INTRODUCTION:

Infertility is defined as ‘the disease which is characterized by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or due to an impairment of a person's capacity to reproduce either as an individual or with his/her partner’^1,2. This is the problem, affecting approximately 8-10% of couples in their reproductive age. About 60-80 million couples are suffering from infertility worldwide and among them, 15-20 million are in India alone^3,4.

Changed lifestyles⁵, eating habits, working culture⁶, globalization, internet usage, environmental changes⁷, use of insecticides, pesticides, fertilizers, chemicals⁸, industrialization, commercialization⁹ has substantially impacted the life of humans. Among general population, female partner shares around 68%, male partner shares around 10%, and unexplained factors are around 22%¹⁰.

We found infertility is prevailing since era of Vedas. ‘Rigveda’ (10/162/2) describes some ‘Krimis’ (worms) that destroy the uterus¹¹. ‘Yajurveda’ (8/29) describes the method of getting pregnant¹². ‘Atharvaveda’ (5/25/10-13) gives detailed description of vagina (yoni), ovum (beej), sperm (virya), uterus (Garbhashaya), along with the place of fertilization i.e. fallopian tubes (Gavini). Atharvaveda (5/25/9), also explained implantation and growth of foetus in uterus. It has described certain worms like Vatsapa (8/6/1), Durnam (2/52/2), Karnav (2/25/3), which destroy the foetus in uterus and cause infertility in females¹³.

In the holy Bible, Sarah, wife of Abraham was suffering from infertility¹⁴ (Genesis:16, Genesis:17, Genesis:21). In the holy Quran, there are many examples of Prophet and their followers suffering from infertility. Prophet Zakariya and his wife, conceived in her later ages after lot of sufferings¹⁵ (Maryam 19, section 1, verse 6).

Shrimad Bhagwat Gita, the holy book of hindus has description of couples which were suffering from infertility, pregnancy losses and still births¹⁶ (Arjun Pratigya, Dhasham Skand part 2). In Mahabharat, the hindu mythological book, birth of five sons of Pandu from his two wives ‘Kunti’ and ‘Madri’ without mating and only through blessings of five different biological fathers may be an example of assisted reproductive techniques (ART) of that time. ‘Adi Parva’ of Mahabharat, explains the birth of hundred sons of ‘Gandhari’ from hard ball of flesh, and the development of full fledge fetus in the pots of clarified butter¹⁷. Although it all seems to be fictious stories, but it could be seen as a premiere for development of embryo in vitro.

In Ayurveda, infertility is corelated with Vandhyatva and its detailed description is present in Samhitas (collections) like ‘Charaka’, ‘Sushruta’, ‘Harit Samhita’ and ‘Vagbhatt’. In ‘Kashypa Samhita’, ‘Acharya Kashypa’ gave description of ‘Jataharini’ which find relation to the causes of pregnancy loss and implantation failure to some extent. According to ‘Ayurveda’, healthy sperm, healthy ovum, and a healthy uterus are necessary for conception. The embryo can only implant and thrive in a fertile environment, good state of health, leading to the production of healthy offspring. The causes for ‘Vandhyatv’ listed in Ayurveda have connections to contemporary theories of infertility and can be used to determine why recurrent implantation failures (RIFs) occur despite significant advances in modern science.

In search of finding the solution of infertility in human, assisted reproductive technologies are being used to aid in achieving pregnancy in individuals who are having difficulty doing so spontaneously. In Vitro Fertilization (IVF) is by far the most common ART procedure performed and is now widely applied for the treatment of infertility due to variety of causes, including endometriosis¹⁸, tubal disease¹⁹, oligomenorrhea or amenorrhea, male factor or unexplained infertility²⁰. Assisted Reproduction techniques help these couples to achieve pregnancy but, only 25% of the transferred embryos successfully implants. With the advancement of technology and researches, we are not only able to make an ovulatory cycle, but are able to do superovulation for IVF cycles²¹.

