficacy and precision
harmony between different systems remain unaltered. Thus a person doesn’t feel
individual functions of different systems; rather s/he feels him/herself as a whole.
Disease process altered the harmony- a patient starts feeling dysfunction of individual
systems. Homeopathic constitutional treatment restores the precision harmony between
different systems and restores the healthy condition. Thus HCT (Homeopathic
Constitutional Treatment) emerged as an effective treatment for PCOS with an ovulatory
infertility. The well selected remedy Calcarea Carb seemed to modified functions of
different systems in such a harmonious way that some of the improperly matured primary
oocyte got matured and underwent meiotic cell division (up to metaphase II; meiosis II
completes after fertilization) and got fertilized in vivo by her husband’s sperm. Ideal
HCT (Homeopathic Constitutional Treatment) follows certain rule of symptomatology,
known as Herring’s law of cure ( last to appear first to go; goes from inner to outside;
from more important organ to less important organ). Symptoms of the lady also
progressed in diagnostically favorable way. Mental features appeared last and went off
first. (Thus I kept on giving Calc. Card in gradually increasing LM potencies).
Apart from medicinal management, she was advised for healthy life style management
and to control her body weight. It was essential for homeopathic treatment (to remove
exciting and maintaining causes). Moreover, it was necessary to maintain body’s internal
homeostasis and to maintain body’s internal environment conducive for healthy
pregnancy and parturition. I counseled them for healthy conjugal life to ensure good
quality and optimum quantity of sperm. I counseled for visiting health resort to ensure
healthy environments (both body’s internal as well as external); going on vacation as well
as visiting health resort could have helped them to establish positive conjugal relation
conducive of in vivo fertilization.

Conclusion:

In summary, homeopathic constitutional treatment addresses the patient as a whole; it
works on multiple targets simultaneously to improve and to cure the patient as a whole.
Modern medicines took the case on problem based approach and was not able to treat the
case. PCOS is a functional disorder addressing problem of many systems and organs.
Problem based approach couldn’t solve the case. But the Homeopathic holistic
treatment helped the case to get pregnancy and to improve conditions of different
organs to help problem free and healthy pregnancy and parturition. More specifically,
this case report demonstrates how homeopathy can be applied to facilitate gynecological
and other systemic problems associated with PCOS. The successful treatment with
Homeopathy for this case highlights potential of HCT (Homeopathic Constitutional
Therapy) to manage a complicated case like PCOS with NAFLD and an ovulatory
infertility. The case came to me with previous laboratory reports performed as per their
gynecologist’s advice; I didn’t advised her any further laboratory report excepting reports
for pregnancy. But the reports advised by the gynecologist is not exactly conducive to
diagnose PCOS. The case cannot be distinctively stamped as a case of PCOS. There
were many deficiency in laboratory work as I mentioned earlier:
A) _there was no LH hormonal assay; (Raised LH with raised FSH is indicative of
PCOS.

B) In USG report there was marked indication of Fatty liver; still no hepatocellular
enzymatic assay was performed. In fatty liver usually Alkaline Phosphatase gets
elevated with normal to high normal SGPT. But in this case no such investigations
were done.
C) NAFLD usually associates (rather caused by) raised triglyceride. But the
Gynecologist didn’t advice for any such report.
Though the case cannot be told as a definitive case of PCOS but maximum of its features
were indicative of PCOS with NAFLD. In homeopathy laboratory demarcation of a
disease is not essential; but this type of complicated chronic diseases are very suitable for
HCT. The HCT (homeopathic Constitutional Treatment) can address multiple systems
and/ organs in simplest and surest way (on basis of their symptoms similarity); thus,
HCT can effectively manage a complex case with a very positive outcome and/ prognosis.
This case is a nice example of elucidating the effectiveness of HCT in the treatment of
cases of infertility (suggesting to be an ovulatory infertility). In future we can perform
more extensive clinical research about effectiveness of HCT in treatment of infertility.
Furthermore, this paper will facilitate the possibilities of treating complex multi systemic
disorders related to endocrinological and/ reproductive systems. Then after we can
further advance our study with ideally designed randomized and controlled clinical trials
on use of HCT in the treatment of Infertility associated with PCOS.
References

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Sirmans SM, Pate KA (2014) Epidemiology, diagnosis, and management of polycystic
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Chávez-Castillo M, Bermúdez V(2014) The role of metformin in metabolic disturbances
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William Boricke’s Homeopathic Materia Medica: http://www.
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Kent’s Lecture on Homeopathic Materia Medica :
http://homeoint.org/books3/kentmm/index.htm

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