Inhibition of Ovulation in the Human 223 



be deranged in what we could call conditions of relative estrogenicity, such 

 as with cystic-stromal hyperplasia, as well as with granulosal cell tumor, or 

 with dysthyroidism. 



Yet another manifestation of extrapituitary pathology that inhibits ovula- 

 tion is what clinicians might call progestinicity, such as is attributed to theca- 

 lutein or corpus-lutein cysts, as if ever they do produce, for any length of 

 time, a progestin — which I rather doubt. We also find anovulation with 

 the chorionic gonadotropism incident to chorionepithelioma. 



2. Intrapituitary pathology. Among diseases involving intrapituitary 

 pathology, anovulation is associated with Simmonds' disease (hypophyseal 

 cachexia), as well as with Sheehan's disease (postpartum pituitary necrosis), 

 with Cushing's disease (basophilism), Addison's disease (hypobasophilism), 

 and the Chiari-Frommel syndrome (pituitary adenomatosis), as also with 

 inanition, doubtless made more harmful to the pituitary by coincident 

 avitaminosis and contributory hypothalamic deprivation. (It is difficult to 

 define the relative roles of nutritional deficiency and of stress reaction in the 

 neurosis that manifests itself in anorexia nervosa.) 



II. EXOGENOUS INHIBITION OF OVULATION 



A. Reasons for Suppressing Ovulation 



We might ask: "Why suppress ovulation?" It could be a simple exercise in 

 biological research. We do not quite do that in humans, if we can help it. On 

 the other hand, ovulation has been prevented therapeutically in order to 

 relieve dysmenorrhea (5). Essential dysmenorrhea occurs only from what is 

 improperly called a "secretory" and, more properly, a "progestational" 

 endometrium. Furthermore, one might suppress ovulation to avoid Mittel- 

 schmerz, or even to prevent conception. 



B. Means of Inhibiting Ovulation 



With the latter aim in view, i.e. to control fertihty, particularly in certain 

 overpopulated areas, several methods of suppressing ovulation have been, 

 and are still being, investigated (6-9). The requisites for ovulation have been 

 reviewed by the previous speakers: the organs, the tissue systems, the 

 hormones, and the various unctions. Thus one might find means of suppress- 

 ing ovulation by disaflfecting one or another of these numerous required 

 cellular composites. 



One can destroy the primordial follicles, as by radiation; or one can 

 castrate. Specific thalamic function may be disturbed by scaring a woman 

 "to death". Then she would not ovulate by virtue of stress reaction resulting 

 in hormonal disturbance of thalamic neurones and their dependent pituitary 

 cells. Normal cyclic function in these mid-brain nuclei may also be upset by 

 direct medicinal modification of sex hormone concentrations. This will be 

 discussed later. 



