Management of Primary and Secondary Sterility with
(i) Aloes Compound (ii) D & C-Aloes Compou nd and
{iii) D & C-Aloes Compou nd with Inj. Placentrex
by
Mrs. Usha Khosla ,
MBBS., MAGS. (USA), Obstetrican & Gynacologist, and
K. Khosla,
MD ., MCCP. (USA), Khosla Clinic & Nursing Home, Phagwara 144 401, Dist, Kapurthala, Punjab
‘
T H E M EDICI N E & SU RGERY ·
A Montly Medical and Surgical Journal
Sayajiganj , BARODA – 390005 – INDIA
Introduction
Childless couples lead their lives in anguish. A child in their home is more important to them than any amount of wealth. Childlessness is a tragic human problem all over the world The solution to this problem is limited to those cases where organic defects are the causative factors which can be corrected.
Infertility becomes a baffling problem when the woman does not conceive even though investigations show no organic defects and her husband is normal without any sperm defects or deficiency. lt is said that about 10% of t he couples all over the world face the problem of infertitity.
The object of this study was to see whether Aloes Com pound an Ayurvedi c products, is useful in the management of Primary & Secondary sterility. Aloes was in regular use in Allopathy till some years ago when it was a B.P. drug. Now hormonal treat ment is in vogue.
Treating cases of Primary & Secondary sterility becomes all the more difficult in a rural area where sophisticated techniques are not available or are beyond the reach of the majoritv of the local community. Our object was to get the best conception results within the limited facilities and resources available to suit the local community. Having found good results in cases of primary and secondary sterility in our clinical practice with Aloes Compound, we decided to undertake a regular study of the drug,
| Each tablet of Aloes Compound contains :– | |
| Aloes Indica | 70mg |
| Hira Bol (Balsamo- dendron Myrrha) | 70mg |
| Kamboji (Breynia patens) | 30mg |
| Manjishta (Rubia cordifolia) | 35mg |
| Hurmal (Pegunum harmala) | 35mg |
| Kasis (Ferri sulphas) | 30mg |
| Jeevanti (Leptadenia reticulata) | 30mg |
The actions of Aloes Compound are given as follows :
Stimulates ovulatory menstrual cycles, regulates menstrual periods where they are not normal, useful in scanty, irregular periods, improves fertility index in cases of Primary and Secondary Sterility; there are no hazards or multiple births as seen with clomiphene etc. ; Checks obesity. Materials & Methods 140 cases consisting 110 cases of Primary Sterility and 30 cases of Secondary Sterility are included in this study. These exclude cases t hat could not be followed up regularly. We do not have facilities for endometrial biopsy, histopathology, patency tests for Fallopian tubes, etc, The male partner was examined and semen analysis was done. Cases of azoospermia and moderate to severe oligospermia were excluded from the study. Cases of mild oligospermia and those with sperm defects like lesser percentage of motile sperms were included in the study. Testicular biopsy could not be done for want of facilities.
Cases of Sterility were divided into three Groups :
Group I received Aloes Compound only; Group II had D & C and then were given Aloes Compound, and Group Ill had D & C and were given Aloes Compound and Placentrex lnj. In all the Groups, treatment was stopped, when pregnancy was suspected. Placentrex Inj. was given every alternate day or twice a week to a maximum of 15 Iuj. Though most of our patients belonged to low income group, in cases of Group II and III, D & C was done and Group III received Placentrex lnj. also as these patients were very much anxious to become pregnant soon · and were prepared for extra cost. In Group I (Aloes Compound), the trial period was 12 months or till pregnancy if earlier. In Group II & Ill, the total trial period was 15 months or till concept ion if earlier, as they had received Aloes Compound for the first three months without success. However, the assessment of results are made on the basis of 12 month period commencing from D and C in Group II and D & C and Placentrex Inj. in cases of Group III. The number of cases in each group was as follows : Group 1 : 56 cases; Group II :28 cases: Group III-: 56 cases.
Fortege was given to male partners to correct sperm defects, if any, and to tone up sexual, nervous and muscular systems for better sex performance. Fortege was continued in male partner, as long as the female partner received Aloes Compound.
Aloes Compound was immediately stopped when pregnancy was suspected. The results as to conception rates were divided into two categories : those who conceived within six months of therapy and those conceived between 7-12 months of therapy. Those who did not conceive within 12 months of therapy, were considered a failure.
Secondary Sterility
18 cases (60%) of Secondary Sterility .were in the age grou p of 20-30 years and 12 cases (40%) were in the age group of 31-42 years. (Table I)
Menstrual History
Out of the total of 140 cases, 100 cases (71. 4%) had menstrual disorders and only 40 cases (28.6%) had regular menstruation. 50 cases (35.7%) had oligomenorrhoea with periods extending beyond 35 days. 20 cases (14.3%) had dysmenorrhoea, and 30 cases (21 .4%) had irregular and or scanty menstrution.(Table II)
Distribution of Cases Among I, II & Ill Groups
Among the total of 140 ca.ses of sterility 56 women of Group I were treated for 12 months, or till pregnancy if earlier, with Aloes Compound only. 28 women of Group II received Aloes Compound for the first three months without success and then D & C was done and were continued with Aloes Com pound for 12 more months or· till pregnancy, if earlier. 6 women of Group III, received Aloes Compound .for first three months without response and then D & C was done. and were continued wi t h Aloes Compou nd for 12 more mon ths. or t ill pregnancy, if earlier. In addition, group III patients received Placentrex lnj. every alternate day or twice a week for a maxi mum of 15 Inj. after D & C. In all cases treatment was stopped immediately pregnancy was suspected. All cases of secondary Sterility were given only Aloes Compound treatment . (Table III)
Duration of Marriage
Duration of marriage in cases of sterility ranged from 3-20 years, though there was only one case with married life of 20 years, and this was of primary Sterilit y.
