II. HYALURONIDASE IN TREATMENT OF HUMAN STERILITY

Abstract

Abstract Hyaluronidase, an enzyme capable of hydrolyzing hyaluronic acid, has attained moderately widespread use in the treatment of sterility. Doubtful as its value in this connection seems to be, it is thought worth while to report a case of a local reaction encountered during its clinical application. The enzyme hyaluronidase, a so-called spreading factor, has been recommended in the treatment of human sterility by Kurzrok et al. 1 who have reported favorable results. The theoretical basis for the trial of hyaluronidase in this work rests upon several biological considerations, 2, 3, 4 most important of which is the fact that the enzyme is said to be capable of causing dispersal of the follicular cells of recently ovulated mammalian ova. The use of hyaluronidase implies acceptance of the belief that this disintegration of the corona is a prerequisite to fertilization of an ovum. It is not within the scope of this report to discuss the rationale or practicality of this employment of the enzyme. The method has not been successful in the hands of one of the authors of this paper (R. E. T.). The hyaluronidase which was used in the treatment of sterility was derived from bovine testes. The bull testis hyaluronidase was provided by Schering and Co. It is protein in nature, and contains inorganic phosphorus and organic sulfur. One of us (R. E. T.) has collaborated in the experimental treatment of a series of 35 women. The technique in most instances was that suggested by Kurzrok, namely, the packing of 10 mg. of hyaluronidase into the cervix near to ovulation time, this application followed by intercourse within a few hours. Of the 35 women to whom a total of 90 treatments were administered, one complained of a troublesome local reaction following each of three cervical applications of the enzyme. None of the other patients experienced such discomfort.