Mrs. T.S, 31/F consulted us for Secondary Infertility. She has a 3 year old daughter from her first marriage but is unable to conceive since her current marriage of 2 years. HSG (Hysterosalpingography) showed non-visualisation of both fallopian tubes and no spillage of dye, suggesting bilateral cornual block. Subsequently a recanalization was done after which adhesions were freed but still no spillage of dye was seen. On starting the homeopathic simillimum, within 3 months she conceived and was monitored for her ANC (ante-natal care) with Homeopathy.
Keywords: Infertility; Tubal block; Homeopathy; Aurum metallicum
Tubal block accounts for 20% of cases of female infertility. It comes under the ICD 10 classification N97.1. Distal tubal occlusion (affecting the end towards the ovary) is typically associated with hydrosalpinx formation and often caused by Chlamydia trachomatis. Pelvic adhesions may be associated with such an infection. In less severe forms, the fimbriae may be agglutinated and damaged, but some patency may still be preserved. Mid-segment tubal obstruction can be due to tubal ligation procedures as that part of the tube is a common target of sterilization interventions. Proximal tubal occlusion can occur after infection such as a septic abortion.
Common causes leading to a tubal block are as follows:
|· Endometriosis||· Pelvic Inflammatory Disease (PID)|
|· Ectopic pregnancy||Tubal Ligation Removal|
|· Genital Tuberculosis (still common in developing countries, especially India)||· Complications from lower abdominal surgery such as Cesarean section.|
Name – Mrs. TRS
Address- Chandivali, Andheri (E)
Age- 31 years
Gender- F Marital status: Married since 2 years
Occupation- Homemaker Date of consultation- 02/03/2016
Patient is unable to conceive.
Married since 2 years, no H/O (history of) contraception used
ODP- Unable to conceive despite regular, unprotected coitionà consulted her Gynaecologist and was investigated for the sameà HSG showed non-visualisation of both fallopian tubes & no spillage of dye- suggesting bilateral cornual block. Subsequently a recanalization was done after which adhesions were freed but still no spillage of dye was seen and she was then referred for Homeopathy.
Coital History: 3-4/week; no H/O contraception used and no H/O dyspareunia or post-coital bleeding
Headache since 4-5 years. Headache is accompanied by giddiness & blackout. Husband confirms that there are episodes of blackout & such episodes occur 1-2/ month. She had taken treatment for the same without much relief.
F/H: Father- Died due to CA of Tonsils
P/H: Appendicitis, 10-11 years back
Patient as a person (Physical Characteristics):
Appetite: Diminished due to medication (for headache) Non-Veg
Likes: spicy food 2+
Thirst: cold water, 2-3lit/day
Stool: NC (but occasional itching around anus)
Perspiration: Profuse on scalp, patient says it has increased after first delivery, earlier it was scanty.
Sleep: Decreased during night but feels sleepy during day time.
- Of people fighting, death of family members.
- Sometimes dreams of baby and dreams of menstruation. ( especially before menses)
F.M.P (first menstrual period): 10 years
L.M.P (last menstrual period): 26/02/2016
– Colour: Dark red with clots
– Duration: 5days
– Cycle: regular, 25-30 days
– Odour: offensive
– Quantity: profuse
Complaints: before- pain in legs and abdomen
During -pain in abdomen and lumbar region
Leucorrhoea: Moderate; thin watery, causes itching in parts and weakness
G1 P1 A0 L1– female child-3.5years; FTLSCS due to Breech presentation.
- H/O- PPH (20 days after LSCS )
General Reactions (Including Thermal Modality):
Height: causes giddiness light: irritation in eyes
Bus riding: vomiting
Patient lives with her husband and daughter; (this is her second marriage)
In 1st marriage, in-laws were expecting more financial income and her husband was accusing her of having an extra-marital affair with a work colleague (current husband) and other accusations which she could not tolerate so she left him after 3 months.
Her present husband supported her through that phase and said- “Your marriage ended because of me so I will marry you and look after your daughter too.”
She always feels guilty that her husband has sacrificed a lot for her, and that’s why to make all things proper, she now wants a baby. Her in-laws tell her husband that because she already has a daughter she doesn’t want a child with you and this upsets her a lot. She says this marriage is very understanding. In family quarrels, she never answers back. She says “childhood was not childhood” since at a very early age she started working and became independent, and now if at home she feels like a “typical housewife” which she doesn’t like (she has recently quit work for her infertility treatment & headache)
She likes to work, says “job was a stress reliever from family clashes”; she is still ambitious, wants to start her own firm and get back to work. Due to her complaint (secondary infertility) she feels very angry and irritated, wants to have a baby desperately.
Her husband says she is very focused on her work and is ambitious. She is always very serious, not much into going out and recreation.
Pulse: 68 /min. BP: 112/70 mm of Hg R.R.: 16 /min Temp: afebrile
C.V.S: S1S2 heard
R.S.: AEBE clear
G.I.T.: PA soft
03/02/16- Serum creatinine:1.20 HIV: -ve Hep. B : -ve
16/12/15- Beta HCG- below 1.2 LH-0.513 FSH- 3.675
Both fallopian tubes are not visualized and no spill is seen s/o cornual block
Diagnosis: Secondary Infertility (tubal factors)
Guilty about not conceiving (R- Reproaching herself)
Strong sense of responsibility at an early age (R- Taking responsibility too seriously)
Ambitious (R- Ambition increased)
Better when occupied (R- occupation amel)
Dreams of fights
Desires- spicy food
Motion sickness (R- Nausea after riding a carriage)
Perspiration on scalp
Infertility (R- Sterility)
AURUM MET 200 (3P)
SL 30 TDS X 15DAYS
In cases of tubal block, the following is the protocol followed in modern
- If the block is at the terminal (fimbrial) end of the fallopian tube it often forms a hydrosalpinx. Earlier, tubal surgery was performed to open this kind of blocked tubes. However, the results were very poor. The tube would usually close down again, or would never function properly, because its inner lining was damaged – damage which cannot be repaired by surgery. Some of these patients would then go on to have tubal (ectopic) pregnancies.
- If the tube is blocked at the cornual end, it’s sometimes possible to repair these tubes. Sometimes the block is not a real block, but just an apparent block because of tubal spasm. Sometimes the block is because of a mucus plug or debris, and this can sometimes be cleared with the help of FTR (fluoroscopic tubal recanalization).
As regards our case, it was possible that the block was due to a previous LSCS or an apparent block due to spasm/debris/mucus plug. However, despite recanalization there was no release of the block which is an indicator that it was the homeopathic medicine that opened the block. While assessing the efficacy of the therapy, it is also to be noted that the associated complaint was also cured.
While taking on such cases, the scope of treatment must be explained to the patient clearly- we had given a time frame of 5 months to Mrs. TRS.
Aphorism 3 lays emphasis on knowledge of medicines- Aurum metallicum was prescribed for her basic core of ambitiousness, strong sense of responsibility, serious disposition and feeling of guilt towards the husband with self-reproaching; keeping in mind it is a great remedy for infertility.