Polycystic Ovary Syndrome

Kovacs GT editor . Polycystic Ovary Syndrome . 325 pages, tables, figures. Cambridge, U.K. : Cambridge University Press , 2000 . Price GBP 55.00 . Although everyone agrees that there is a clinical condition which deserves to be labelled the polycystic ovary syndrome (PCOS), there is no consensus on its exact definition. It was easier in 1935, when Stein and Leventhal described seven hirsute women with amenorrhea associated with bilateral polycystic ovaries. The treatment was wedge resection of the sclerocystic ovaries, whereupon the women conceived, and that was it. Many years later, in the 1970s, radioimmunoassays revealed the biochemical correlates: increased levels of androgens and luteinizing hormone, but not in all. Since 1980 evidence of hyperinsulinism and insulin resistance have piled up; combined with androgen excess, this contributes to obesity in most of these women. By transvaginal sonography in the 1980s we could see the ovaries, but every addition to the diagnostic spectrum made a definition of the syndrome more difficult. This may be part of the reason why prevalence figures vary widely. But even with the most restrictive definition, the condition is fairly common. Polycystic Ovary Syndrome is a book which meets the demand for an update on every aspect of it. Thirty-five experts have contributed. They come from Australia, Canada, France, New Zealand, Sweden, UK and USA. Coincidentally, our Chief Editor, Per Olof Janson, wrote the chapter on long term health implications, in collaboration with Eva Dahlgren. Other chapters relate the history of PCOS, inheritance and genetic basis, pathology, imaging and skin manifestations. One on lifestyle factors in the etiology and management is followed by chapters on the various options for infertility treatment, in which Halvard Gjønnaess’ electrocautery from 1984 recurs in one chapter after another. Since the syndrome is many-faceted, so are the treatment modalities. They range from weight reduction (induced by surgery or diet and exercise) through ovulation induction by anti-estrogens or gonadotrophins, to the most sophisticated ways to fertilize eggs extracorporeally. The question of long-term monitoring of women with PCOS is discussed in the last chapter, with no clear recommendation. Polycystic Ovary Syndrome is a book for the clinician. The chapters are well-written, easy to read, with appropriate lists of references. I endorse the back cover text, which says that it will appeal to all doctors with an interest in reproductive endocrinology, including gynecologists, in vitro fertilization specialists and obstetricians.

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