So, at one time the technology has helped so many couples to conceive, same time the new window has emerged that why there is failure to get conception? In majority of patients who could not conceive through IVF the reason is Implantation failure i.e., the embryo could not make relation with the endometrium. Multiple failures of IVFs leave the couples desperate to get the answer and leads to frustration and anxiety in clinicians and patients both²². This condition is called Recurrent Implantation Failure (RIF).

Factors for Recurrent Implantation Failure:

Repeated implantation failure (RIF) is used to describe the inability of a woman to achieve a successful pregnancy after multiple attempts at IVF. RIF can be caused by various factors, including maternal, paternal and embryonic factors (Fig 1).

Maternal Factors:

The factors which are associated with the female partners are maternal factors which could be congenital or acquired.

Fig. 1: Factors causing infertility and the recent advances in ‘ART’ Assisted Reproductive Technology. LMWH, low molecular weight heparin, IMSI, Intracytoplasmic morphologically selected sperm injection, * IVIg, IV Immunoglobulin, ICSI, Intracytoplasmic sperm injection, * PGA, Pre genetic analysis for aneuploidy, PGM, Pre genetic analysis for monogenic disease, *LIT, Lymphocyte immunization therapy, G-CSF, Granulocyte stimulating factor, MACS, Magnet assisted cell selection.

Anatomical uterine abnormalities:

Uterus is the place where embryo is to be placed. Uterine abnormality which may make it difficult for embryo to implant and grow. These abnormalities either congenital or acquired can lead to failure of embryo to implant.

Congenital:

Congenital abnormalities are present from birth and may affect the shape, size, or structure of uterus. Some examples of congenital anomalies include:

· Bicornuate uterus – The uterus with two horns and a central septum.

· Septate uterus- The uterus with a central septum which divides the cavity in two parts, making two cavities.

· Didelphys uterus- Uterus having two separate cavities and two cervixes.

· Hypoplastic uterus- The uterus smaller than normal size.

· Arcuate uterus- The intend on the fundus of uterus. Unicornuate uterus, didelphys uterus.

Acquired:

Acquired uterine abnormalities are those that develop later in life. Few examples of these are:

· Adhesions -Which may be resulted from infections like tuberculosis, previous surgeries, Infections, or other injuries to uterus.

· Fibroids- Growths that develop in cavity, myometrium or wall of uterus.

· Endometrial Polyps- Growth that develops in the lining of the uterus.

· Synechiae or adhesions -Which are formed inside the uterus after infections or septic abortions.

· Hydrosalpinx- Fluid in fallopian tubes due to infection or endometriosis.

Endometrium:

The innermost lining of uterus is endometrium, which undergoes changes during the proliferative and secretary phases of menstrual cycle.

· Window of implantation (WOI), considered to be the crucial period for embryo transfer in which the endometrium undergoes biological changes and morphological changes hence embryo attaches, invades and then implant.

· The cross talk between endometrium and embryo is initiated by many immunological substances like cytokines (IL1, IL6, leukocytes inhibition factor (LIF), growth hormone, prostaglandins, human chorionic gonadotrophin (HCG), all these supports the process of embryo apposition and hence implantation. The endometrium also produces certain factors such as vascular endothelial growth factor (VEGF) and placental growth factor (PIGF)²³.

Thrombophilia:

This is the state of Hypercoagulability of blood. It refers to Inherited or acquired thrombophilia state of mother is associated with RIF, this leads to disturbance of the blood flow to endometrium and placenta and hence implantation failure.

· Inherited thrombophilia- It is caused by genetic mutations and causes clotting inability. Due to these mutations, there may happen deficiencies in protein C, and protein S, antithrombin, all these are regulating factors for clotting.

· Acquired thrombophilia are because of lifestyle conditions like obesity, diabetes, and hypertensions and hormone replacement therapy (HRT)²⁴.

Immunological Factors:

Pregnancy itself is a state during which woman’s body is forced to accommodate the foreign body of fetus.

· Human leukocytes antigen (HLA) is a protein which is present on surface of most of cells in the body. HLA compatibility plays major role in triggering the immune response of mother hence it accepts or rejects the semi-allogenic placenta and fetus.

