Failed IVF, low AMH & Immunological infertility

Written by- Vaidya Vibhuti Rao

Reema (name changed), aged 29 years came to my clinic in early March 2020 along with her husband for infertility treatment. Covid had just started to spread its wings in India and we were taking all precautions while seeing patients. She was moderately built, previously diagnosed with hypothyroidism and highly positive Anti-TPO. She had a regular cycle of 24-26 days apart with 2-3 days flow. There were no other health complaints, except not being able to conceive. Married for 4 years without children, she was ‘very much frustrated’ as she described to me in her initial consultation. First two years of her marriage the couple was not serious about conception as they believed it will happen on its own. After two years, they started trying for it seriously. However, there was no result. Finally, they visited fertility doctors, as it was not possible to conceive naturally. “No people have started coming to Ayurvedic Fertility clinics initially, within 1 year of trying naturally. Ayurveda also provide pre-conceptional support for couple who want to avoid IUI/IVF and conceive naturally with a healthy child.”  

The human body has its mechanism of constant checking what’s going wrong and then fixing the problem. For women, this mechanism is complex and more important when it comes to reproductive health. A Uterus is an organ where an embryo takes shelter and grows into a baby. A balanced and strong immune system is needed here, to receive the embryo and nurture it well for 9 months. If the immune system goes wreck, and you end up being vulnerable to many infections. It can affect your fertility in many ways, especially when the body identifies its body tissue as a foreign threat, which leads to serious inflammation. And then, ovulation does happen and conception becomes impossible without an egg. Additionally, the body starts destroying sperms- thinking it is a dangerous object and even embryos (you might have heard of issues with implantation even with well-graded embryos. Autoimmune abnormalities (antiphospholipid, antithyroid, antinuclear and anti-sperm antibodies) have been investigated for possible associations with reproductive failure.
The couple went to one of the acclaimed best infertility centers in Bangalore. First, they tried 6 months of ovulation induction with Letrozole. Sadly, it did not work out for them. After that, the doctor advised them to go for IUI and they tried 2 IUI which all failed. Finally, the couple were left with the only option to go for IVF/ICSI. Thinking that there is no other way to have a child, the couple took the undesired decision to go for it, as doctors were constantly reminding them that they are losing their age and it will be difficult to conceive once they are 30 plus. Moreover, she also had poor ovarian reserve (AFC was poor) although AMH was 1.7ng/ml. The main issue doctor found was the presence of Natural killer K cells (High positive) and Tumor Necrosis Factor activity (moderately positive) in the endometrium lining. And that might be the reason for not conceiving considering it as immunological infertility. For this she was treated with some medications.
​
The Fertility doctor diagnosed her with primary infertility and low ovarian reserve. The stimulation had started in August 2019. After 10 days of stimulation (rFSH 300IU + HMG 300IU), 4 oocytes were retrieved. Out of 4, only 2 oocytes fertilized and cleaved and formed embryos. Her husband’s semen analysis showed 2% morphology, normal motility. There was no treatment given for him considering all was fine at his side. 2 embryos were frozen for transfer later, using the ‘freeze all’ technique. The day 5 embryo (1-Early) and another day 6 embryo were (1-3AB) graded in quality. The embryos were transferred (ICSI) in February 2020. 

To their nightmare, the most awaited IVF failed. The couple could not leave that this might happen to them as they thought IVF can give them a baby as their case is not that bad. However, this was not the case. They were advised to go for donor egg, as the quality of eggs were poor. But the couple decided not to go for it and find an alternative solution. Thinking that there might be a way out to this, they walked into my clinic.

In my practice, history and case taking are very important. I like to listen to my patient and understand their case and diagnose them as per Ayurveda. People are not very much aware that Ayurveda has its own diagnostic and treatment method and it can work for them. They come to Ayurveda only when they don’t have options left in allopathy or other systems of medicines. They don’t show similar faith in the system as they show in the allopathy. They say ‘they want to try Ayurveda’. However, things are changing for good now.

Well, this is the opportunity for an Ayurvedic doctor to give their best to each case and make such people believe in Ayurvedic treatments. Once they have a natural conception with Ayurveda, their whole perspective changes and they feel more confident not just in their own body but also in natural conception. Ayurveda gives control to you, does not control your body. Ayurveda medicines are natural, mostly plant-based and help your body to work for you.  Ayurveda should be the first choice for any couple who want to start a family. We also help such couples with our pre-conception Ayurvedic planning and help them avoid going to IUI or IVF etc.

Anyways, coming back to my case, I diagnosed her with Vata-Kaphaja Bandhyatva and referred her husband to see Dr Samarth Rao, although his semen analysis reported showed normospermia. In Ayurveda, we have our ways to diagnose male infertility issues. I first decided to go for Panchakarma in this case. We conducted Vamana Karma followed by Virechana Karma, which took almost a month. Next cycle I started Ayurvedic medicines such as Garbhakara Ghritam (medicated ghee), Vatahara kashyam, Jeeraka combinations, Amrutha etc. We asked the couple not to try for at least 3 cycles of the treatment.
​
In June, she missed her periods, and the home pregnancy test - UPT was positive. I started Garbhasthapana medicines for her and referred her to a local obstetrician where she would like to deliver her baby. Sadly, there are not many health professionals, who believe in Natural conception, pregnancy care and delivery. Women take a lot of medications during the pregnancy and always are filled with fear of what if they lose this precious pregnancy. Well, it depends on the case, some cases don’t need many interventions and some require at-most care. At 13 weeks, we came to know that there is a low-line placenta and short cervical length for which she was given cervical stitching. Well, finally she delivered a healthy baby in early February 2021. I supported her with our 45 days of “Ayurvedic Sutika Paricharya” and my role was over here.
​
Many times, a difficult case looks impossible initially, but the perspective about difficult changes when we start to see results. When a patient walks into the clinic saying that there is hope left for us to conceive, and this is our last try with Ayurveda, it overwhelms us. Patients come to Ayurveda with a lot of expectations and in search of a cure. Ayurvedic practitioners have a huge responsibility of treating difficult cases. Alas, patients come to Ayurveda after years of conventional treatments, weak body and hopeless minds. The science makes me believe that this couple will not conceive naturally or without donor egg IVF. But Ayurvedic science and practice has made me believe differently; hopeful with so many successful pregnancies in our clinic. Let me come back to you with another case study, until then keep trying well. 
Namaskara,
Vaidya Vibhuti Rao
Ayurvedic Fertility  Expert