Infertility is the inability to conceive; it may be
remedied. However, should the conditions persist; it is referred to as
sterility.
In the United States,
one out of every 8 to 10 couples are
childless because of infertility; it is a major medical and social problem.
Both husband and wife are urged to seek medical attention for complete
examinations and evaluation, since almost as many men as women cause a sterile
marriage.
It is usually recommended that the male be evaluated first,
because tests for the female are more expensive and time-consuming. Such tests
may require the services of a urologist, gynecologist, endocrinologist, and
internist.
In the female, the organs of reproduction and the glands
influencing them are evaluated. Among the causative factors may be displacement
and tumors of the uterus, genital infantilism, and inflammation. To allow
fertilization of an ovum, it is necessary that the vagina, cervix, and uterus
to be patent and have mucosal secretions receptive to the sperm. Semen is
alkaline, as is cervical secretion; normal vaginal secretion is acid.
Treatment is directed towards correcting the deficiencies
encountered in the individual patient. The following tests assist the
gynecologist in delimiting the problem.
1. Rubin test
This procedure is to determine the potency of the fallopian
tubes by introducing carbon dioxide through a sterile canula into the uterus,
into the tubes, and into the peritoneal cavity.
By listening with a stethoscope on the abdomen, the
physician may hear the gas swishing into the abdomen. If the pressure gauge
reaches 200 mm.
of mercury, an occlusion may be suspected.
2. Salpinogram; Hysterosalpingogram
A radiopaque substance is often used to determine the site
of tubal obstruction; an x-ray picture then shows the outline of the tubal
lumen.
3. Hubner test
Within an hour or two after intercourse, the physician
aspirates cervical secretions with a long cannula. The woman is to be
instructed not to void, bathe, or douche between coitus and the examination; a
perineal pad is worn until she is placed in “lithotomy position” in the
examining room. Aspirated material is placed on a slide and examined under
microscope for presence and viability of sperm cells.
Treatment
The treatment of sterility is a difficult matter, because it
may be caused by a combination of several factors. Efforts are made to build up
the general health of the patient, supplying lacking glandular hormones as
indicated.
Operative treatments include removal of obstructions and
plastic operations to restore tubule potency. Unfortunately, these are not too
successful; in addition, there is a high incidence of tubule pregnancy
following such operations.
The psychic and social factors of infertility must not be
overlooked. Among some religious groups and nationalities, it is important to
have blood descendants; adopting children is not acceptable in these families.
In other family groups, the man’s virility, or woman’s
femininity are suspected when a couple fails to have children. Many pregnancies
have occurred after an infertile couple has adopted a child, moved to another
location, or the husband had a change of jobs.
All of these things indicate that the concepts behind
infertility are not absolute and concrete. There are instances that the
information about this particular problem may have underlying causes that
should not be blamed on the inability of the person to conceive.
Boiled down, the problem on infertility is more of a social
problem than a biological problem. It is not the aspect of not being able to
conceive that persons involved are hesitant to disclose the matter.
If it is more than just biological malady, then, it requires
tough solutions.
