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Title: Studies in human sterility, with special reference to the investigation of the patency and function of the Fallopian tubes and of the condition of the endometrium
Author: Sharman, Albert
Awarding Body: University of Glasgow
Current Institution: University of Glasgow
Date of Award: 1944
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Abstract:
1. Five hundred cases of "primary sterility" were studied and followed-up during the course of almost ten years. 2. Tubal insufflation was performed in four hundred and eighty patients, the total number of insufflations amounting to one thousand and three. 3. Normal tubal patency was present in 58.9% of cases, spasm-normal patency in 2.5% , stenosis in 0.6%, end non-patency in 38.0% 4. The injection of lipiodol into the uterus and tubes (hysterosalpingography) was performed in one hundred and fourteen cases. Tubal patency was shown in 62. 3%, and non-patency in 37.7% 5. Endometrial biopsy was performed on eight hundred and fifty occasions in three hundred and ninety-two patients. 6. Of three hundred and fifty eight patients in whom biopsy was performed premenstrually, 6.4%, exhibited anovular cycles. 7. Of three hundred and ninety two patients in whom biopsy was performed, 5.1%, showed chronic tubercular endometritis. 8. Seminal examination in 114 husbands revealed normal characteristics in 68. 4% , marked deficiency in 13.2%, and azoospermia in 18.4%. 9. Lines of treatment employed include tubal insufflation, hysterosalpingography, pelvic diathermy, hormones and surgical methods. 10. Of four hundred and nine cases traced, one hundred and fifteen, i.e., 28.1%, became pregnant. 11. Pregnancy did not occur when anovular cycles or endometrial tuberculosis or azoospermia were present (with the exception of one case of anovular cycles after treatment). 12. Of two hundred and ninety four sterile marriages, in one hundred and fifty-two, i.e. 51.7%, infertility factors were found such as to render pregnancy impossible or very unlikely. If a greater number of cases had had endometrial biopsy and seminal examination performed, there is little doubt that infertility factors of anovular cycles, tubercular endometritis and azoospermia would have appreciably reduced the figure of one hundred and forty-two cases in which, as far as investigation went, no reason was discovered for the infertility of the marriage. 15. Important conclusions are: (a) Tubal insufflation is an essential diagnostic and a valuable therapeutic measure: the addition of a kymograph not only provides a permanent record but is most informative in illustrating tubal function and indicating such deviations as spasm and stenosis. (b) A single insufflation finding of non-patency is not reliable. For diagnostic accuracy, it should be repeated at a later date: two such findings of non-patency render the diagnosis of tubal blockage almost certain, (c) Hysterosalpingography is a very useful adjunct to insufflation and may be of therapeutic importance. The correct interpretation of the films may be difficult and may be erroneous. (d) Premenstrual endometrial biopsy must be regarded as a very important procedure in the scientific investigation of a case, in view of the importance of anovular cycles as a major infertility factor. (e) Endometrial tuberculosis is much more common and of more significance in cases of sterility than has been generally recognised. In every case, therefore, with this fact in mind, endometrium should be examined histologically. (f) The incidence of azoospermia (and gross seminal deficiency) is sufficiently high to render seminal examination essential in a sterile marriage. (g) Treatment should be based on the results of diagnostic investigations: in some cases these results will indicate that every line of treatment will almost certainly be unavailing, in others that expectation of success will depend upon improvement or removal of a specific infertility factor but in many others that any or all therapeutic procedures should be used, either simultaneously of successively, which will raise the "fertility-sterility level above the threshold of conception".
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.803495  DOI: Not available
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