Problems of Fertility in General Practice

THIS book, with a foreword by Sir Eardley Holland, and published under the auspices of the Family Planning Association (F.P.A.), represents the considered advice of that Association on some of the physical problems associated with family life under present-day conditions in an industrial society. There are essentially two aspects of fertility dealt with in the book, namely, the ability to regulate normal procreative activities so that the successive births in a family may be suitably spaced out to give the optimum conditions of nurture for the infants, and relief from the strain to the mother of too frequent pregnancies; and, secondly, the inability of some married couples to produce the desired children. Information on these social problems has been gathered by the F.P.A. over a considerable number of years, and the authors have been able to draw freely on this valuable material as well as on their own records. The main emphasis in the book is on the problem of sub-fertility and its investigation and treatment. Useful practical advice is given on the difficult enquiries and investigations necessary if suitable help and treatment are to be given to the infertile or sub-fertile couple. The details of treatment of mental difficulties are omitted, as they are outside the scope of this small and essentially factual book. That sub-fertility is a matter calling for an investigation of the "couple," and not of the female partner only, is rightly stressed. All too often the investigation of the male is confined to the determination of the presence of spermatozooa in the seminal fluid, a fact in itself of importance, but virtually useless as the sole test of the ability of the male to fertilise an ovum. Elaborate and potentially dangerous tests of a perfectly normal female may be avoided if the advice given here on investigation of the couple is carried out. The most important single test is the post-coital test (Simms or Huhner test) for the presence in considerable numbers of actively motile and normally formed sperms in the upper vaginal or cervical canal. Details are given of how this, and the various other tests required for the full investigation of both male and female, may be carried out. Not all the procedures advocated will necessarily be accepted uncritically by specialists in the various types of investigation. Such investigations and the correct assessment of the various factors involved are usually beyond the scope of general practice. An appendix lists seven centres-all in England-where teams of experienced workers have been established. At many of the other centres noted in Great Britain some advice and treatment may be obtained. The second part of the book is devoted to illustrating and describing methods of preventing conception. Some of the drawings are not particularly helpful, and anyone attempting the fitting of preventive appliances to the female should have suitable instruction at one of the numerous clinics mentioned. Useful appendices describe suitable proprietary contraceptive appliances and chemicals, the keeping of temperature records for the determination of ovulation times, and the details of the laboratory investigations mentioned in the main text. It can be said that general practitioner, specialist, and also medical student wvill gain much from a perusal of this book, which deals in an admirable and restrained way with the investigation and treatment of a subject practically untouched in an ordinary text-book. W. R. M. M.