· Tumor Necrosis Factors Alfa (TNF¥) is pro-inflammatory cytokine, which is considered to trigger the immunological maternal response.

· Uterine natural Killer cells (u NK cells) are present in uterus and if are more active they destroy the embryo.

Paternal Factors:

Genetical and environmental factors affect the sperms counts and morphology, which further may become the cause of pregnancy loss or failure of embryo implantation.

· Oligospermia (count less than normal): It can be caused by variety of factors like hormonal imbalance, varicocele, lifestyle factors such as smoking and alcohol use.

· Teratozoospermia (abnormal morphology of sperms): Radiation exposure, toxins, drug usage may lead to Teratozoospermia.

· Sperms with DNA fragmentation (damage to the genetic material in the sperms): Oxidative stress and exposure to environmental toxins, radiation, advanced age may be the causing factor.

Embryonic Factors:

Embryo (zygote formed after fertilization of egg with sperm) itself is sometimes abnormal so may not implant. The various causes are

· Genetics of embryo-embryos with aneuploidy may not implant properly or result in miscarriage.

· Embryo itself is 1/3 responsible for implantation failure

· Abnormal embryo is responsible for RIF²⁵.

· Zona Pellucida of Zygote if the outer layer of embryo is thick it does not hatch and thus does not implant²⁶.

Infertility and its explanation in Ayurveda:

Although in any referral book of Ayurveda, the unequivocal description of infertility is not found. But all these books have given description of infertility in one or other way. ‘Charka Samhita’ has explained infertility as ‘Vandhaytava’. This book is one of the major referral books in Ayurveda. Here it describes the defects of female genital tract²⁷, along with characters of semen in male²⁸. According to Acharya Charak, ‘Vandhaytava’ is caused by ‘pradusht’, ‘Garbhashay’ (abnormal genital track), ‘beej bhag’ of ‘shonita’ (ovum/menstruation/hormone of reproduction in females), and ‘beej bhag’ of ‘shukra’, (abnormal sperm from father). It has described 20 diseases of female genital tract due to vitiation of ‘dosha’ and ‘dushay’²⁹These diseases of female genital tract are compiled here in table 1.

Table 1: Twenty ‘Yonivyapad’ Defects of female genital tract.

S. No.	Yonivyapad	Symptoms
1	Vataj	Vitiation of Vata
2	Pitaj	Vitiation of Pita
3	Kaphaj	Vitiation of Kapha
4	Tridoshaj	Vitiation of all the three doshas
5	Asrija	Flow of menstrual blood continuous even after conception
6	Arajska	Dirty colour discharge from Vagina
7	Acharna	Not maintaining hygiene of vagina (Infection in vagina)
8	Aticharan	Excessive desire of coitus (itching due to fungal infection)
9	Prakcharna	Pain in groins, back pain (pelvic inflammation)
10	Upaluta	Yellow coloured vaginal discharge(infection)
11	Pariuplata	Colour of menstrual blood changes may become yellow or black (endometriosis)
12	Udarvartini	Retroverted condition of uterus
13	Karnini	Untimely labor pain leading to premature delivery (cervical incompetence)
14	Putraghani	Kills its own fetus in uterus. Recurrent pregnancy losses.
15	Antarmukhi	Congenital abnormality leading to pain in coitus.
16	Suchimukhi	Anatomical defect of genital tract.
17	Sushka	If natural urges are suppressed during coitus, there happen the dryness.
18	Vamini	Expulsion of semen out of vagina with or without pain
19	Shandi	Congenital disorder of vagina
20	Mahyoni	Muscular protuberance causing pain in groins

Similarly, ‘Charak Samhita’ has described the special characters of pure semen as, ‘the Retah’ (semen), which looks like white crystal quartz, which is ‘picchila’ (slimy), ‘avidahi’ (non-blazing), ‘snigdha’ (unctuous and greasy). is good quality semen³⁰. Any alteration in semen from these characters due to pathological and physiological reasons, lead to defects in semen and hence infertility. According to ‘Ayurveda’, physiology and pathology depends upon three humors ‘Vataj’, ‘Pittaj’, ‘Kaphaj’, and due to their vitiation seminal defects occur^30. The defects of semen are also described as in table 2.

