Female Fertility

Stages of Womanhood

Bala – Birth till 10 years of age, childhood period

Kumari – 10 to 12 years, pre-menarche period

Rajomati – 12 to 16 years, puberty period

Yuvati – 16 to 40 years, early adulthood

Praudha – 40 to 50 years, middle age

Adhirooda – 50 to 60 years, elderly

Vriddhi – Above 60 years of age, old age

4 Factors for conception-

 * Ritu (Proper season) - Ovulation period 

* Kshetra (Soil) - Uterus and other reproductive organs

* Ambu (Water and Manure) - Nourishing substances such as a diet of the pregnant lady, Amniotic fluid, placenta

* Bija (Seed) - Healthy sperm and ovum

Causes of Female infertility-

◦ Abnormalities in the factors of conception

◦ Imbalance in 6 factors

◦ Trauma

◦ Vitiation of Srotas

◦ Menstrual abnormalities

Types of infertility-

1. Vandhya: It is absolute sterility. This type is most difficult to treat because sterility occurs due to Bija Dosha or congenital chromosomal abnormalities.
2. Apraja: It is primary infertility or unsuccessful conception. This condition is treatable with Ayurveda herbs and therapies.
3. Sapraja: This is secondary infertility, which occurs after successful conception and giving birth to one or more children.

Ayurveda Treatment Approach-

1. Ama Pachana: Removal of endotoxins from the system
2. Agni Dipana: Restoring the Digestive and Metabolic fire
3. Dosha Shamana Chikitsa: Pacification therapies for balancing the Doshas
4. Vata Anulomana: Restoring the downward movement of Vata Dosha
5. Shodhana Chikitsa: Detoxification Therapies
6. Aushadha Prayoga: Administration of Ayurveda herbs
7. Pathya Ahara Vihara: Adopting a wholesome diet and lifestyle

Beneficial Therapies – Abhyanga, Shirodhara, Nasya, Virechana, and Basti

* Abhyanga and Shirodhara activate the pituitary gland and help maintain hormonal balance.

* Nasya therapy stimulates the hypothalamus, thereby regularizing Gonadotropin, Releasing Hormone secretion, and leading to ovulation.

* Virechana helps to remove toxins from the body, clear any obstruction in the channels of circulation, improve circulation to the reproductive organs, and help restore the balance of ovarian, tubular, and uterine functioning, which is essential for conception.

* Basti regulates the normal functioning of Vata Dosha, strengthens the reproductive tissue, improves the quality of the ovum, facilitates the timely release of the ovum, and improves the chances of conception. A specific type of Basti, known as the Uttarabasti procedure, helps to maintain the alkaline pH of the vagina, helps in rupturing of follicles, improves the quality of the ovum, nourishes the endometrium, and helps in the implantation of the fertilized ovum.

Recommended Herbs – Chandraprabha vati, Kanchanara Guggulu, Pushyanuga churna, Guduchi (Tinospora cordifolia), Punarnava (Boerhavia diffusa), Ashoka (Saraca asoca), Gokshura (Tribulus Terrestris), Shatavari (Asparagus racemosus), Shatavari ghrita, Phala sarpi

Diet & Lifestyle (To favor) – Include Barley, Rice, Ghee, Fresh fruits and vegetables especially root vegetables, Grapes, Pomegranate, Asparagus, Garlic, Nuts, Sesame seeds, Pumpkin seeds, Honey, spices like turmeric, cumin, cinnamon. A moderate amount of exercise or walking, routine, Timely meals, Timely sleep, and Yogasana, especially Sarvangasana (Shoulder stand), Padahastasana (Hand to foot pose), Paschimottanasana (Sitting forward bend), Halasana (Plough pose) are recommended.

Diet & Lifestyle (To avoid) – Avoid excess intake of Spicy, Salty, and sour tastes, frozen food, raw vegetables in excess, coffee, tea, and carbonated drinks. Food high in fat like red meat; Refined carbohydrates such as white bread and pasta; Food containing preservatives and artificial sweeteners. Try to reduce Strenuous exercise, exposure to cold wind, suppression of Natural urges, especially urination and defecation, mental Stress, staying awake late at night, and a sedentary lifestyle.

Method of Administration of Vajikarana

Depending upon one’s body strength, the status of Doshas, Prakriti (Constitution), and Agni (Digestive & Metabolic fire), one should administer Panchakarma first to detoxify the body, after which Vajikarana herbs, a suitable diet, and lifestyle are suggested.

