Phantom menace:
Infertility in developed countries is a well known phenomenon.  But what do you see when you actually look at the women?  I have just done some continuing education – doctors do that as do those in many fields – and today I was looking at a lesson on a kind of study called “hysterosalpingogram.”  (For the record, I was late getting around to doing it.)  It is often done as a first and best study working up infertility. 

In the study you inject contrast material into the lumen of a woman’s uterus and get x ray studies.  According to the lesson, (CDR vol. 35 no. 11 May 31, 2012) something is found to account for infertility 10% to 15 % of the time.  This is in contrast with my own experience which has been that it is almost always normal.  When it is going to be abnormal I know it ahead of time because the surgeon who ordered it is there to watch.  They know.  Take your choice, either I have missed a lot of pathology or my patient population in a front line clinic has been different from the patient population in a top of the line referral center such as one run by the kind of doctor who is asked to write a definitive review.  I was very much surprised to learn than in the great majority of patients a cause of infertility, either on the male side or the female side of the study, can be identified.  I had thought the identifiable causes amounted to a minority of patients.  Again, there may be a difference between the study population and the community at large, but that is only a quibble.  There is more to be learned here. 

Of course my antennae were up.  This was a state of the art, best of its kind, trust it with your life, up to date … and so forth.  It is a respectable source.  Sure enough they acknowledged that there is a rise in infertility.  This they account for with two explanations.  The first is that women are delaying starting their families.

Well I knew that one.  I call it having their biological clocks slowing down.  It is a matter of a woman having a career because she doesn’t want children yet or a woman delaying children for her career?  The latter is the usual assumption.  I don’t have any idea how to put evidence together to prove it one way or the other.  The fact that women then tend to make up for lost time indeed tends to load the probability toward it being choice.  All right.  I don’t believe it.  I don’t think it’s all choice.  There is just too much evidence to the contrary.  But this certainly does not add to that evidence. 

The second cause named was a “presumably” increasing number of sexually transmitted disease.  “Presumably”?  Why would you presume anything.  They count such things.  So I did my best to look it up.

Cases of STDs reported by state health departments: United States, 1997-2009
Downloaded July 25, 2012

Cases of STDs reported by state health departments

Chlamydia is being screened for more which I think they say affects reported numbers.  But classical gonorrhea and syphilis don’t exactly seem to be on the march.

So while what I have learned does not make me any happier with my own explanation – that it is due to failure to marry close enough kin on average – at the same time I am not so very happy with the explanation by the brightest and best.

I think more talent needs to address this whole issue.

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