Table 2: Semen characteristics as per Ayurveda.

S. No.	Doshaj	Characteristics
1	Vata	Frothy, scanty, arid, slender, painful ejaculation
2	Pittaj	Putrid odour, yellow or blue coloured, burning sensation
3	Kaphaj	Extremely slimy, obstruct passage of seminal vesicles

There could be some disorders of male partner, which are caused by excess intercourse, untimely and un-natural coitus, or complete abstinence, anxiety, emaciation to diseases, cautery, rage, apprehension, intake of food with excess of bitter, astringent, salty or soury taste. There are some disorders which are not treatable like ‘Klabaya’(impotency) due to agenesis of testies, this state is described as ‘beej upghat’, can be congenital or hereditary. ‘Dhawajoupghat’ (erectile dysfunction), ‘jara’ (senility), and ‘shukrashamkhshay’ (diminished semen)³⁰.

‘Sushruta Samhita’ has included infertility in diseases of ‘gynecological disorders of women’. But a complete entity of infertility is not there. according to ‘Acharya Sushrut’, ‘Vandhytava’ is explained under the ‘vataj dosha of yoni’. It writes ‘vandhayam nashtartvam vidyat’ which means absence of ‘beej’ or ‘rajsarav’ (menstrual blood)³¹.

‘Acharya Sushruta’ explained that for a female to conceive, there required the essential factors which are named ‘Garbsambhav Samagri’ in his samhita. These are four in number (i) Ritu – fertile period, (ii) Kshetra – uterus, (iii) Ambu – nutrition, and (iv) Beej – ovum and sperm. When all these factors come together the conception takes place. Just like the case if seed, appropriate season, fertile land and water come together the healthy crop is produced³².

According to ‘Acharya Sushruta’, there are eight ‘Shukra Doshas’ signs in paternal semen³³ that cause male infertility, (i) Vata – semen vitiated by the deranged Vayu acquire (reddish- black) colour and gives rise to pain which characterises the Vayu, (ii) Pitta – semen deranged by Pitta gets a yellowish or bluish colour and produces burning sensation, (iii) Kapha – semen vitiated by the action of deranged Kapha has white colour and produces itching sensation, (iv) Rakta –the semen vitiated by Rakta produces pain similar to that of Pitta and semen smells like putrid corpse, (v) Granthi-Bhoot – the shredded or clotted character of the fluid (Granthitha) is due to deranged Vayu and Kapham, (vi) Puti- Puya –looks like putrid pus by the action of deranged Pitta and Kapha, (vii) Ksheen- Shukra – semen is thin due to deranged Vayu and Pitta, and (viii) Mutra- Purisha Gandhi – A concerted action of the deranged Vayu, Pitta and Kapha causes the semen to smell like urine or faecal matter.

‘Ashtang Hridya’ and ‘Ashtang Sangrha’ two other referral books has also discussed infertility. It has been explained that infertility can be caused because of loss of ‘Beej’(ovum) and ‘Aartav’ (mensturation)³⁴. The congenital causes of infertility have also been mentioned, like If the ovum get vitiated by some doshas then the child born will be infertile³⁵. Further the congenital defects of foetus and recurrent pregnancy losses, intrauterine growth retardation are also related to age, diet and diseases of female and male³⁶. ‘Harit Samhita’ has explained infertility, not only the inability to conceive but also not having the live child even after conception, that means recurrent pregnancy loss (RPL). It has named the female ‘Vandhya’, who is childless even after the conception. According to ‘Harit Samhita’, this is of six types³⁷, (i) Kakavandhya – one child sterility, (ii) Anapatya – no child i.e., primary infertility, (iii) Garbhsravi – repeated abortions, (iv) Mritvatas – repeated still births, (v) Dhatu-Kshay – loss of specific strength to conceive, and (vi) No Ayurveda term written here sexual intercourse with girl before menarche causes contraction of uterus.

