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This is a 32 years old woman; she is married and works as a kindergarten teacher.
Chief complaint: endometriosis and secondary infertility with male factor

Clinical
• She had a miscarriage in 2012 in 8th week of pregnancy
• In 2013 she had been diagnosed by ultrasound for first time to be suffering from endometriosis (left ovary)
• The first laparoscopy in 2014: cyst on left ovary sized 60 x 56 mm
• The second laparoscopy in 2015: cyst on left ovary sized 79 x 76 mm
• In 2015 Chlamydia infection
• Many unsuccessful IVF attempts
• Therapy with hormonal contraceptives
She consulted me for first time on 09 Oct. 2015

Menstrual Function:
• The cycles are irregular and shortened to 3 weeks or less
• Menses scanty lasts 3-5 days
• Lower back and ovarian pain before menses (1-2), amel. by warmth
• In the past watery and slightly bloody discharge during ovulation
• Menses difficult to wash of (1)
• Vaginal mycosis in the past
• Irritable before menses (3)
• Occasionally soft stool before menses (1)
• Desires for sweets during menses (1)
• Has sexual aversion to coition (3)
• Occasionally vaginal pain during coition (2)

The other symptoms:
• Thermal reaction: cold
• Head sensitive for cold air (2)
• Likes jogging and feels better after that (3)
• Likes music and sometime weeps while listening to it (2)
• Throat sensitive for cold drinks (2)
• Aversion to milk and milk products since childhood (3)
• Aversion to meat (1)
• Desires for sweets (2)
• Knotty stool sometimes

Sleep:
Good
Sleep position: on side

Past history:
• Jaundice
• Recurrent tonsillitis in childhood
• Sometimes eruption on the forearms and elbows (1)
• Sometimes pain on the left hip by motion (1)
• Dental granuloma (surgery)
• As child warts on the fingers
• Ingrowing nails in the past

Family history:
• Father alcoholic
• Mother ovarian cyst, early menopause
• Sister herpes zoster
• Grandfather (father's side) cancer of throat and alcoholic

This is a smart and pretty young woman with mostly dark cloths indicating a shy person. But in our conversation she left impression of an outspoken person.
She was the second of three children in the family. She had never good relationship with her mother. The mother was emotionally unavailable and unreliable. There were difficulties in communication with her. „I missed connection with my mother.” But she had understanding for her mother because she had three kids, little money and no support.
Her father was emotionally absent.
She married a „very good man“. He took care about household and cooked for them both.
She is angry with men because of their power and she discussed that topic with her husband too. She told him, she didn't want to cook for him. She is not interested in doing household work. She doesn't want to live like her mother. She said, she was prone to hate men and did not hide that from her husband. „I don't like men at all“. „I'm a feminist. “ Thus she doesn't like men to notice her and avoids attractive cloths. She feels humiliated while being watched by men. She dislikes vulgar clothing. Although she likes red lipstick she would never use it. „Maybe I'm not ready yet to be a woman. “
She would like to live in the times of Victorian England (certainly not because of the situation of women in that époque, rather she prefers distant men with good manners).
When I asked her what she would have changed about herself, she answered she would like to be more relaxed, flexible and more emotionally opened.

Analysis of the case

Concerning problems with infertility and endometriosis I always pay attention to symptoms regarding the menstrual cycle.
• Dysmenorrhea, head pain during, before and after menses, depressive mood, fullness of breast before and during menses
• Duration of menses, color, smell and consistency
• Candidiasis, leucorrhoea, pruritus vulvae, painful coitus...
It is also important to eliminate the miasmatic layer. Endometriosis is a sycotic condition because of the nature of the disease, which involves the pelvic and sexual organs. This case belongs to the sycotic miasm also due to miscarriage, overgrowth of tissue, benign enlargements, infertility. I don't use the nosods only as miasmatic but also as constitutional remedies. But with some complains such as endometriosis and infertility I use the nosodes as intercurrent remedy. The response to the indicated constitutional remedy dramatically improves after the use of the anti-miasmatic remedy.
When dealing with infertility it is important to treat not only the woman but also her man even if he was not diagnosed with MFI (male factor infertility), while the constitutional remedy would boost his immunity too. In this case it was obvious to me that her husband must be treated (Oligoasthenoteratozoospermia) and I treated him with his constitutional remedy Calc-carb. (obesity as child and young men, kyphosis, profuse perspiration after slight exercise and other symptoms) and Luesinum as the intercurrent remedy because of the degenerative processes (kyphosis).

So I picked following repertory rubrics (R. van Zandvoort) for this case:
• Mind; Indolence, aversion to work; housework, aversion to her usual
• Mind; Irritability; menses; before
• Female; Coition; aversion to
• Female; Endometriosis
• Female; Enlarged; ovaries
• Female; Menses; early, too, frequent; scanty, and
• Female; Menses; short, too
• Female; Sexual, libido; desire; diminished
• Generalities; Food and drinks; milk, milk products; aversion
• Generalities; Motion, motions; amel.
10 Oct. 2015: Sep. 10M

Firs follow up 15 Nov. 2015:
• Two months before the homeopathic therapy she had a menstrual cycle of 17 days, now it appears after 24 days
• During menses she felt ovaries and cramps in the uterus, but this time she didn't have lower back pain
• After work she didn't feel as tired as she used to
• She started to jog
Sach. lac.

Follow up 01 Dec. 2015
• Menses after 19 days
• It lasts 2 days
• A little leucorrhoea before menses
• Restless sleep
• Sore throat, which disappeared after two days without being treated
Thuj. 1M
(Between Thuja and Medorrhinum as anti-sycotic remedies I chose Thuja for this case because it is a chilly remedy, while Medorrhinum is a hot one. Medorrhinum also has much more local symptoms.)

Follow up 10 Jan. 2016
• Menses after 25 days
• Libido a little increased
• No detectable cysts on ultrasound
Sep. CM (Fincke)

Follow up 15 Feb. 2016
• Menses after 26 days
• No more vaginal pain during coition
• She needs less sleep
Sep. CM (Fincke)

Follow up 20. March 2016
• Menses after 25 days
• Libido increased
• The feet no more cold
• She feels like cooking
Sep. CM (Fincke)

Follow up 25 Apr. 2016
• There are already 26 days after the last menses and she didn't get her period yet
• She feels generally good
Sach.lac.

After one week she contacts me to say she was pregnant.

Now, after two months of pregnancy, she doesn't have any remarkable complains.

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A case which is very informative , well taken up and with detailed analysis. Did she ever take birth control pills in her life? Can this be verified please?.

Dear Mr Ram sarup saini, thank you for your comment. Yes, I checked it, the patient had been taking birth control pills for two years ten years before homeopathic treatment.

Birth control pills have a dire effect when women want to have children later on in life

Good observation. Yes, birth control pills can alter the hormones and the cycles. Often times Sepia addresses the effects. Thank you Zaklina for sharing your experience. 

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