July 14, 2015

Wendy Burch


Dear Wendy Burch:
I have read an abbreviated account of your successful efforts in starting a family and offer my congratulations.  You certainly fought the good fight. 

I am a diagnostic radiologist (semi retired you might say).  My introduction to fertility was mostly through doing hysterosalpingograms, a procedure I am sure you know about that involves injecting contrast through the endocervical canal and getting appropriate x rays.  Let me digress and tell you a true story told us by a professor at Harvard Medical School.  Now at the far end of my career it seems to me that medical school in my time was mostly a matter of keeping the lads cheered up until the inevitable day when they would go out and try to cope with utter horror using inadequate tools. 

According to the story a woman came to the surgeon giving the lecture and complained of infertility.  When he examined her he found a mass.  He explained that it could be cancer and would have to come out, all other interests being secondary.  In those dark days we did not have 2D ultrasound or CT, much less MR, so the surgeon went in with the knowledge that there was a lump in there, plus of course the knowledge of decades of experience.  When he found the mass instead of just getting control of it and cutting he examined it closely and sent off a bit for the pathologist.  The upshot was that it was a right vagina.  She had two.  The one she knew about was her left vagina.  The right vagina had no opening to the outside and was packed with the residue of years of frustrated menses.  So at this point he had a patient with two vaginas.  But when he palpated he still found a mass.  Some more hunting revealed that it was the other uterus.  So when he was through she had two vaginas, each with its uterus, and no hint of cancer.  That was good news already, but then a few months later she conceived a pregnancy in her right uterus.  The surgeon of course kept track of her and over later years she had more babies, two on the left and one more on the right.

(Insert happy laugh from a hundred students who in a few years will be hoping to have similarly good judgment.)  Miraculous as the story seems, there is this thing called selection.  If you don’t grow up and have offspring then humanity will not resemble you as much as it will those who did.  This obviously places reproduction front and center as the one thing the body cares most about.  Yes, I know you know that, but bear it in mind.

So I did hysterosalpingograms.  Very rarely one was abnormal, in which case invariably the surgeon was there to watch the procedure and make sure I got the information he’d need.  But the overwhelming number were normal.  I don’t mean normal as in “pretty good” or “’twill do ‘till something better comes along.”  I mean perfect, like a Rembrandt, a Vermeer; one spoke in hushed tones.  As you remember, after 9/11 they spent days going through the ruins hoping to find survivors.  But it was so futile the dogs began to get upset; they thought they were failing.  So rescuers would hide in the wreckage so the dogs could find somebody and have the heart to go on searching.  As a diagnostic radiologist I hardly ever see a perfect study.  There’s always a scar here or a bit of embryonic rest there or something just a trifle off.  I would ignore those.  I needed to find the important stuff.  And by and large with the histerosalpingograms it was that same useless perfection time after time; I knew how much the anatomy could be disturbed and nature could still work around it.  Obviously something we did not understand was making these women infertile.  Or making their husbands infertile, but of course they had been studied thoroughly already.   So if the husband is perfect and the wife is perfect, what could possibly be wrong?

So phrased the answer is obvious; it’s the wrong combination.  And what would be a good combination?  Well throughout almost all of history almost everybody married a cousin

And there were lots of babies.

So yes, you marry kin.  That’s not to say you can run out and marry a second cousin and all your problems are solved.  One must distinguish between pre-zygotic infertility wherein the sperm is prevented from reaching and entering the egg to produce a zygote and post-zygotic infertility wherein the zygote is prevented – for genetic reasons – from developing into an embryo and even into a fertile adult.  In the first generation only pre-zygotic infertility is encountered or eliminated in mammals and pre-zygotic infertility is never very strong.  An otherwise fertile member of one  population can marry an otherwise fertile member of a population separated for as long as humans have been out of Africa and they will likely have some children.  (Descendants of Montezuma still survive in the Spanish aristocracy.)  Besides direct injection of sperm should bypass pre-zygotic infertility. 

On the other hand nobody knows.  This is a woefully understudied field.  That needs to change.  Somebody needs to ride to Lexington and Concord raising the alarm. 

Apparently as generation after generation marries non-kin, and of course that is relative – we are all kin – and I mean non-kin out to 10 generations, post-zygotic infertility rises until births fall to zero.  That was demonstrated in mice by a man named Calhoun, the second graph in the attached document.  The first graph shows how ancient empires fell according to a fixed schedule; if there is any explanation other than accumulating infertility I have yet to hear of it after years of challenging experts.

Don’t take my word for it.  Consult the recent textbook Handbook on Evolution and Society, chapter 19 “Marry in or Die Out” by the brilliant and prestigious Robin Fox.  I have indeed made a small contribution demonstrating an effect in fruit flies.  Their fertility of course dwarfs that of Calhoun’s mice so my results are less overpowering.  There is a link at the end of the attachment.

If you want to bury yourself in the topic, and considering the efforts you have already made I expect you will, here is a link to what I have been able to gather over the years:
And of course if there is anything at all I can do, please let me know.


M. Linton Herbert

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