Shukra Dushti Chikitsa (administered by an Ayurvedic doctor)

Shukra Shodhana (Purification of semen), by administering suitable Panchakarma and herbs according to the Doshas vitiated, will help treat Shukra Dushti. Panchakarma, mainly Vamana (Therapeutic emesis), Virechana (Therapeutic purgation), Niruha Basti (Decoction enema), and Uttarabasti (Urethral enema), will help in the purification of semen. Acharya Susrutha says that 18 Basti will help to eliminate Shukra Doshas.

Vataja Shukra Dushti: Anuvasana Basti (Oil enema) and Vata balancing, strength-promoting herbs such as Ashwagandha and Kaunch are beneficial.

Ayurveda Formulations

* Jivaniya Ghrita, Ashwagandha Ghrita, Shatavari Ghrita, Special Chavanprash, Kaunch Pak, Ashwagandhadi Lehya, Shilajit vati, Chandraprabha vati, Gokshuradi Guggulu, Kapikacchu (Mucuna pruriens),

Role of Diet

Wholesome Diet- Coconut water, milk, ghee, fresh fruits, unsalted butter, honey, natural sugar, rice, wheat, black gram, dates, garlic, Khichadi, and sesame seeds.

Unwholesome Diet- Excess use of salty, spicy, and bitter tastes, trans-fat, caffeine, carbonated drinks, junk food, Tobacco and Narcotic drugs, alcohol, and smoking.

Antenatal and Postnatal Care in Ayurveda

Ayurveda, the classical natural health care system from India, teaches that pregnancy is sacred and must be carefully planned and prepared. Pregnancy is when everything the pregnant mother tastes, sees, touches, hears, and smells should nourish the mother and child. There are particular recommendations to balance the pregnant woman's consciousness, mind, body, behavior, and environment. Ayurvedic texts say that a pregnant woman is to be treated as delicately as if one is carrying a cup full to the brim with oil without spilling a drop. From the first day of conception, the pregnant woman should always remain in a happy mood, be clean, wear simple ornaments and light clothes, and partake in prayers for peace, good deeds, and worship.

If a pregnant woman is taken care of as advised, she will give birth to a child who does not have any diseases - a healthy, physically strong, radiant, and well-nourished baby.

Advice on Pre-Conception

Just as a healthy seed bears healthy fruit, if the parent’s sperm and ovum are healthy, the child is more likely to inherit a healthy gene and immunity. Conversely, if parents conceive when mentally or physically weak, this may negatively impact the child’s condition. Ayurveda suggests parents observe a preconception regime called vajikarana. The aim of vajikarana is to enable a couple to produce healthy offspring. About six months before conception, an Ayurveda physician prescribes a personalized purification and rejuvenation regime for the couple to ensure optimal ovum and sperm quality and quantity. For a couple to produce healthy offspring, both partners should be careful about their diet, activities, behavior, and emotional status before and after conception.

Young women less than sixteen and boys under twenty should not indulge in sex. The rules of sexual intercourse are also explained in Ayurvedic texts. Men are advised to take aphrodisiac herbs like Ashwagandha, and Kaunch, which improve virility. Women are given cleansing and fortifying herbs to enhance the health of the uterus, like Shatavari and Ashoka.

The couple is advised on diet, lifestyle, herbs, Panchakarma, yoga, and meditation. There are also many compound formulations suggested for optimum fertility. The recommended diet includes warm cow’s milk, ghee, yogurt, black sesame seeds, black gram, green gram, honey, dates, almonds, onions, and saffron. Hot spices should be avoided. Daily self-massage and sufficient rest are observed. When a couple keeps this advice, the healthy sperm passes through the healthy uterus and produces healthy offspring.

When the male and female seeds unite, and the soul enters the union, it becomes an embryo (garbha). So also, those of antenatal care: the husband and other family members are advised to take care of the pregnant woman’s diet and encourage activities that are dear to her and beneficial to the fetus or child growing in her body. Thus, the approach towards motherhood, that is, pregnancy and childbirth, is holistic.

As plants reproduce from healthy seeds, so should we nurture the fetus with a healthy diet, lifestyle, wisdom, and kindness for others. Ayurveda compares human conception to the germination and sprouting of a seed and its transformation into a sapling. When the sperm and ovum unite, and the soul enters the union, an embryo (garbha) is created. For healthy growth of a sapling, four factors, namely Bija (Healthy seed), Kshetra (Proper soil), Ritu (Suitable season conducive to the development of sapling), and Ambu (Water), is necessary. In the same way, for the achievement of conception and proper growth of the fetus, 4 factors, namely Bija (Healthy sperm and ovum), Kshetra (Uterus), Ritu (Ovulation), and Ambu (Nourishing substances).

