Ovulation

“ This passing away of the ovum (singular of ova) is called ovulation, and it occurs in the woman about every twenty-eight days. The uterus is lined by a mucous membrane similar to that which lines the mouth, and at this time of ovulation this membrane becomes swollen and soft, and little hemorrhages, or bleedings, occur for three or four days, the blood passing away through the vagina. This is called menstruation.
Sometimes, when girls have not been told beforehand of the facts of menstruation, they become greatly frightened at seeing this blood and imagine that they have some dreadful disease. ”

“ Incapacity for ovulation, the first and most decisive cause of sterility in women, may be absolute and irremediable, or relative and transient. We have to do with the former in cases in which the ovaries are entirely wanting, or when they are affected with organic disease to such a degree that they have become incapable of fulfilling their function of ovulation ”

“ Hence, from the fact that amenorrhœa exists, we cannot with certainty infer that a woman is sterile. Moreover, we must remember that physiologically amenorrhoeic women often enough conceive—during lactation. Although we hold the opinion that there is an intimate connexion between ovulation and menstruation, yet it is always possible in cases in which menstruation fails to occur, that ovulation has taken place, but that the stimulus which that process has exercised upon the reproductive organs has been insufficient to give rise to the customary flow of blood. ”

“ Knowing as we do that generally speaking an intimate connexion subsists between menstruation and ovulation, we are indeed able to assert that regular menstruation and fertility in women run a parallel course, and further, that the greater the irregularity of the menstrual function, the greater the tendency to sterility. ”

“ The gradual accumulation of this irritation finally caused a reflex action which determined an afflux of blood to the uterus and ovaries, which constitutes the catamenial flow.
The ovulation theory was refuted by the following facts: Ovulation may and does occur without menstruation; women who have never menstruated may conceive; conception may occur during lactation, without the menses having returned since the last parturition; children at birth have many ovules contained within the ovaries ”

“ Some experienced observers maintain that an ovary is a valuable possession to any woman who menstruates, even at the age of fifty years, the persistence of menstruation being obtrusive evidence that this gland is functional. Experimental evidence, obtained from rabbits, proves that the removal of the whole uterus has no deterrent effect on ovulation, and it does not prevent the occurrence of œstrus and ovulation at periodically recurring intervals. ”

“ These outward signs are combined with certain internal changes, affecting especially the ovaries and the uterus, that are described under the terms of ovulation and menstruation.
Ovulation.—The ovaries produce ova that are retained in cavities termed ovisacs (Graafian follicles) , which are scattered throughout the ovary. Sometimes an ovisac contains more than one ovum, but usually each ovisac contains but one. When the ovary becomes functionally active, some of the ovisacs in the deeper part of the organ increase in size and develop toward the surface. ”

“ Occasionally the incapacity for ovulation and the sterility dependent thereupon are hereditary—paradoxical as this may appear. It is necessary to assume, that just as the sperm is at times unsuited for effective fertilization, so also the ova may be in a less or greater degree insusceptible of fertilization. ”

“ The ovarian cycle begins in midsummer, soon after ovulation, and continues up to the time of the next ovulation. Follicular growth is rapid in the period from spring emergence to ovulation. Large follicles remaining after ovulation represent, in many instances, eggs that will be laid later in the same season. Follicular atresia is never great enough to account for the destruction of all large follicles remaining after ovulation. All mature females lay at least one clutch of eggs per year. It is estimated that one-third of the females produces two clutches of eggs in a single season. ”

“ It seems probable, therefore, that the ripening of the ovum in the ovary is independent of the process of menstruation, though the increased blood-supply to the generative organs during menstruation may, to a certain extent, determine the time of ovulation when a sufficiently ripe ovum is present. ”

“ In monkeys, therefore, menstruation may take place without ovulation, and it is 403 probable that the same is true for the human female. Ovulation and conception may occur in the human female when menstruation is absent; pregnancy not infrequently occurs during the amenorrhea associated with lactation, and in India, where the girls are married at a very young age, pregnancy and child-birth occur before menstruation has begun. ”

“ Nature’s lavish provision of something more than 100,000 ova 50for each woman, who uses only about 500 in the course of her life, excites no little wonder. But whatever the purpose of this enormous supply, its existence makes possible the removal of all but a small fragment of ovarian tissue in cases of disease, without interference with the process of ovulation, which in turn permits reproduction. ”

“ For its physiological action, both in menstruation and in pregnancy, is the direct consequence of ovarian functions, and closely dependent upon them; and the period of its prominent activity does not come until after the action of the ovaries has been completely established; that is, the period of maternity is, or should be, consecutive to the period of adolescence, and the work of gestation only entered upon when the work of ovulation has long been thoroughly accomplished. ”

“ In a she-bat ovulation does not take place until the end of winter, although she has received the male in the autumn: females caught during hibernation have the vagina swollen with inert sperm which does not act until the spring waking. ”

“ They consider themselves of little account for business or social duties. They must be petted and nursed, and have every passing whim gratified.
The meno-pause is simply a cessation of ovulation. It is the exhaustion of the germ-making power. If a woman menstruates because of the monthly ovulation and deposit, she will cease to menstruate because ovulation has ceased to be a physiological operation.
At puberty the ovaries enlarge. When fully developed they begin casting off each month perfected ovula, which are taken up by the fimbriated extremities of the oviducts and conveyed to the uterus. ”

