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Case Study

Hyperprolactinaemic Infertility
NATIONAL JOURNAL OF HOMOEOPATHY 1998 Sep / Oct VOL VII NO 5.
Dr [Ms] Meena Mankani
'Ipecac

Introduction
Elevation of Serum Prolactin is a common endocrine finding and may arise from a variety of causes. In men, hyperprolactinaemia usually presents with loss of libido or impotence. Whereas in women, amenorrhoea, oligomenorrhoea, deficient luteal phase progesterone production or menorrhagia may all be associated. Hence it becomes very important to measure Prolactin in cases of unexplained infertility or irregularly irregular periods.
Herewith I present one such case, wherein the indicated Homoeopathic remedy corrected the dominant hormonal dysfunction, effectively.

Our Patient:
This was a 28-year-old young woman, fat, fair and flabby; with a not-too- friendly expression on her face. She came accompanied by her husband on 3rd of Feb 1997. She spoke very little, whereas her husband did all the talking, including all the intimate details of her emotional and physical sickness.
He elaborated every detail of her 'not too normal' behavior right in front of her, of which she neither approved nor disapproved, but just remained quiet.

Chief complaint:
After her first child [girl] at the age of 20, she conceived again at 22, but had a miscarriage at 1½ months. After that her periods have become far spaced out and very scanty, lasting only for a day. Also she had not conceived since then, in spite of all their attempts. All the investigations showed no abnormality except for the S. Prolactin levels, which when first done, was 490 mu/litre. With treatment, the level decreases for sometime, but that does not help in conceiving or regularizing her periods.

Besides, 4 times in the last 6 years, she had bad episodes of profuse bleeding and every time she was 'extremely upset'. The bleeding would start suddenly, bright red blood steadily flowing out, accompanied by severe nausea and vomiting. Each time she had to be hospitalized and given blood transfusions and percutaneous hormonal treatment.

Life space and mentals:
Being the only pampered child, she had learnt to have things her own way. Even after her marriage at 19 years, being the eldest daughter-in-law, she was given all the due respect and importance. She also, in her own way, served her in-laws with all the sincerity. The birth of her 1st child was rejoiced a great deal. The sailing was smooth until the stepping in of her younger sister-in-law [SIL], who came from a very affluent family and brought a magnificent dowry. The newcomer soon became the favorite of her in-laws and the cause of our patient's miseries, since she was now tactfully sidelined.

To the shock and horror of her in-laws, whenever anyone praised her SIL or appreciated things brought by her, she would start yelling, abusing and cursing her in-laws for the injustice being done to her. Besides, now her greed knew no bounds. She had always been in a habit of hoarding all necessary and unnecessary things, but now the exaggerated insecurity and the jealousy accentuated her foolish shopping sprees. She had everything, yet she wanted more and more. She would buy things without knowing why, but would never be satisfied with it. She would get expensive sarees for herself, but no sooner she came home, she would not like them and yearn for something else and something more. She would always feel less privileged. She just kept on yearning for more and more but never knew what. On one such occasion, when it became too much for her husband to bear, he beat her badly in front of everyone in the house and threatened her with dire consequences, if she did not behave herself. Ten days later she had a miscarriage of 1 ½ month pregnancy. Thereafter she became quiet and indulged herself most of the time in eating anything kept in front of her, to the extent that in a span of 4 years she swelled from a reasonable 60 kg to a whopping 85 kgs. She would just wallow in self-pity and not talk much to anyone in the house, even to her husband.

Consequently, their sexual life also suffered to a great extent. During this period, whenever her resentment reached unbearable limits, she would suffer from the bleeding episodes and would need hospitalization. Although everyone treated her very gently and were sympathetic towards her, yet she could never overcome her greed and resentment and could never feel one with them.

Some Other Personal Details:
She did not suffer from any major disease in the past. Both parents have Diabetes Mellitus and Hypertension. She did not have any particular cravings since she would just eat anything and everything she rested her eyes on. Thirst was not much. She had a disturbed sleep with a lot of vexatious dreams, due to which she would wake up unrefreshed and sulky. She hated summers and loved air conditioners and cool baths.

