What Doctors Can Do to Promote Fertility

In this informative interview, Dr. Edward T. Tyler, associate
clinical professor of medicine, obstetrics and gynecology at the
University of California at Los Angeles School of Medicine, and
also president of the Pacific Coast Fertility Society, discusseso
the latest medical developments in helping infertile
couples who would like to have children

Condensed from Today's Health, published by American Medical Association, ©1961

BY GRACE NAISMITH

Q : Dr. Tyler, is it true that there are more couples unable to bear children than there used to be?

A:Yes. According to statistics, one of every ten married couples is faced with the problem of a barren marriage. Of course, more men- as well as more women-are willing to seek medical aid today. This increases the statistical record.

Q: You said "more men" are seeking medical aid. Isn't it thought that sterility is the woman's fault?

A: Some people still make this mistaken generalization, but be tween 40 and 50 percent of all sterile marriages may be attributable primarily to the husband. Neither the husband nor the wife is to be "blamed for a condition which prevents them from conceiving a child. Often these conditions can be corrected.

Q: But don't most people think of sterility as hopeless?

A: Strictly speaking, sterility is, as one doctor defined it, "the permanent state of infertility." Today more
and more infertile couples are being helped to be fertile.

Q: How large a percentage?

A: About 40 percent. And more could be helped if husbands would cooperate with medical examination and treatment. Many specialists and clinics, such as the Margaret Sanger Research Bureau in New York City, will take cases only when both husband and wife come for treatment.

Q: Why don't all husbands cooperate?

A: Perhaps because of the male ego. Many men don't know the difference between "virility" and fertility. But we have found that most infertile male patients are entirely normal with regard to all "he-man" traits

Q: What causes infertility?

A: There are as many causes as there are vulnerable spots in the reproductive process. Conception requires that a sperm cell from the male and an egg (ovum) from the female meet in the Fallopian tubes. If fertilized, the egg is propelled into the uterus, where it is implanted, nourished and grows until ready for delivery nine months later. Infertility can occur if any link in the chain is broken in this reproductive process. And the entire chain is far more complex than this brief description indicates.
In the fertile woman there must be normally functioning ovaries. She must ovulate (produce an egg). The uterus must be normal and the Fallopian tubes must be clear so that the sperm and egg can meet. In the fertile man there must be production of millions of healthy, active sperm. And in both the man and the woman the hormone-producing glands must be normal.

Q: What tests are made to find out if anything is not normal?

A: For the female, basic tests include, in addition to complete physical examination, a test of the Fallopian tubes for blockage, an X ray of the pelvic organs, a check on blood iodine, and study of tissue samples taken from the lining of the uterus. For the male, tests include complete physical examination, a check on blood iodine, and semen evaluation.

Q: Who can treat infertility?

A: Any well-trained physicianthe family doctor, a gynecologist, a urologist, an internist or an obstetrician. Each year the American Society for the Study of Sterility conducts meetings, seminars and postgraduate courses for physicians. Last year more than 700 physicians attended one of the major conferences.

Q: Can anything be done for an infertile couple whose tests show that husband and wife are "normal"?

A: Yes. "Normal" is a category which includes between 30 and 40 percent of all infertile couples. For these we try more tests, some of which are new and experimental. One of the most recent and exciting research discoveries leads us to believe that there is some type of "reproductive incompatibility" among certain couples which prevents conception. The male sperm and the female ovum simply do not get along. We might say that they are "allergic" to each other.

Q: Then this might account for the childless woman who remarries after divorce or after her husband's death and immediately conceives?

A: Yes. Reproductive incompatibility is difficult to explain. Let me attempt it this way:

Two physicians in the Netherlands, Drs. Philip Rumke and George Hellinga, both associated with the Red Cross Blood Laboratories in Amsterdam, made extensive studies of the blood of some 2000 infertile and fertile persons. In a number of the infertile patients they found that the blood contained substances "hostile" to sperm. These substances are similar to the blood chemicals called antibodies which protect us against certain diseases. It is conjectured that antibodies-described by Webster as any substance that opposes the action of another substance-can make ineffective or neutralize the ability of sperm to fertilize or even to move.

Q: Isn't there another kind of hostility between male and female reproductive secretions? It's related to the acidity of the female's secretions?