Dosage Schedule of A loes Compound
Aloes Compound was given 1 tab.two times a day, for two weeks from the first day of menstruation, and then 1 tab. three times a day in the third week and the full dose of 2 tab. two times a day during the , fourth week. Patients were advised not to take Aloes Compound on an empty stomach and preferably to take after meals. By this schedule, no side effects were observed, as in my experience some patients may have griping and nausea if full dose is given from the start and in a few cases there may be diarrhoea also. Aloes Compound was stopped two days prior to the expected period and started again from the 1st day of the period. If no period occurs Aloes Compound was stopped altogether as pregnancy was suspected and the patient was keptunder observation and all care was taken to sustain the pregnancy. However, in cases of dysmeorrhoea and oligomenorrhoea, they were advised to take Aloes Compound continuously ( including during menstruation ) till these complaints were corrected, when they were advised to stop Aloes Compound 2 days before the expected period.
Aloes Compound was completely stopped when once a period was missed & pregnancy was suspected.
Fortege For Male Partners
Fortege (Alarsin) was given, two tablets, two times a day continuously to male partners, for 12 months (the trial period), or till his wife became pregnant, if earlier. This was to improve the quality and quantity of semen & for better sex performance.
Results : Conception Rates, Primary & Secondary Sterility
Among the total of 140 cases of all the three Groups, 100 women (71. 4%) conceived within the trial period and 40 women (28.6%) did not conceive. Among 110 cases of Primary Sterility, 80 women (72.7%) conceived and 30 women ( 27.3% ) did not conceive and were considered as a failure in this trial. Among 30 cases of Secondary Sterility, 20 cases (66.7%) conceived 10 and cases (33.3%) did not conceive and were considered as a failure. (Table IV)
Conception Rates : Groups I, II, Ill. Among 56 cases of sterility of Group I ( Aloes Compound only ), 40 cases ( 71.4%) conceived and 16 cases ( 28.6% ) did not conceive. Among 28 cases of Group II (D & C and on Aloes Compound ). 20 cases (71.4%)conceived and 8 cases (28.6%) did not conceive. Among 56 cases of Group III (D & C, Placentrex lnj. Aloes Compound) 40 cases (71.4%) conceived and 16 cases (28.6) did not conceive.
Conception Rates Within 6 Months And Between 7-12 Months: In group I (Aloes Compound) 40 cases conceived. Among these 30 cases (75%) conceived. Within 6 months of treatment and 10 cases ( 25% ) conceived between 7-12 months of treatment. In Group II (D & C and Aloes Comp.), 20 cases conceived. Among these 10 cases (50%) conceived in six months and 10 cases (50%) conceived between 6-12 months In Group III (D & C, Placentrex lnj.. Aloes Com.), 40 cases conceived Among these 10 cases (25%) conceived in 6 months and 30 cases (75%) conceived between 7-12 months Overall, 50 cases (50%) conceived within first 6 months and 50 cases conceived between 7-12 months. (Table VI)
Discussion A patient of Primary Sterility aged 40 years and married for 20 years conceived within a year’s treatment with Aloes Compound only. She delivered a healthy female child by Caesarian. Majority of patients of Sterility (71.4%) had menstrual disorders. This appears to be the main contributing factor to sterility. There were 30 cases with irregular scanty menstruation. More than half of these patients had so much irregularity that they used to bleed only about thrice a year that too just spotting. Some of these conceived. These persons profoundly expressed their gratefulness to me because they had lost hopes of conceiving. In my opinion, the mode of action of Aloes Com pound is that it increases fertility index by correcting menstrual disorders where present. We are getting encouraging results with Aloes Compound in the management of Primary and Secondary sterility. This is all the more important, as we lack facilities for investigations like endometrial biopsy, tubal patency tests, testicular biopsy etc. Even with these limitations and shortcomings, we are glad that we are getting good results wi th Aloes Compound. In a developing country like ours and with backward rural areas which constitute 80% of the population, Aloes compound gives hope for infertile women.
Conclusions and Summary
140 cases of Sterility, comprising 1t O cases of Primary Sterility and 30 cases of Secondary Sterility were treated with Aloes Compou nd alone (Group I), D & C and Aloes Com· pou nd (Group II) and D & C, Aloes compound with Placentrcx lnj (Gr· oup lll). The trial period was 12 months. The study was done during 1979-80. Those who did not conceive with in the trial period were considered a failure. Treatment was stopped immediately pregnancy was suspected. Among the total of 140 cases too cases (71.4%) conceived and 40 cases (28.6%) did not conceive. Among 110 cases of Primary Sterility, 80 cases (72.7%) conceived and 30 cases (27.3%) did not conceive. Among 30 cases of Secondary Sterility, 20 cases (66.7% ) conceived and 10 cases (33.3%) did not conceive. 50 cases (50%) conceived within 6 months of treatment and 50 cases (50%)conceived between 7-12 months. The conception rates in Group I, Group II and Group III were all the same, namely 71.4% This shows that in many moffusil places like Phagwara, where facilities for endometrial biopsy tubal Patency tests, semen analysis and other investigations are generally not available, the sterile women and Fortege for their husbands gives a high concepton rate (71.4%)Aloes Compound and Fortege are found to be safe drugs without any side effects.
Acknowledgement
The authors thank M/s. Ala rsin Pharmaceuticals for their coopera tion, References 1 Mrs. Agrawal, R. S. (1979}-A Controlled trial of Aloes Compo und in cases of Sterility and mens• trual irregularity : Frist Asian Con gress of induced Abortion & Volun tary Sterilisation, Bombay, 4-9 Ma rch, 1979.
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The Medicine & Surgery : July 1981