Most childless marriages result from involuntary sterility. Physicians want to help these married couples that want a child. Recognition that the sterile marriages involves both partners, has been an impetus to intensive investigations and led to progress.
Sterility has thus become a medical problem. There are many mechanical and functional defects and difficulties which the physician can recognize; therefore, he is in the best position to remedy them. Increasing knowledge in this field has led to specialization by physicians who have drawn from other sciences such as biology, zoology, physiology, biochemistry, and genetics, facts that aid them in tracing down faults of reproduction and in finding remedies to correct them. Results of this widening horizon of the knowledge of the causes of sterility has been a better appreciation of the fact that childless couples are not necessarily always sterile.
There are many degrees of sterility from a temporarily lowered fertility that may be readily improved, to absolute sterility for which there is no relief under present conditions. Most childless marriages are subfertile, a careful analysis of the causes leads to remedial measures that increase the fertility index of the two mates, often to the point where conception and successful pregnancy to term can and does take place.
It is naturally of the greatest importance to the particular sterile couple to know what cause or causes are responsible for their specific failure. A program of investigation has been developed that succeeds in most cases, if carried out conscientiously in determining the reasons for the sterility. For the majority measures of relief have been devised. Those who cannot be aided have the satisfaction that everything has been done that modern science can offer.
Investigation is equally essential in both sexes as far as the general constitutional condition is concerned for reduced vitality and organic diseases play an important role in the sterile mating. The specific differential examination is in the genital sphere. The faults may be local, anatomical and obstructive or they may be of a general nature consisting for example of nutritional deficiencies and errors of sex hygiene that tend to depress the level of fertility. Their correction raises the fertility index.
In the last decades tests have developed that aid the physician in estimating the barriers that prevent the married woman from becoming pregnant. This necessitates tests for her male partner also. In recent years stress has been laid on glandular disorders, playing a role in subfertility. There are various signs and symptoms of disordered internal secretory gland function that must be considered for the husband and wife. It may be said that we are now in a position to determine in at least 80 o/o of all cases whether a married couple can potentially concieve. In the other 20 o/o science has not as yet succeed in determining the actual cause for sterility. The particular categories into which sterile couples fit can be relieved in the most favorable cases to the extent of 50 o/o. If one out of two sterile couples has a chance of having a child in the most favorable circumstances, it certainly should give encouragement to many to undergo the benefits of a complete modern scientific investigation, for, while these statements hold for sterile matings in general, the problem after all is an individual one and concerns a particular man and wife who desire to have a child and have not been able to have one after a trial of one or more years of natural living.