Abstract
Infertility is a general problem with important psychological, economical, social, and medical aspects. The incidence of this disease is about 15%. 1 This disease can lead to different psychopathologic disorders like anxiety, depression, lack of self-confidence, marital crisis, and even divorce. 2 Its treatment is complicated and costly and is not always successful. However, complementary medicine has good capacities to help with conventional treatments 2 and interest in complementary medicine has grown with regard to the treatment of infertility. 1,3
A review of the English literature showed no published articles on the treatment of relapsing ovarian cyst and infertility using Iranian traditional medicine. Therefore, this is the first report in this regard.
Case History
A 28-year-old woman who was married for 6 years was referred to the outpatient clinic of the School of Traditional Medicine, Tehran University of Medical Sciences, with the complaints of relapsing ovarian cysts, primary infertility in February 2014. The medical history of the patient showed that she could not become pregnant after several surgeries, induction of ovulation and the use of letrozole for 2 months, and routine procedures by gynecologists.
The menstrual history of the patient showed menarche at 13 years and marriage at 22 years of age. Menstrual cycles were regular, and vital and systemic signs were normal. On gynecological examination, the cervix was normal and conical in shape. Vaginal examination showed a normal-sized anteverted uterus that was fornices free, mobile and uniform. Her husband was healthy and had a normal sperm analysis.
That patient had a history of 6 operations, including 4 emergency operations on the ovarian cyst during 2010-2014, an emergency appendectomy at the age of 12 years in 1999 in a university hospital. She underwent a diagnostic and therapeutic laparoscopy as well in 2013. The patient underwent 4 emergency operations—in June 2010, December 2011, January 2013, and January 2014—due to abdominal pain and tenderness and left ovarian cysts. Pathological evaluation showed hemorrhagic cysts in the left ovary.
Considering infertility and multiple ovarian cysts that led to multiple operations, the patient attended an infertility center in June 2013 where different diagnostic procedures were performed. The patient underwent laparoscopy and hysteroscopy, which showed adhesion, ovarian cyst, and endometriosis. A luteal cyst was excised from the left ovary and the endometriotic foci were cauterized. It was the first report of endometriosis and pathology reported a corpus luteal cyst.
The report of hysterosalpingography in May 2013 showed that the uterus had a normal size and position with no finding in favor of a filling defect. Both fallopian tubes, especially the right one, were opacified with free spillage.
After a diagnostic laparoscopy in 2013 and other diagnostic procedures, the patient started letrozole to induce ovulation in November 2013. After 2 months, she again had a ruptured ovarian cyst in January 2014 for which she underwent emergency surgery.
Because of numerous problems, she underwent multiple ultrasound examinations, all of which reported a normal-sized uterus with a normal myometrial pattern and endometrial thickness but revealed polycystic ovary syndrome and endometrioma. The last ultrasound examination after the last surgery and before attending the Traditional Medicine clinic in February 2014 showed that the ovaries still contained small 5- to 6-mm follicles and a 24-mm cyst without an internal echo (Figure 1).
Ultrasonography after the last surgery and before attending the clinic of Iranian traditional medicine in February 2014.
Ultrasound examination of the internal organs as well as thyroid function test, liver function test, and hormonal profile were normal.
One month after the last surgery, she visited the Traditional Medicine clinic. Routine evaluations were unremarkable. Treatment based on Iranian traditional medicine was started at her request.
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Three months after the start of the treatment, ultrasound examination was performed on May17, 2014, which was the ninth day of the last menstrual period. The report of sonography showed that the size of the uterus from the fundus to the external orifice was 84 × 56 mm, the right ovary had a normal size and view, and the ovarian cyst became smaller in size. There were 4 dominant follicles measuring 11, 13, 15, and 18 mm in diameter in the left ovary and one dominant follicle measuring 15 mm in diameter in the right ovary. The patient was advised to conceive and she became pregnant in the same cycle. The pregnancy test was positive on June 7, 2014. Ultrasound examination on June 16, 2014 revealed a gestational sac with mean sac diameter = 11 mm, corresponding to 4 weeks and 6 days (Figure 2). The patient delivered a healthy boy weighing 2250 g through normal vaginal delivery on February 1, 2015. Another interesting information is that she is now (May 2016) 10 weeks pregnant with her second child.
Ultrasonography showing gestational sac of 4 weeks and 6 days.
Discussion
Scientific methods of infertility treatment have advanced in recent years but they are mostly expensive, invasive, and time-consuming. 2 Complementary medicine is becoming more and more popular in the world, especially Western countries 3,4 ; for example, 75% of the women in the reproductive age used one of the methods of complementary medicine in 2006. 5
The patient in our study underwent 4 emergency operations due to hemorrhagic ovarian cysts during 4 years and suffered from infertility for which she received letrozole before trying traditional medicine. Her ovarian cyst again ruptured after letrozole and therefore she underwent another emergency operation. Thirteen days after her last emergency surgery, ultrasound evaluation showed that the patient still had a large ovarian cyst. The traditional medicines used had aphrodisiac properties that might have helped with improving ovulation, and were brain and cardiac tonics. These medicines improve the overall function of the vital organs and help with pregnancy. The
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Conclusion
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