Restoration of Ovulatory Cycles and Natural Conception in Pcos-Associated Secondary Infertility: An Ayurvedic Case Report

Background Polycystic Ovary Syndrome (PCOS) is a multifaceted neuro-endocrine-metabolic disorder characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. In reproductive-aged women, PCOS is the leading contributor to anovulatory infertility. In Ayurveda, this presentation correlates with Artava Kshaya / Pushpaghni Revati (Jataharini) and Vandhyatva (infertility) rooted in Kapha-Vataja Sroto-avarodha (channel obstruction) and impaired Dhatvagni. Case Presentation A 29-year-old female presented to the outpatient department with complaints of delayed, oligomenorrheic menstrual cycles (cycle length 60–90 days, flow lasting 1–2 days), progressive weight gain (BMI: 28.4 kg/m²), facial hirsutism, and an inability to conceive for 2.5 years following the birth of her first child (secondary infertility). Transvaginal ultrasonography (TVS) confirmed bilateral polycystic ovarian morphology, and endocrine profiling demonstrated an inverted LH:FSH ratio (2.3:1) and hyperinsulinemia. Semen analysis of the spouse was normal. Intervention A structured, phased Ayurvedic protocol was instituted: initial metabolic detoxification and channel cleansing (Deepana-Pachana and Kostha Shodhana via Virechana Karma), followed by targeted herbal formulations (Kanchanara Guggulu, Pushpadhanva Rasa, Varunadi Kashaya, and Shatapushpa Churna) aimed at clearing Avarodha, augmenting Agni, and stimulating the follicular microenvironment. Intrauterine administration of Phala Ghrita (Uttara Basti) was administered post-menstruation for three consecutive cycles. Outcome Within four months of intervention, the patient established regular, spontaneous 30–32 day menstrual cycles with physiologic flow (3–4 days). Serial follicular monitoring confirmed follicular maturation leading to spontaneous ovulation (dominant follicle measuring 21 × 19 mm with subsequent rupture). In the fifth month, the patient missed her menstrual period; a urine pregnancy test and subsequent obstetric ultrasonography confirmed a viable single intrauterine gestation with cardiac activity. Conclusion Sequential Ayurvedic intervention incorporating systemic bio-purification (Shodhana), targeted ovulatory stimulants (Shamana/Artavajanana), and local organ-specific therapy (Uttara Basti) reversed ovarian channel obstruction, restored hypothalamo-pituitary-ovarian axis physiology, and facilitated successful natural conception in chronic PCOS-associated secondary infertility.