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X-ray therapy of sterility
felal life cannot earlier diagnosis had no illnst~rative
Nolen,
ibe couilrmetl 5y other means. Theoretically, this method should l~ermit of multiple pregnancy than is available by other methodsi but the authors case to bear this out. l)o~:or,i\s M. lla~h-fi:s
James P., a,ncl Du Sanlt, Lucille: The Elimination of Untoward Radiation Sequelae in the Treatment of Carcinoma of the Uterine Cervix, Surg., Gynee. & Ohst. 94: 539, 1952.
In a statistical analysis of 214 patients with carcinoma of the cervix iu clinical Stagt+ I, II, and III, the authors have attempted to study the clinical occurrence of factitial radiation reactions. The complications which were known to depend upon the amount of radiation delivered were selected and their incidence compared to the incidence of sueoessful treatment which depended upon the stage of the disease and the dose delivered. The question asked was whether the complications studied should be accepted as a necessary sequel to successful treatment. The findings seemed to suggest that in mild cases (Stage I), such domplications were noc necessary if cure was to be effected. However, in Stage II carcinoma, cure was neces sarily accompanied by a definite percentage of gastrointestinal and urinary tract complications. T,. M. Hsr,r,hrar\
Sterility Asherman,
J. 6.:
X-ray
Therapy
of Sterility,
Uynaeculogitl
133:
65, 1952.
soon after the stimulating effect of roentgen rays v-as discovered, European worker*, treating functional disorders of menstruation by irradiation of the ovariesj repeatediy met with pregnancies, in many cases where any l’ossibility of pregnancy seemed out of the question. Severtheless, they refused to recommend, for many reasons, the use of x-ray therapy for the treatment of sterility. American authors, hovvever, were more daring, and advised the use of roentgen therapy not only to the ovaries, but also to the pituitary; for both the treatment of functional amenorrheas and also for sterility. Many hundreds of suecessful results were thus obtained. However, despite a great deal of experimental research, It is well known that the pituithe value of pituitary irradiation is still under dispute. tary is very radioresistant, and yet resul.ts were obtained in cases where pituitary irradiation alone was employed. The auhor has attempted to clarify this situation by the treatment of 90 cases of sterility by the use of combined ovarian-pituitary irradiation as compared to irradiation of the pituitary alone. All cases were studied in Jsrael during the years IO&7 and 1948, and were of the type where all other kinds of therapy to combat the sterility bad failed. In a general study of all cases treated, it was found that an immediate and complete graphs was observed in 36 per regulation of the menstrual cycle with biphasie temperature cent. Twenty-five patients conceived within the first 6 months, 5 more within a year, aud -L more during the second year. Twenty-nine cases did not respond to therapy at all. Moreover, it was noted that 13 per cent of all cases, regardless of which type of therapy AIwas used, lost their menses entirely and entered an artificial permanent menopause. though over half of these women were more tha.n 35 years of age, it was felt that radiation therapy is not a procedure which can be indiscriminately recommended since it does hear the possibility of the production of unfavorable and embarrassing results. The 90 cases studies were divided into groups according to the type of patholog) Irradiation in normal cases, i.e., where history, physical examination, and basal noted. temperature charts were within normal range, was unproductive of pregnancy in any instance. Similar results were obtained where congenital anomalies were noted to be prescnt. Irradiation in eases where anovulatory cycles were observed or where the menses occurred at grossly irregular long intervals produced the best results, in that over 40 per cent of these patients became pregnant, carried to term, and were delivered of normal offspring.
Volume 65 Number 6
SELECTED
ABSTRACTS
1371
The value of combined irradiation to the pituitary and ovary, as compared to irradiation of the ovary alone, is expressed briefly in the following; (1) If considering the regulation of the menses alone, 43 per cent were improved with the combined therapy as compared with 28 per cent improved with only pituitary irradiation. (2) When resulting pregnancies are the deciding factor, 43 per cent became pregnant with combined ovariopituitary (3) theratpy as compared with 23 per cent when the pituitary alone received stimulation. On the negative side, only 21 per cent had no effect whatsoever with the combined irradiation, as compared with 44 per cent when only the pituitary was stimulated. The eonclusions reached, therefore, are that the pituitary is not completely radioresistant, and that irradiattion of that organ does produce a noticeable effect on the ovaries; that irradiation of both organs is approximately twice as effective as pituitary stimulation alone, and that the beneficial effect is due to the re-establishment of normal ovulation and ovarian funetion both by stimulation of the ovary directly and by increased hormone stimulation from the anterior pituitary. It was to be noted, moreover, that all offspring thus produced were healthy and showed no signs of injury due to irradiation. However, the author cautions that the procedure is not entirely harmless and innocuous, in that with both methods, especially in women over 35 years of age, a permanent artificial menopause may be produced. L.