‘Kashayap Samhita’ has described the appearance of secondary sexual characters in the age of sixteen. If dietary habits are good the secondary sexual characters may develop early³⁸. Further it has been mentioned here that due to misdeeds of pregnant woman and her surroundings where she is living with her husband, are befitting then‘Jataharinis’/’Revati’, kill the mother and fetus³⁹.Revati causes various types of abnormalities in offspring, and hence infertility in females by afflicting the woman during different phases of menstrual cycle, like at the time of ovulation, conception, antenatal or puerperium. If the basic norms of physical, mental and social conducts are not followed by the couple then these ‘Jataharinis’ may invade the pregnant woman. The basic cause seems to be asocial behavior like jealous, hate, disrespect, apathy towards elders and respectable people, egoistic nature, sedentary lifestyle, lack of hygiene, using infected garments or belongings of infected woman, swimming at place open to public, moving bare foot and getting contamination through soil. If both husband and wife are infected, then prognosis is bad but if wife only or husband only is affected then the treatment can be done. Presentation of various types of ‘Jataharinis’, their symptoms and relation to modern diseases is given in table 3⁴⁰.

Magnification of present through the lens of past:

Ayurveda is indigenous system of medicine. The authors of medical literature written in times of ‘Vedas’ and ‘Samhita’ were aware of infertility. ‘Acharya Charak’ has written that when a man combats with the woman of different clan after menstruation in fertile period then healthy sperm, healthy ovum, healthy uterus, time, with the management of wholesome diet, the healthy fetus delivers in time and with ease. In case of defects in genitalia, mental worry, derangement of sperm, ovum, diet and behavior, time and loss of stamina the female although being fertile conceive very late⁴¹. Here the foundation of genetics has been laid by saying different clan. Total 36 questions about conception were answered by Acharya Charaka. Here he discussed the origin of human being. Above all non- consanguineous cohabitation is advised. Along with this there is explanation of how sex of fetus is determined? why twins or multiple pregnancy takes place? why fetus is born with different congenital sex disorders? why intrauterine growth retardation takes place? what is pseudopregnancy? How beautifully the physiology, pathology, immunology and formation of embryos, the nutrition, the development of fetus as conceptus, the behaviors, lifestyles, day today activities, diets and etiquettes of pregnant woman has been explained⁴². Detailing it further, in following literature Kashyap Samhita has brought the concept of ‘Jataharinis’. ‘Jataharinis’ are the group of demons which who have divine vision, they attack women to destroy or produce serious problems of menstrual cycles, recurrent abortions, still births, intra uterine fetal death, neonatal deaths and severe diseases to newborn hence decrease their life span. If we have a closer view of etiology of ‘Jataharinis’, it reveals that this is the group of diseases which includes viral infections, contagious infections, sexually transmitted diseases, neonatal jaundice, twin transfusion syndrome, eclampsia, pregnancy induced hypertension and diabetes.

DISCUSSION:

Technology has been so advanced that we can make good grade embryos in laboratories, we can do pre genetical detection, selection and hence find the euploid embryo to transfer in uterine cavity. We could produce recombinant gonadotrophins, oestrogens and progesterone. These drugs provide support (nutrition) to the endometrium. Biotechnology has played an important role in production, quality control and quality assurance, transportation from factory to users. Industry is trying hard to make these fertility drugs cost effective so that these drugs could be affordable to people of every socioeconomic class. In spite of all these efforts, carry home a healthy baby is still a difficult task. To improve the results of IVF we should focus on causes of failure. One of the important causes of IVF failure is abnormal embryo and implantation failure. Ayurveda clearly explain four main reasons for conception are, Ritu (fertile period), Kshetra (uterus, fallopian tubes, vagina), Beeja (healthy ovum and healthy sperm) and Ambu (nutrition). Acharya Charak also talks about concept of Beeja, Beejabhaga and Bheejbhaga-avyav which is probably the base for highly evolved concept of genetic of infertility. Acharya Kashyap gave detailed description of ‘Jataharinis’ in which group of infectious disease, genetic causes, environmental and psychological aspect of infertility are explained. Modern medical research provides an explanation for the unidentified causes of prenatal death and infertility, and moreover chromosomal abnormalities, together may be referred to as ‘Jataharini’.