“ A fault of sexual function does not spring into existence the moment sexual life is to be crowned by ovulation. This imperfect function is a result, not a process. It antedates the commencement of ovarian life. It may be occult in the years of childhood, it may be antenatal, or even an error of ancestry. I believe it exists with the force of a law, that the conditions which result in ovarian irregularity are operative before and not during the establishment of that function. This office, like any other of the body, is exposed to the accidents of disease ”

“ Ovulation, which probably occurs about midway between the menstrual periods, is simply the name which has been given to the principal function of the ovary and may be defined as the development of the ovum, or egg, and its expulsion, when mature, from the ovary. As the entire human 29body has its origin in this tiny ovum, its career and course of development are of momentous importance to us, and at the same time furnish a tale of absorbing interest. The ovaries are packed full of these tiny egg-like cells, which probably lie dormant, as stated before, until the girl reaches puberty. ”

“ I may fairly infer that similar incitements on the mind of females may have a stimulating effect on the organs of ovulation. I have frequently known menstruation to be irregular, profuse, or abnormal in type during courtship in women in whom nothing similar had previously occurred, and that this protracted the treatment of chronic ovaritis and of uterine inflammation. ”

“ From the vital phase in which, marked by the visible manifestations of puberty and by the first appearance of menstruation, ovulation is assumed to begin, the sexual life of woman continues to the period of life in which, marked by the climacteric cessation of menstruation, ovulation also ceases. The total duration of this sexual period in woman’s life is usually about thirty years ”

“ The increase of fluid in the follicle of the ovary, and the excessive charge of blood in the vessels on the walls of the follicle, seem to be, without any actual contraction taking place, the physiological causes of the freeing of the ovum from the follicle, so that it may come in contact with the semen. Ovulation can take place without intercourse. But sexual intercourse can also favor ovulation ”

“ In addition, there are many influences which are known to prevent or to diminish ovulation in the case of the lower animals, and which may therefore be assumed with considerable probability to have a similar effect in women. ”

“ We need only allude in passing to the fact that later in life marked changes occur in the uterus as a result of pregnancy and parturition. The hypertaemia and the bleeding that take place periodically during menstruation lead to certain changes in the mucous surface of the uterus. Ovulation, which in the sexually mature woman recurs at four-weekly intervals, also gives rise to certain permanent changes in the ovaries. ”

“ The gradual decline of the ovarian function is a type of its equally gradual inception. It is a reasonable inference that, whatever takes time in throwing down, also requires time in the building up. So far as the importance of the change of life and the beginning of ovulation are concerned, the latter greatly exceeds the former—I am speaking of the two phenomena as physiological acts—and yet we see the former always attended by anatomical preparation, and by a functional activity so slowly diminished, that even the subject herself is unconscious of the crisis through which she is passing. ”

“ In the words of Négrier,7 "It seems well proved that the ovarian function, creative of germs, is prolonged in life in direct ratio of the volume of the ovaries and of the precocity of ovulation; thus the girl nubile at twelve will continue menstruating until fifty or even fifty-five; whilst the girl who did not menstruate until eighteen or twenty—a fact which reveals feeble development and small energy of the organs—will cease to menstruate at forty, an early age."8 Cessation occurs later in women who have passed through repeated normal pregnancies than in virgins or sterile females. ”

“ From the earliest times the process of menstruation has attracted the attention of natural philosophers, and has led them to formulate hypotheses and to institute investigations, especially in order to ascertain whether the connection between ovulation and menstruation is one of temporal succession merely, or whether the relation is a causal one. ”

“ According to L. Meyer, under the influence of ovulation, a continual production of substances, oophorines, necessary for the growth of the foetus, takes place. These substances circulate in the blood, and, when they are present in large amounts, cause a stimulation of the entire nervous system. This explains the nervous irritation and other phenomena of this period. During menstruation these substances are excreted. ”

“ Chronic inflammation of the vagina also gives rise to acrid secretions, which destroy the vitality of the spermatozoa. Suppression of the menses, or any disorder of the uterine functions, may disqualify the female for reproduction. Flexions of the uterus, displacements, congestions, and local debility, may likewise prevent fertility. Sterility may result from impaired ovarian innervation or undue excitement of the nerves, either of which deranges the process of ovulation. Even too frequent indulgence in marital pleasures sometimes defeats conception. ”

“ Though menstruation is usually deficient or absent in obese sterile 481women, and though it is commonly supposed that amenorrhœa implies sterility, it is necessary to point out that whilst failure of menstruation is a frequent and important sign of suppression of ovulation, it by no means invariably has this significance. It is an established fact, and one borne out by my personal experience, that women who have never menstruated have nevertheless become pregnant ”

“ Physicians have repeatedly propounded the theory that one ovary produces eggs capable of developing only into females, the other only those capable of becoming males, and the suggestion has been made that in the case of human beings ovulation takes place alternately from the ovaries. From this it would follow that were the sex resulting from one fertilization known, the sex of a subsequent fertilization could be predicted, or by choosing the date of fertilization, selected. ”

“ The most important indication of the general changes occurring in the external and internal genital organs, the proof that the young woman has become fitted for the fulfilment of her reproductive vocation, is the appearance of menstruation, a sanguineous discharge from the genital organs recurring every four weeks as the external manifestation of the internal process of ovulation. ”