With the recognition of the importance of the male factor in barren marriages, much of the energy of infertility studies during recent years has been correspondingly diverted toward overcoming this obstacle. Although the beneficial possibilities of tubular regeneration by prolonged testosterone therapy, as noted by Heller and co-workers,1 is worthy of note, hormonal therapy in the infertile male, with the exception of desiccated thyroid, has in general proved futile in the attempt to produce a more potent semen. As a result, certain mechanical therapeutic measures have been adopted in an effort to afford the maximum possibility of fertilization in the presence of any semen deficiencies. Oligospermia has been the particular target of mechanical aid.Two methods are used. Both employ the principle of semen concentration. The first involves removal of the spermatozoa from the semen by dilution with Locke's solution and a subsequent process of centrifugation and decantation. In this way the spermatozoa are concentrated within a 1 cc. volume. Insemination with this vol¬ ume has been intravaginal, intracervical, or intrauterine, and in the most recent study -' has been intracervical but associated with the use of an artificial cervical plug to prevent backflow. The second method, first described by Whitelaw,3 concerns the use of a relatively tight-fitting plastic cervical cap. This cap acts as a means of concen¬ trating the entire ejaculate in close approximation with the external cervical os, in an environment favorable to sperm survival. In the present study the cervical cap has been employed in every case.
SELECTION OF COUPLESAll couples included in this group had experienced a reasonable period of infertility. With reference to the qualifications required of a couple to be included in our over-all sterility studies, as noted in a forthcoming publi¬ cation,4 all couples in this particular group had experi¬ enced sincere unsuccessful trial at conception for at least one and one-half years. Subjection of both partners to an intensive diagnostic and therapeutic regimen over a two to four-month period invariably preceded selection and established the basis for inclusion in the series.Accepting a sperm count of 60 million per cubic centi¬ meter as the arbitrary lower limit of the normal range, the principal criterion for admission to this special group was oligospermia of less than this figure. Other apparent deficiencies of the semen, mainly decreased motility and longevity, and abnormal morphology, were factors in selection. In this series these deficiencies, when present, were associated with oligospermia in every case. Multi¬ ple semen analyses were performed, according to the tenets of Falk and Kaufman,5 before a diagnosis of de¬ ficiency was made.Not infrequently other inhibiting factors to fertility were uncovered in couples included in this series, chiefly decreased metabolic function in one or both partners or other endocrine disturbances in the female partner, as noted mainly by the basal metabolic rate, vaginal...