Examination:
Pulse- 88/min. BP - 142/84 mm of Hg
Temp - 98.60 F
Dark circles around eyes ++
Tongue smooth, salivated and indented
Smooth clear nails
Grey hair + 
Ht 5' 3"
Wt - 89 kgs

Analysis Of The Case:
A remedy had to be selected which would have intense overt passions in its pathogenesis -anger, greed, jealousy etc the forceful suppression of which lead to pathological breakdown and haemorrhage. Particularly interesting was the jealousy in the case, which was in striking contrast to the well known jealousy of Lachesis. A Lachesis jealousy is often difficult to identify owing to the shrewd manipulation of the patient. Whereas in this case, it was clearly open for everyone to see. There was no adult restraint of the negative emotions, but a childlike simple yelling and fretting. And when the emotional yelling was strangled, the uterus started yelling out.

If we look into the rubric in the Synthesis [all rubrics in this case have been taken from it]:
METRORHAGIA, Vexation, after, the remedies are: Ipecauanha and Kali-carb, of which in my opinion, Ipecac suited the case the best.
If we were to carefully look into the personality of our patient, we can easily appreciate two beautifully distinct facets of the remedy, arising from the same basic disturbance,. The 1st facet: OVER PASSIONS, wherein mainly the mind suffered. The Rubrics:

03

MIND, ailments from anger, indignation with

79

MIND, Delusions, unfortunate, he is

114

MIND, Greed, cupidity

25

MIND, Capriciousness, longing for things which are rejected when offered

83

MIND, Desires, full of inexpressible

117

MIND, howling

2

MIND, Abusive, insulting

38

MIND, Cursing

134

MIND, Jealousy, appreciate anything, desires that others shall not

At this stage of vital disturbance, when she was subjected to the exciting factor of scorn, by being beaten up in front of everyone [MIND, ailments from scorn pg5], the elementary disturbance shifted to further intense and deeper levels of derangement; now both at the mental and physical levels. This second facet could be understood from the following rubrics:

3

MIND, Ailments from, anger, suppressed

79

MIND, Delusions, unfortunate, he is

111

MIND, Forsaken feeling

115

MIND, Grief, silent

159

MIND, Quiet disposition

191

MIND, Talk, indisposed to

114

MIND, Gourmand

672

STOMACH, thirstless

1615

GENERALITIES, hemorrhage, blood bright red

648

STOMACH, Nausea, hemorrhage with

903

FEMALE, menses, scanty

903

FEMALE, menses, short too

The Remedy Response:
On 10th Feb 1997 she was given a dose of Ipecac 10M followed by placebo Gradually, in course of time, her periods regularized and she conceived by March 1998 and is 8 months pregnant now. The remedy was repeated in 10M potency on 5th of April 1997 and 18th of Aug 1997. The 50M potency was given on 30th of Dec 1997 and 28th of May 1998. The last dose was given in CM potency on 8th of July 1998.

As far as her mental condition is concerned, she needed a great deal of counseling still. Now, she has softened towards her in-laws. But the exciting factor [SIL being more affluent in every way] being constantly persistent, her hoarding and displeasure does continue to some extent, although her displeasure is never as overt and unpleasant as before. However, her purchasing sprees are much spread apart since now she feels, what is the use? Most of the things just expire before I can use it."

Her appetite has also reduced a lot and she had lost 16 kgs and looks much better before she got pregnant. Now she is pleasantly looking forward to the birth of her child, boy or a girl.

What I Learnt About Ipecac From This Case:
Ipecac, generally thought of in coughs, bronchitis and gastric ailments, particularly in children, has rarely been used in chronic difficult conditions. However, the excellence with which it worked in this case, correcting the vital derangement at all the deeper levels, proves its efficacy in the most difficult conditions as well.

The mental - emotional picture that emerged from the study of this patient is most impressive. They seem to be the most unfortunates, unfulfilled gourmands. They are never satisfied and content with anything and they know not what will make them content [MIND, Discontented 85] so their greed knows no bounds and they go on HOARDING THINGS, and at physical level, they go on eating. Unlike Calc and Lyco who eat for pleasure, an Ipecac overeats since nothing pleases or satisfies their fretful palates. They go on hoarding and eating with a desire of fulfillment, which forever evades them. They never reach FULFILMENT and so forever feel unfortunate [even in the best of conditions]. Since nothing satisfies them, they can't appreciate anything and out of jealousy they also don't like if others appreciate certain things that pleases them.

They are the typical DISSATISFIED HOARDERS who never achieve fulfillment owing to their CAPRICIOUSNESS. So they end up screaming, yelling, howling and quarreling. They feel they are lucky enough to get their curative remedy that finally puts some clarity and sensibility in their confused and greedy brains.