Jawis,
Garth 1083,
L.:
Evaluation
of Thyroid
in the Treatment
of Sterility,
B.
WINKELSTEIN
South
M.
J.
45:
1952.
Thyroid treatment factory procedure for have been disappointing.
in the infertility.
infertile Other
couple forms
has proved of treatment,
to be the only universally in. the opinion of this
satisauthor,
Since it is believed that thyroid therapy predisposes to fertility through its ability to favor the development of a mature ovum, the author advocates its use. It is with the basal body temperatures that a correlation has been made between thyroid therapy and treatment of the infertile pati,ent. Those patients who have shown an inadequate progestational-phase endometrium generally have a low basal body temperature in the last half of their cycles. The administration of thyroid seems to favor the development of the progestational endometrium and therefore facilitates nidation and growth of the fertilized ovum. Thyroi,d was administered by the author in a dose of 65 mg. daily to a group of patients suffering anovulatory cycles and others showing defective progestational changes in the endometrium. It was his belief that ovulation was induced in some patients and maturation of the endometrium was accomplished in others: thus favoring their fertility. WILLIAM
Horn.e, Herbert W., Jr., and Rock, John: Oral Terramycin vicitis in Infertile Women, Fertil. L Steril. 3: 321, 1952.
Therapy
BICKERS
of Chronic
Endocer-
Fifty-six patients with long-standing infertility were given oral terramycin in an effort to clear the endocervix of bacteria which might be lethal to sperm. Medication was given on the sixth, fifth, and fourth days prior to ovulation (as determined by temperature curves). The dose was 3 Gm. of terramycin daily for one group and 6 Gm. daily for the second group. Ko pregnancies
occurred
in the first
group
that
could
be attributed
to the therapy
(13
eases). In patients,
the second or 28 per
group which cent, a figure
received somewhat
the higher dose there were higher than that expected
If the only recognized abnormality is poor or absent state that ‘lit seems reasonable to consider that terramycin for 3 days before ovulation improves the chance of conception.”
sperm given
10 pregnancies by chance. migration, orally in
EUGENE
N.
in
35
the authors 6 Gm. dosage SCADRON
Nolen,
ibe couilrmetl 5y other means. Theoretically, this method should l~ermit of multiple pregnancy than is available by other methodsi but the authors case to bear this out. l)o~:or,i\s M. lla~h-fi:s
James P., a,ncl Du Sanlt, Lucille: The Elimination of Untoward Radiation Sequelae in the Treatment of Carcinoma of the Uterine Cervix, Surg., Gynee. & Ohst. 94: 539, 1952.
In a statistical analysis of 214 patients with carcinoma of the cervix iu clinical Stagt+ I, II, and III, the authors have attempted to study the clinical occurrence of factitial radiation reactions. The complications which were known to depend upon the amount of radiation delivered were selected and their incidence compared to the incidence of sueoessful treatment which depended upon the stage of the disease and the dose delivered. The question asked was whether the complications studied should be accepted as a necessary sequel to successful treatment. The findings seemed to suggest that in mild cases (Stage I), such domplications were noc necessary if cure was to be effected. However, in Stage II carcinoma, cure was neces sarily accompanied by a definite percentage of gastrointestinal and urinary tract complications. T,. M. Hsr,r,hrar\
Sterility Asherman,
J. 6.:
X-ray
Therapy
of Sterility,
Uynaeculogitl
133:
65, 1952.