Hence, Ayurveda prescribes specific nutritional measures for the growth and protection of the woman to keep her vital and pure.

Garbhini Parichaya-

The development of the fetus in the uterus is discussed in the Charaka Samhita in the Garbhava Kranti section, and particular regimens are prescribed each month in the subsection Garbhini Paricharya.

Ayurveda explains the basic guidelines for an easy delivery that has to be followed during the nine months of pregnancy.

General Rules from Inception of Pregnancy till Delivery.

The general rules of antenatal and postnatal care are explained in Ayurveda texts. The husband and other family members are advised to oversee the pregnant woman's diet and encourage activities that are healthy, enjoyable to her, and beneficial for the child developing in her body. Guidelines regarding diet, exercises, behavior, and mental training *(ahar(food), vihar(recreation), achar, and vichar(thoughts), respectively) are also detailed. The goal is the protection and nourishment of both the growing fetus and the mother.

In general, a pregnant woman should eat cooked, liquid, unctuous, nourishing, warm, fresh, organic meals enriched with all six tastes of sweet, sour, salty, bitter, pungent, and astringent in the right proportion and supplemented with herbs and spices which increase appetite and digestive power. The food she eats should be delicious to her. In the latter phase of pregnancy, the stomach is squashed; hence small, frequent meals are usually more digestible. She should avoid skipping meals, fasting, and eating on the run or in stressful circumstances. Try to eat at regular times of the day. Don’t eat too late at night; leave 1-2 hours before sleep. Avoiding red meat, alcohol, carbonated drinks, caffeine, garlic, mushrooms, fermented foods, leftovers, dry food, and heavily processed and artificial foods.

The mother-to-be should always be happy, clean, neat, and well-dressed, wear simple clothes and ornaments, engage in peaceful and benedictory activities, and listen to relaxing music.

She should also avoid excessive sex, particularly early. Late pregnancy, overeating or fasting, speaking in a loud voice, sleeping during the day time and staying up late at night, wearing tight clothes and tight belts, sights that give rise to feelings of sorrow, anger, fear or pain, chemical cosmetics, long walks, negative emotions, traveling in a vehicle on rough roads, squatting for a long time or sitting in an uncomfortable position or on a hard surface, lifting heavy things or remaining in a bending position for a long time, beholding natural urges and visiting abandoned places.

Everything (diet, mood, emotions) that affects the mother impacts the baby. Thus, she should surround herself with positive influences and avoid harmful stimuli. It's essential that the mother be happy and healthy, for then the baby will be happy and healthy and will have the best possible start in life.

Techniques such as Abhyanga and gentle and therapeutic Ayurvedic massage are recommended for the mother to be under the guidance and supervision of a qualified Ayurvedic physician. The massage and other techniques balance Vata dosha, prevent fatigue, and relieve tension.

Diet and herbs during the First Trimester 

During the first three months of pregnancy, the fetus is in a formative stage and is nourished directly by ‘upsnehan’ or percolation; therefore, a mother-to-be should take a light diet and plenty of liquids, juicy fruits, coconut water, and milk. Ayurveda considers cow’s milk an ideal constituent in the diet of pregnant women as it is a source of calcium, lactose, clarified butter, and moderate amounts of protein with anabolic properties that impart strength.

Also, most women experience nausea and vomiting during this period and thus cannot take proper diet. Using a cold, sweet liquid diet and milk will prevent dehydration and supply nourishment. Herbs such as Vidari, Shatavari, Yasthimadhu, Parushaka, and Brahmi are anabolic and promote the growth of the fetus. Cow’s milk, honey, butter, and ghee are also recommended. Brahmi helps calm the nerves and is also a good prajasthapan (sustainer of pregnancy). Ginger tea helps prevent morning sickness.

Diet and herbs during the Fourth month

In the fourth month – Milk with 1 tablespoon of clarified butter, Shashtika rice with curd, and soup with meat are advised. This is because from the fourth month onwards muscular tissue of the fetus grows sufficiently, requiring more protein supplied by meat soup.

A mother will also instinctually crave tastes to balance her and the baby. This mainly manifests during the fourth month when the child’s heart develops, and the mother becomes known as ‘the one with two hearts’ (dauhrudini). It is said that the child’s desires are expressed through the mother’s cravings, and the baby will be healthy if their desires are fulfilled with judicious moderation. Healthy alternatives may be substituted for unhealthy desires. For example, a craving for acidic chocolate may be replaced by alkalizing carob. Sugar cravings can be managed with maple or rice syrup.