A: Yes. The male seminal fluid is alkaline. The fluids in the female vagina are acid-this probably being nature's way of helping to keep harmful bacteria from causing infection there. At the same time, acidity is harmful to sperm, and if the semen lacks enough alkaline to neutralize the female's acid fluids, the sperm can be immobilized. Fertility specialists sometimes need to "equalize" the alkaline-acid environment in the vagina to avoid the destruction of the sperm.

Q: Suppose the sperm are weak to begin with?

A: Unfortunately, there are only limited types of treatment available for the husband. Proper diet, rest, a clearing up of certain infected areas such as bad tonsils, often improve fertility conditions. In some cases, hormones are helpful.

Q: What about the psychological aspects of infertility?

A: Some physicians believe that emotional problems cause infertility in a great number of patients. Dr. Karl Menninger, of the Menninger Clinic, Topeka, Kan., says that numerous cases have been reported where "reorganization of the psychic life" was followed by pregnancy in marriages barren for ten to 20 years. Just reassurance and understanding may help in "relaxing" a couple so that pregnancy occurs.

Q: Is it true that many childless couples adopt a child, "relax" and then have one of their own?

A: That is common belief, but several studies have proved "it ain't necessarily so." Some adoption agencies are now seeking additional statistical information on this theory.

Q: What are the tests for ovulation?

A: First, one must understand that ovulation-the release of the ovum from the ovary-occurs but once during the menstrual cycle. We are not sure, as yet, how long the sperm are capable of fertilizing the egg or how long the egg is capable of being fertilized. Though sperm can live almost a week in the female, they may be able to fertilize for not much more than 24 hours.

It is obvious that to the couple wanting a child, the date of ovulation must be pinpointed as closely as possible. There are various methods. One is by a daily check of body temperature. Ovulation is thought to occur at a point when temperature lowers and then rises slightly.

Other tests include vaginal smears, "spinnbarkeit"-a measure of the cervical secretions-and the fern test, which is useful in showing under a microscope a series of patterns indicating the ovulation period. More recently, a paper-color test based nn the detection of glucose in cervical secretions has been developed, but it is not very accurate. We are constantly on the lookout for new ovulation tests-particularly those which women may use themselves-to ascertain the 12-to-24-hour fertile period.

Q: What if a woman does not ovulate?

A: Ovulation fails to occur in only about five percent of infertile women. One experimental treatment for this condition involves a new pill an 'anti-estrogen which stimulates the ovaries to produce an egg. But this anti-estrogen-which is not a hormone, incidentally-must be discontinued immediately after ovulation or it may act as a contraceptive.

Q: Then what helps one couple to have a child may help another to have fewer children?

A: Definitely. One such treatment is the oral contraceptive pill. Many persons, in spite of all the publicity about it, are unaware that the pill was originally developed for infertile women. When used as a contraceptive measure, then discontinued, the oral pill may' increase the fertility potential. This pill is made of a synthetic hormone closely related to progesterone, which is the hormone Formed after ovulation and responsible, among other things, for conditioning the lining of the uterus so that it can adequately receive and nourish the embryo.

These new synthetic hormones, taken by mouth, are effective in inducing and maintaining pregnancy. However, they are extremely potent and must be administered only in carefully diagnosed instances.

Q: How long should a couple try to have a baby before seeking medical help?

A: No longer than a year. Studies show that, if contraception is not practiced, pregnancy occurs within that time in go percent of couples of child-bearing age.

Q: What is the cost of fertility treatment?

A: Fees and medical costs vary; much depends on whether a flat fee is charged for all fertility tests of both male and female, or whether they are charged for separately. Recently, Dr. Charles M. McLane, former president of the American Society for the Study of Sterility, made a nationwide study of these fees. A thorough infertility examination for husband and wife in New York, for example, may cost about $>65 to $200. One should also bear in mind that there are about 150 infertility clinics in the United States, many of them sponsored by the Planned Parenthood Federation of America, Inc., for patients in lower-income groups.

Q: Can surgery help?

A: Though surgery is not always successful, surgeons are doing breathlessly minute operations in an effort to bring about conception. It has been possible, for example, to operate on a hopelessly blocked Fallopian tube and transfer a threadlike bit of the intestinal "gut" into place to serve as a passageway for the ovum from ovary to uterus.

All of the work I have mentioned shows how new directions may help to conquer infertility. The researchers and specialists in this field are imaginative and optimistic men. And, believe me, the satisfaction of helping to bring children into a childless home is great indeed. Many physicians find no phase of medical practice more richly rewarding.