The Influence of the Harmonal Activity of the Ovaries Upon the Character of Tubal Contractions as Determined by Uterine Insufflation: A Clinical Study

Abstract

<h2>Summary</h2> The character of tubal contractions as elicited by uterotubal insulation was studied in relation to the type of menstruation in 513 patients with tubal patency. The patients with normal menstruation were divided into three groups: (1) those who were insufflated from the seventh to the tenth day, counting from the first day of the menses; (2) those between the tenth and sixteenth days, and (3) those between the sixteenth and twenty-eighth days. Because of the greatest interest in identifying the event of ovulation, which is said to occur between the tenth and sixteenth dad- of the menstrual cycle, more than half of the cases fell into Group 2, totaling 300. These three groups were compared to each other and also served as a comparison for patients with abnormal menstrual cycles. There were 142 patients with habitually delayed menses, 20 with prolonged spontaneous amenorrhea, and 33 who had been subjected to x-ray castration for the purpose of inducing abortion. There were 5 women in this series who had been subjected to treatment by so-called stimulating doses of x-rays to regulate the menses. Nine women who had entered the menopause had their tubes insufflated for comparative purposes. In addition, tubal contractions were studied in a group of 20 women with frequent and profuse periods. The results of this study have shown that <ul><li>A.In general the tubes in patients with normal menstrual cycles exhibit during insufflation uniform contractions and relaxations varying in rate between 3:4 to S:9 per minute; the less frequent rate coinciding with the anovulation phase (7:10 and 16:28 days); the more frequent rate of contractions with the ovulation phase (10:16 days). The tonicity of the tubes is moreover somewhat greater during the ovulation phase as evidenced by deeper ranges of pressure fluctuations.</li><li>B.In the patients with habitually delayed menses the uterotubal tone is in general lowered and the contraction relaxation rate less frequent per minute except when insufflation happens as it appears to coincide with a possible ovulation phase.</li><li>C.In the group of cases of spontaneous prolonged amenorrhea occurring during the reproductive period, uterotubal tone, frequency and range of tubal contractions are as a rule decreased, although a cyclical variation may be demonstrated in a number of them. In the amenorrhea of menopause, uterotubal tone, contraction rate and amplitude are all markedly diminished, contractions being frequently absent.</li><li>D.In x-ray castration during the reproductive period, a certain cyclical pattern is frequently maintained but the tonicity and frequency of contractions are relatively diminished.In the cases where so-called stimulating doses of x-ray were used, the effects upon the contraction rate and amplitude are augmented.</li><li>E.In the cases of frequent and prolonged menses, uterotubal tone, contraction rate and amplitude are less than in patients with normal periods and more than the group with habitually delayed and scanty menses.</li></ul> There appears to be a definite correlation between the character of tubal contractions as elicited by tubal insufflation and the menstrual function. Since the menses depend in the main upon ovarian function, whether this be primary or subordinated to the pituitary or other inner secretory glands, it follows that absence of menses or depressed menses may be assumed to be due to under-function of the ovaries. As tubal contractions are influenced by the hormonal action of the ovaries, any deviation from the normal may therefore be reflected in the pattern of tubal contractions. This appears to be susceptible of clinical assay and demonstration by uterotubal insufflation. In a few cases of prolonged secondary amenorrhea systematic injection of program was carried out. A dynamic effect upon the tubes appeared to be demonstrated (note. Fig. 2). Where there had been shallow or irregular and infrequent contractions prior to the progynon injections, they became regular, of increased amplitude and frequency after the injection. In order to establish typical patterns corresponding to the ovulation phase, a greater number of cases will have to be examined by this method and paralleled by blood and urine estrogen determinations as well as histologic examination of uterine and vaginal biopsies. The method is limited to patients with normally patent Fallopian tubes. When the tubes are nonpatent the uterus may serve as the medium for this Assay by the same method.