Marriage And Sterility
( Originally Published 1918 )
TO be the mother of a child is the hope and joy of every normal woman. To be denied this privilege is one of the keenest disappointments of her life, in many cases being the cause of wrecked homes and continual unhappiness.
Sterility is practically always due to some disease of the genital tract of either the husband or wife. In this chapter we will not consider the former although he is responsible in nearly half of the cases. If no cause can be found in the woman, it is possible that a close examination of the husband will determine the reason for the absence of children.
Sterility is the condition in which a woman is incapable of reproduction. It is considered absolute sterility when no conception is possible, and relative sterility when conception occurs but the foetus dies.
There are many conditions which are said to be responsible for absence of the ability to bear living children. The majority of all cases are due to inflammatory disease of the uterus, tubes, or ovaries, often the result of infection. The inflammation causes a thickening of the walls of the fallopian tubes, which, together with the pus and catarrhal exudate, so occludes the lumen that either the ovum cannot reach the uterus, or the spermatozoon is prevented from fertilizing it. Often, too, the ovum is prevented from leaving the ovary because of thickening of the covering of the latter. The lining of the uterus may also be so injured by the inflammatory process that it is no longer a suitable field for the attachment of the ovum, even after fertilization.
Lacerations and ulcerations of the cervix may be . responsible for the failure of fertilization, these conditions preventing the entrance of the spermatozoa into the uterus. Syphilis, tuberculosis, polypi and tumors may also be mentioned as causes of this condition.
Congenital malformations are occasionally responsible, such as imperforate hymen, absence of ovaries, tubes, uterus, and even of the vagina. Early marriages are more often childless than later ones, the most fertile being those occurring at from twenty to twenty-four years of age.
It is also certain that a lowered condition of the health of the woman is likely to destroy the childbearing function, although it sometimes happens that the bearing of children acts as a stimulus to the functions of the body and good health follows.
The habitual use of alcohol is considered by some to be detrimental to fecundity. Just how this acts it is impossible to say beyond that it lowers the nervous tone and general health of the body. Overwork, worry, and emotional disturbances may at times so depress the nervous and physical powers of the woman that healthy ova are not secreted.
Venereal disease is too often the cause of sterility. This may be gonorrhea in either the husband or wife, causing destruction of testicles or ovaries, or, as occasionally happens, a chronic inflammatory condition of the spermatic ducts of the man, or of the fallopian tubes of the woman, producing occlusion which prevents the passage of the male and female elements of conception.
That syphilis is a potent cause of non-pregnancy is maintained by many urologists and, gynecologists. Whether it is truly syphilis, or the treatment usually taken for this disease, has never been determined. It is certain that the mercury and arsenic used in the treatment of syphilis, with the idea of killing the treponema pallida in the blood, cannot fail to have a degenerative effect upon both the spermatozoa and ova. There are many cases on record, however, where healthy children have been born after either one or both parents had been infected and received treatment. Personal health is probably the deciding factor after all.
Sterility, of course, necessarily follows operations for the removal of the tubes and ovaries. If one tube and part of an ovary are left, pregnancy is possible.
A woman thinking herself sterile should undergo an examination to determine the presence or absence of inflammation, growths, or malformations. If there is inflammation of uterus, tubes or ovaries, treatment for these conditions must be instituted. If there is a displacement, it must be corrected. In case of imperforate hymen, a slight surgical operation is indicated. If there are malformations, or one of the necessary generative organs is absent, there is, of course, no remedy.
Very often there is such an excessive leucorrhea of an acid nature, that the spermatozoa are either killed or prevented from reaching the uterus or tube. In such cases a vaginal douche, consisting of a teaspoonful of baking-soda and a teaspoonful of common salt to a quart of water, may remedy the condition. The normal reaction of the vaginal secretions is acid, but in ease of ill-health they may become unduly so.
If none of the above conditions can be demonstrated, a general health-building regime should be taken up, along the lines laid down in chapter twelve. In very many cases it will be found that improved health will be followed by conception.
Women should understand that not only may a lack of vitality resulting from overwork, want of food, or actual disease, be the cause of sterility, but that there are also mental and emotional conditions which may cause barrenness. Prolonged or intense mental depression or excitement, anxiety, fear, grief, suspicion, jealousy, anger, revenge, are not only strikingly preventive of conception but also of normal ovulation. Such states, too, may render the male reproductive germs incapable of impregnating as well as the female germs incapable of receiving fertilization. They may also prevent the normal development of an embryo after fertilization has once been effected.
It may be well for us to consider briefly some of the local causes of sterility. For example, if the hymen has never been perforated it would be impossible for the male germs to enter the uterus and, therefore, fertilization will be impossible. There may be some other malformation or defective development of some part of the sexual system. If some part of the reproductive canal—as, for example, the vagina or the fallopian tubes-has grown together, thus completely interfering with the proper passage of the germ cell, conception cannot take place. Displacements of the uterus and similar derangements may have the same effect.
Sometimes the lining membrane of the uterus may be so diseased as to prevent the necessary attachments of the ovum to the uterine walls for the purpose of development. Acid secretions, resulting from leucorrhea and other complaints, may kill the spermatazoa and thus prevent fertilization.
Probably the most common of these local causes of sterility are defects in the ovaries or fallopian tubes. As has been mentioned else-where, if the gonorrheal infection reaches the fallopian tubes, it may cause a complete closing of these passages, thus preventing the ovaries from reaching the uterus. This alone causes more than fifty per cent. of involuntary sterility. In many of these cases, the actual condition can be determined only by competent physicians, and a goodly percentage of these abnormal conditions, it is encouraging to know, can be relieved by the proper treatment.
One other cause must also be considered. This has been termed a lack of adaptation. The husband and wife may be so fundamentally unadapted to a real union of life that their physical union does not result in conception.
As we said before, the husband is too often to blame, and it is needless to say that he should investigate the matter and take as great care of his health as the wife. Indeed if there is no obvious cause in the wife, the condition of the husband should be ascertained before the wife is subjected to examination.
The time of the connection is often responsible for the failure of pregnancy, although this is not absolute, inasmuch as pregnancy is possible and has occurred at any time. If intercourse takes place within a week after menstruation, however, pregnancy is more apt to follow.
Conception and childbearing are normal functions of woman, and just as other bodily functions are dependent upon good health, so the occurrence and satisfactory termination of the reproductive crisis is dependent upon this condition.