Diet and herbs during the Fifth month

Ghee, Shashtika rice cooked in milk, rice gruel, the meat of wild animals, and rice cooked with milk is advised.

Diet and herbs during the Sixth month

Ghee medicated with Shatavari or Gokshura is recommended. Intake of cow’s ghee and Sweetened curd is also advised. During the end of the second trimester, most women suffer from edema of feet and other complications of water accumulation. The use of Gokshura, which is a diuretic, will prevent water retention and its complications.

Diet and herbs during the Seventh month

The regimen advised is the same as the sixth month. Sweetened ghee, medicated with Vidarigandha group of herbs (vidari, gokshura, shatavari, punarnava, sariva, kaunch). Vidarigandha group of herbs are diuretic, anabolic and relieves emaciation, mitigates pitta and vata, and maintains the health of the mother and fetus.

Fat, salt, and water should be taken in small quantities in the diet from the seventh month onwards.

During the seventh month, the uterus is enlarged due to the growing fetus and produces stretching of abdominal skin, which causes itching and striations. This is known as Kikkisa (Striae gravidarum). Apply the paste of sandalwood or paste made of Neem, basil, and Manjistha or oil medicated with jasmine. Irrigation of the abdomen and breasts should be done with a decoction of neem, manjishta, and basil.

Diet and herbs during the Eighth month

Rice gruel prepared with milk and mixed with ghee and a liquid diet is advised. This is when yastimadhu and Shatavari should be consumed regularly, and dried grapes are also beneficial. Anuvasana Basti is also recommended, which helps in the downward movement of vata. Most women experience constipation in late pregnancy due to the pressure of the gravid uterus over the

bowels and the effect of progesterone. The use of an enema in the eighth month will relieve constipation, affect the autonomous nervous system governing myometrium, and help regulate their function during labor.

Diet and herbs during the Ninth month

Rice gruel mixed with ghee, meat soup added with fat, and cooked rice mixed with fat is recommended. This will help in the nourishment of the mother and baby and the formation of breast milk. Daily baths with cold decoction prepared with pounded leaves which mitigate Vata, like nirgundi, dashmool, and Bala, are recommended.

Anuvasana Basti and Yonipichu (Vaginal douche) are recommended for lubrication of the cervix, vaginal canal, and perineum.

Yoni Pichu destroys pathogenic bacteria in the vaginal canal and prevents puerperal sepsis, besides this softens vaginal passage and perineum, thus helping in its relaxation during labor.

During pregnancy, a woman’s calcium needs go up, so at least 2-3 servings of calcium-rich foods like green leafy vegetables, raisins, dates, guava, and oranges should be taken daily. Interestingly, the suggested Ayurvedic diet correlates to modern nutrition recommended for pregnant women, such as high protein, vitamins, and minerals. 

Treatment of diseases in a pregnant woman (administered by an Ayurvedic doctor)

Any disease occurring in a pregnant woman should be treated with mild, compatible, and safe drugs for the fetus. Panchakarma (detoxifying procedures) should not be advocated, except Anuvasana Basti (oil enema), in the eighth and ninth months of pregnancy. Ayurveda also describes nine diseases that are caused because of the pregnant status of the woman. These diseases are peculiar to pregnancy and are called garbhopadravas. They are nausea, anorexia, vomiting, dryness of mouth, fever, edema, anemia, diarrhea, and retention of urine. Their specific treatments are also elaborately described.

As far as possible, medication should be avoided during the first three months of pregnancy. Only symptomatic treatment with very mild herbs and a suitable diet should be offered.

Guidelines for Easy Delivery

Ghrita preparations or medicated ghee preparations can be taken from the first month of pregnancy, as they quickly help deliver the baby.

Herbs during Pregnancy- 

Shatavari, Phal Ghrit, Laghusutasekar vati, Muktasukti Kamadudha capsule

Sutika Paricharya (Postnatal care)

Post-natal care with a regulated diet and mode of life should be followed for at least 45 days after delivery.

A puerperal woman should be given powdered pippali, pippalimoola, cavya, chitraka, sunthi with ghee / warm jaggery water for 2 – 3 days till lochia rubra (abnormal blood) is appropriately excreted. From 3 rd to 7 th day, – Vidarigandha group (vidari, gokshura, shatavari, punarnava, sariva, kaunch) mixed with ghee or milk should be administered. Massage with Bala taila and oral administration of fats with medicines and decoctions should be done for 3 to 7 days after delivery. From 7 th or 12 th day, cooked shali rice and medicated meat soup with barley, jujube, and horse gram is advised.

