Sterility Study: The Essentials of the Diagnostic Survey *

Whether or not the student of social evolution agrees with the philosophy of Spengler that progressive sterility of the educated classes, like the advent of the machine age, the congregation of men into cities, the pursuit of money and the neglect of culture, signify the decadence of Western civilization, he will recognize that this subject has an importance much broader than its interest to the individual. The study of sterility is a difficult and specialized branch of medical science, not concerned primarily with a morbid process affecting health and longevity, but has for its object the recognition and relief of the one or more conditions in a husband or wife which temporarily or permanently reduces or nullifies individual or reciprocal fertility. It seems hardly necessary to stress that an examination of the husband, including a contemporaneous appraisal of his reproductive specimen, should be one of the first steps in this diagnostic survey, since the institution of treatment, tube tests, and operative procedure in the wife without previous determination of the husband's fertility is now regarded as reprehensible practise. The difficulty of evaluating semen fertility is not generally realized, and grievous errors are frequently made. Another principle which should govern our diagnostic investigation is the recognition that sterility frequently results from concomitant causes in both husband and wife, and coexisting minor defects in the sexual partners may prevent pregnancy, when either might beget children if remarried to a highly fertile mate. For example, in passive congestion, stenosis, or an otherwise innocent uterine displacement the viscosity of the cervical mucus may be increased, and although pervious to sperm cells of strong migratory power it may constantly obstruct semen of reduced vigor. Special methods of investigation and a modified interpretation of clinical findings are required not only to reveal obscure causative factors in patients without demonstrable pathology but to evaluate,