soon after the stimulating effect of roentgen rays v-as discovered, European worker*, treating functional disorders of menstruation by irradiation of the ovariesj repeatediy met with pregnancies, in many cases where any l’ossibility of pregnancy seemed out of the question. Severtheless, they refused to recommend, for many reasons, the use of x-ray therapy for the treatment of sterility. American authors, hovvever, were more daring, and advised the use of roentgen therapy not only to the ovaries, but also to the pituitary; for both the treatment of functional amenorrheas and also for sterility. Many hundreds of suecessful results were thus obtained. However, despite a great deal of experimental research, It is well known that the pituithe value of pituitary irradiation is still under dispute. tary is very radioresistant, and yet resul.ts were obtained in cases where pituitary irradiation alone was employed. The auhor has attempted to clarify this situation by the treatment of 90 cases of sterility by the use of combined ovarian-pituitary irradiation as compared to irradiation of the pituitary alone. All cases were studied in Jsrael during the years IO&7 and 1948, and were of the type where all other kinds of therapy to combat the sterility bad failed. In a general study of all cases treated, it was found that an immediate and complete graphs was observed in 36 per regulation of the menstrual cycle with biphasie temperature cent. Twenty-five patients conceived within the first 6 months, 5 more within a year, aud -L more during the second year. Twenty-nine cases did not respond to therapy at all. Moreover, it was noted that 13 per cent of all cases, regardless of which type of therapy AIwas used, lost their menses entirely and entered an artificial permanent menopause. though over half of these women were more tha.n 35 years of age, it was felt that radiation therapy is not a procedure which can be indiscriminately recommended since it does hear the possibility of the production of unfavorable and embarrassing results. The 90 cases studies were divided into groups according to the type of patholog) Irradiation in normal cases, i.e., where history, physical examination, and basal noted. temperature charts were within normal range, was unproductive of pregnancy in any instance. Similar results were obtained where congenital anomalies were noted to be prescnt. Irradiation in eases where anovulatory cycles were observed or where the menses occurred at grossly irregular long intervals produced the best results, in that over 40 per cent of these patients became pregnant, carried to term, and were delivered of normal offspring.
Volume 65 Number 6
SELECTED
ABSTRACTS
1371
The value of combined irradiation to the pituitary and ovary, as compared to irradiation of the ovary alone, is expressed briefly in the following; (1) If considering the regulation of the menses alone, 43 per cent were improved with the combined therapy as compared with 28 per cent improved with only pituitary irradiation. (2) When resulting pregnancies are the deciding factor, 43 per cent became pregnant with combined ovariopituitary (3) theratpy as compared with 23 per cent when the pituitary alone received stimulation. On the negative side, only 21 per cent had no effect whatsoever with the combined irradiation, as compared with 44 per cent when only the pituitary was stimulated. The eonclusions reached, therefore, are that the pituitary is not completely radioresistant, and that irradiattion of that organ does produce a noticeable effect on the ovaries; that irradiation of both organs is approximately twice as effective as pituitary stimulation alone, and that the beneficial effect is due to the re-establishment of normal ovulation and ovarian funetion both by stimulation of the ovary directly and by increased hormone stimulation from the anterior pituitary. It was to be noted, moreover, that all offspring thus produced were healthy and showed no signs of injury due to irradiation. However, the author cautions that the procedure is not entirely harmless and innocuous, in that with both methods, especially in women over 35 years of age, a permanent artificial menopause may be produced. L.
Jawis,
Garth 1083,
L.:
Evaluation
of Thyroid
in the Treatment
of Sterility,
B.
WINKELSTEIN
South
M.
J.
45:
1952.
Thyroid treatment factory procedure for have been disappointing.
in the infertility.
infertile Other
couple forms
has proved of treatment,
to be the only universally in. the opinion of this
satisauthor,
Since it is believed that thyroid therapy predisposes to fertility through its ability to favor the development of a mature ovum, the author advocates its use. It is with the basal body temperatures that a correlation has been made between thyroid therapy and treatment of the infertile pati,ent. Those patients who have shown an inadequate progestational-phase endometrium generally have a low basal body temperature in the last half of their cycles. The administration of thyroid seems to favor the development of the progestational endometrium and therefore facilitates nidation and growth of the fertilized ovum. Thyroi,d was administered by the author in a dose of 65 mg. daily to a group of patients suffering anovulatory cycles and others showing defective progestational changes in the endometrium. It was his belief that ovulation was induced in some patients and maturation of the endometrium was accomplished in others: thus favoring their fertility. WILLIAM
Horn.e, Herbert W., Jr., and Rock, John: Oral Terramycin vicitis in Infertile Women, Fertil. L Steril. 3: 321, 1952.
Therapy
BICKERS
of Chronic
Endocer-
Fifty-six patients with long-standing infertility were given oral terramycin in an effort to clear the endocervix of bacteria which might be lethal to sperm. Medication was given on the sixth, fifth, and fourth days prior to ovulation (as determined by temperature curves). The dose was 3 Gm. of terramycin daily for one group and 6 Gm. daily for the second group. Ko pregnancies
occurred
in the first
group
that
could
be attributed
to the therapy
(13
eases). In patients,
the second or 28 per
group which cent, a figure
received somewhat
the higher dose there were higher than that expected
If the only recognized abnormality is poor or absent state that ‘lit seems reasonable to consider that terramycin for 3 days before ovulation improves the chance of conception.”
sperm given
10 pregnancies by chance. migration, orally in
EUGENE
N.
in
35
the authors 6 Gm. dosage SCADRON