Human Infertility

This book is a distillation of the authors' experience with human infertility-its prevalence, implications, diagnosis, and treatment. It is a useful practical guide for the physician who deals with this problem and includes detailed discussion of the techniques of investigation. There is an excellent chapter on endometrial interpretation by the late Dr. Earle T. Engle. The authors are to be commended especially for an attempt to evaluate critically the results of current treatment. This is a uniquely difficult undertaking, since every infertility case involves at least two persons, each with physical variables, cultural and emotional attitudes, and psychological vagaries which affect anything that touches upon the procreative function. The difficulty is further compounded. Many couples who have no recognized reason for infertility never achieve a pregnancy, while other patients sometimes conceive in the face of formidable odds. In the treated patient success is usually ascribed to therapy; in the untreated it is accepted as an inexplicable act of God. The authors have taken statistical cognizance of the acts of God, and the results are sobering. For example, complete tubal occlusion, demonstrated by salpingogram, is usually regarded as an insurmountable obstacle to conception unless surgically corrected. An analysis of the results of surgery showed a 14.6 per cent pregnancy rate after tuboplasty in 48 patients, though more than half of the pregnancies were abortive or ectopic (page 177). However, of 71 patients with tubal closure not treated surgically, follow-up revealed a pregnancy rate of 11.3 per cent (page 162). In the important area of infertility attributed to ovarian dysfunction the results of therapy are even more discouraging. The statistical advantage here lay with the untreated group (page 132). An impressive number of infertility patients conceived after history taking or discussion alone, or simple pelvic examination, or indeed after making an appointment for the initial visit! (page 17). It is not surprising that many strange remedies are reported to yield wonderful cures. The waters have long been muddied by our ignorance of what happens to the untreated patient. This is not to say that investigation and treatment are fruitless. There are some spectacular successes in the treatment of Stein-Leventhal ovaries, and many other successes clearly attributable to treatment. These are gratifying, and make the effort worth while, particularly since the specialty is young and rapidly progressing and but lately graduated from armulets and incantations. IRVING FRIEDMAN