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Introduction: Female infertility, correlating with the Ayurvedic concept of Vandhyatva, affects approximately 15–20% of couples globally and presents a significant reproductive health burden. Uttar Basti (intravaginal/intrauterine medicated enema), a specialised Panchakarma procedure described in classical texts including Charaka Samhita, Sushruta Samhita, and Ashtanga Hridayam, is advocated as the foremost treatment in disorders of the female reproductive tract. This review evaluates its classical basis, pharmacodynamic rationale, procedural standardisation, clinical efficacy, and safety profile in the context of female infertility.

Methods: A systematic narrative search of Ayurvedic classical texts and peer-reviewed literature (PubMed, Scopus, Google Scholar, DHARA) was performed from inception to May 2025, using search terms: "Uttar Basti," "Uttarabasti," "female infertility," "Vandhyatva," "endometrial receptivity," "tubal blockage," "Panchakarma." Clinical trials, observational studies, case reports, and classical textual references were included. Studies with incomplete outcome data were excluded.

Results: Across 28 relevant clinical studies and 6 classical textual sources reviewed, Uttar Basti demonstrated significant improvement in endometrial thickness (mean increase: 1.8–3.2 mm), ovulatory function, fallopian tube patency, and conception rates (range 13–45%) in women with thin endometrium, tubal-factor infertility, polycystic ovarian syndrome (PCOS), and unexplained infertility. Medicated formulations such as Shatapushpa Taila, Bala Taila, Phala Ghrita, and Sahacharadi Taila were most commonly employed. The procedure was well tolerated with minimal adverse events when performed under aseptic protocol.

Discussion: The therapeutic efficacy of Uttar Basti appears to operate through local absorption of bioactive lipid molecules, modulation of Apana Vata, and anti-inflammatory, oestrogenic, and neuroprotective actions of its constituent drugs. Integration with contemporary fertility indices (transvaginal ultrasound, hormonal profiling, hysterosalpingography) enhances objective assessment. Methodological heterogeneity across studies, however, limits meta-analytic synthesis.

Conclusion:Uttar Basti is a clinically promising, minimally invasive Ayurvedic intervention for female infertility with a coherent classical and pharmacokinetic rationale. Standardised, multi-centre, randomised controlled trials with long-term follow-up are warranted to establish evidence-based protocols.

Keywords: Apana Vata; endometrial receptivity; female infertility; intrauterine drug delivery; Panchakarma; Phala Ghrita; Shatapushpa Taila; Uttar Basti; Vandhyatva; Yonivyapad