A Criticism of the Present-day Management of the Barren Woman

"And when Rachel saw that she bare Jacob no children, Rachel envied her sister; and said unto Jacob, Give me children, or else I die." (Gen. 30: 1.) MAY I remind you of the old love story of Jacob, Leah and Rachel, the daughters of Laban. Jacob first married Leah and she bore him a succession of sons. Later he married her sister Rachel, and though it was Rachel that he really loved, she remained barren. Indeed, it is here that we read of the earliest treatment for barrenness. Rachel begged Leah for mandrakes, but was spitefully refused. And how much nicer is the English word 'barren' than the modern usage of 'sterile' or 'infertile.' However, to be scientific, one must use classical words, even though they do not express one's meaning so exactly as the words of our mother tongue. To me 'barren' means 'having failed to bear,' whereas both sterile and infertile signify 'unable to bear.' But I hope you will find me an unscientific man-I shall quote you no figures-I shall show you no tables or percentages. I want us to consider the present-day management of the barren woman and to assess critically all the devices and procedures that we use for her benefit. When I first studied gyn:Eecology, all that was ever done was to dilate the cervix uteri, and many women conceived thereafter. Then came Rubin's test or in-sufflation, and we could now pronounce a woman barren with some certainty-it rather shook our complacency when women conceived after we had proved their tubes to be sealed, but now we have excuses for that. Then came salpingography and more certain demonstration of where and to what degree tubes were sealed. With the elucidation of male and female hormones a bright day dawned, for now we could control ovulation and spermatogenesis, we could make imperfectly developed uteruses come to maturity and we could grow decidua where none had been before-or so we thought. Then came the discovery of what a large part genital tuberculosis played in infertility in women. Finally, with the realisation that the male partner was often at fault, came the scientific investigation of the semen-its quantity, its quality, and the ability of the sperms to penetrate cervical mucus. Testicular biopsy may reveal the extent and the causation of male infertility. So we have advanced a long way from the haphazard fiddling with the cervix …