The abdomen should be massaged with Bala taila and wrapped with a clean cloth. This wrapping helps in the compression of the stomach, thus preventing vata from aggravation. Liquid rice gruel mixed with ghee is advised. Irrigation or a bath with hot water in the morning and evening is recommended. A puerperal woman should avoid exercise, coitus, and anger.

From the fifth to the seventh months, drugs, which give strength to the uterine muscles and nourish the embryo, are advised. Ashwagandha and Guduchi are particularly good in this regard. They help ensure optimal condition of the placenta, uterine tissues, and umbilical cord. The diet should contain rice, milk, butter, and gee. Orange or yellow fruits, such as mangoes, apples, carrots, and Amalaki, are advocated. Leafy vegetables are also advised.

Avoid heavy-digest foods such as wheat, meat (esp. red meat), and refined sugar. These foods severely decrease the digestive fire (agni) and produce mucus and toxins (ama). Deep-fried foods are also heavy to digest and highly vata increasing. Excessive intake of sour foods, sauces, vinegar, and hot spices like chilies increases Pitta and heat in the body and reduces digestive power.

Fermented or fermentation-increasing foods such as alcohol, cheese (esp. old and hard ones), yeast-containing foods, sauces, and beer. All fermented foods are sour and therefore have increasing pitta qualities. Ice cold foods and drinks, fast food, canned food, and microwaved foods are devoid of nutritional value, deplete the digestive fire and produce toxins in the body.

General advice on diet during the antenatal and postnatal period

Cooked vegetables should be included in the diet, whereas raw vegetables/salads should be consumed in fewer quantities preceding lunch.

Pulses like yellow and split green gram, pigeon pea, and red lentils are easy to digest, balancing and nourishing the body. Chickpeas, black-eyed, and kidney beans should only be taken occasionally, thoroughly soaked, and well cooked. Tofu can also be enjoyed.

Grains can also be used, including rice, oat, rye, maize, millet, amaranth, quinoa, and flours made from the above grains and buckwheat. Porridge made without milk, but with cinnamon and cardamom, coconut flakes, soaked raisins, or stewed fruit is easy to digest, highly nutritious, warming, and energizing. It is better to avoid bread.

Seeds and nuts such as pumpkin, sesame, poppy and sunflower seeds, pine nuts, almonds (without skin), walnuts, hazelnuts, and pistachios should be eaten in tiny amounts as they are heavy to digest and vata increasing. They are best soaked and made into a paste or milk. The flesh, milk, cream, and coconut flakes can be used liberally.

All sweet fruits such as apples, pears, apricots, grapes, cherries, plums, sweet berries, fresh figs, dates, and pomegranates are good. Dried fruits are okay, but they are best soaked.

Of all dairy products, ghee (clarified butter) is the best - it can be cooked with and added to practically everything. Milk should be warm, preferably spiced with ginger, cardamom, cinnamon, or turmeric. Good alternatives to cow‘s milk are soya milk and rice milk. Fresh cheeses are more accessible to digest than hard, old ones. They are best enjoyed with some black pepper to stimulate the digestive fire.

One should avoid white meat. White meat is okay for consumption, i.e., chicken and turkey. Fish is boiling potently, so one can choose to eat freshwater rather than sea fish. Refined sugar should be replaced by jaggery (solidified sugar cane juice), raw cane sugar, date sugar, molasses, rice syrup, or honey. And when it is not heated, stable and becomes poisonous for the body when heated, cooked, or baked.

Black tea and coffee can be consumed, but herbal and decaffeinated coffee is better. Ginger tea from fresh roots is warming, agni (digestive fire) enhancing, mucus, and toxin removal.

The most essential is the use of spices. Cumin, coriander, fennel, and saffron are the best for balancing all doshas and increasing agni (digestive fire), and should be used liberally. Black pepper, turmeric, cinnamon, cardamom, cloves, mustard seeds, nutmeg, all fresh herbs (remarkably fresh coriander), and onions can be used. Garlic and ginger should also be used in moderate quantities. Asafoetida reduces vata and should be added when cooking pulses, cabbage, and beans to reduce their gas-producing properties.

Herbs during the Postnatal period- Golden Ghee, Shatavari Kalp, Dashmool ghan vati

Ayurvedic approach towards motherhood, that is, pregnancy and childbirth, is indeed holistic. Ayurvedic recommendations touch upon the mother's diet, behavior, and activities and the entire family the child will be born into. Ayurveda regards the woman and her ability to produce and care for children as the basis of family life, which is the foundation of society. Therefore, only if the women of an organization are safe, protected, and content can these qualities manifest in that society.

By: Dr. /VD Lakshmi