Sterility

Abstract

Sterility is the inability to initiate the reproductive process on the part of a couple who have attempted to do so for at least one year. The first and most important step is an organized plan of study of both husband and wife. The minimal diagnostic study consists of complete history, physical examination, urine examination, blood count and basal metabolism determination of both, examination of the semen which includes motility, vitality, number of sperm per c.c. and sperm morphology according to the work done by Moench; postcoital examination, (Hühner test), uterotubal insufflation (Rubin test), and endometrial studies. Further endocrine and other studies of both, and urological examination of the husband, if indicated, are done. Treatment should not be undertaken before the study is completed and should be based upon the findings. Attempts should be made to correct every fault found in each mate, as in that way the best results will be obtained in the shortest possible time. Male sources are usually due to general constitution depression reflected by the infertile sperm specimen, and in only a small percentage of the cases are local factors responsible. The female sources are usually local factors such as mechanical obstruction by cervical and/or tubal pathology. In one-third of our cases, the infertility was due to the husband. Indicated surgical procedures are discussed; needless surgical measures are condemned. Prophylactic measures are listed and some illustrative cases briefly presented. With our present knowledge, we can accomplish more to relieve sterility than ever before. A large measure of the success is due to this more complete study. The method of study outlined can be accomplished by gynecologists in any location, whether it is a large medical center or a small town. The acquired experience in the various tests must be obtained before any treatment is undertaken. The chief purpose of this paper is to prevent unnecessary, useless, and harmful surgery, and to urge every physician who deals with a sterile couple, to make use of the additional knowledge and experience which we now have.