We can apply artificial reproductive technology to make embryos from eggs and sperms and also transfer the embryo in endometrium, if there is any pathological, physiological, anatomical factor either acquired or inherited or unexplained. This invention has helped millions of couples around the globe to achieve the goal of producing progeny. According to Ayurveda, the pathophysiology of infertility is all related to vitiation of Vata, Pitta, and Kapha. When in normal state ‘Vata’ does support (Dharana) and divisions (Vibhajan). That explains the natural process of development of follicle, its maturation and then due to the action of Vata, it releases i.e., ovulate. Due to Pitta, all transformation from progressive endometrium to secretory endometrium, the hormonal changes take place, further Kapha, is responsible for the nutrition³⁴. We strongly recommend the application of our ancient health care system Ayurveda for ‘garbhsambhavsamagri’ (ritu, kheshtra, beej, and ambu), ‘garbh’(foetus) and ‘garbhutpatti’ (carry home baby). The understanding and amalgamation of our past rich and healthy concepts and new techniques may minimize the rate of IVF failure and can bring a ray of hope for future generation^{43, 44, 45, 46}.

CONCLUSION:

Even after so much advancement in treatment of infertility and availability of resources to treat the causes, struggle of infertile couples does not seems to be stopping. We need to guide the people to adopt life styles which are advised by our Ayurved acharyas. The concepts are available in ancient literature of Ayurveda. There is complete description of routines, diets, and regimes to be followed to stay healthy and improve the reproduction, which includes best of Ritu, Khshetra, Beej and Ambu. The ‘Jataharinis’ are probably the abnormalities which affects the genetics of garbha, and has pathological effects on developing foetus, either leads to growth retardation, congenital defects and even intrauterine deaths of foetus. The lifestyle of pregnant women, before and after the conception has effect on development of foetus. Pregnancy induced complications like hypertension, diabetes, renal and liver function alteration can be avoided by mere taking care of planned diets before and during pregnancy. Thus, Ayurveda can help the infertile couples to achieve the goal of parenthood.

ACKNOWLEDGEMENTS:

The authors are thankful to the Lovely Professional University, Punjab for the infrastructural support.

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Received on 05.08.2024 Revised on 16.12.2024

Accepted on 20.02.2025 Published on 05.09.2025

Available online from September 08, 2025

Research J. Pharmacy and Technology. 2025;18(9):4571-4577.

DOI: 10.52711/0974-360X.2025.00656

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

S. No.	Jataharini	Symptoms	Relation to modern diseases
1	Vikuta	Irregular menstruation	Caused by hypothyroidism, uterine myoma, uterine polyp, infection in the uterus, dysfunctional uterine bleeding, cervical cancer, hormonal imbalance, PCOS etc.
2	Parisruta	Abnormal Vaginal discharge	B Bacterial vaginosis chlamydial infection, pelvic inflammatory diseases, yeast infection etc.
3	Andhaghani	Abortion in second trimester.	Uterine malformations, fibroids, cervical anatomical defects, defects of umbilical cord of placenta
4	Durdhara	First trimester abortion	Chromosomal abnormalities, progesterone deficiency
5	Kalaratri	Still birth in third trimester	Infections, hypertensions, gestational diabetes
6	Stambhini	Decreased fetal movements.	Placental insufficiency, fetal hydrops
7	Nakini	Intra-uterine death of fetus.	Pre-eclampsia, abrupt placenta
8	Pischai	Fetal death immediately after birth	Associated with neonatal jaundice
9	Vashay	Fetal death in 5^th, 6^thand7^th month of conception	Clotting disorders of females, placenta previa, placental insufficiency
10	Kulkhshavkari	Only male fetus die, female survives	X-linked genetic disorders
11	Punvaiani	Fetus dies immediately after birt	Birth asphyxia
12	Sandanshi	When next baby born the previous one dies	Malnutrition due to less gap between two pregnancies
13	Indravadha	Death of twin fetus	Twin to twin transfusion syndrome
14	Badhvamukhi	Death of twins	Single umbilical cord