Polycystic ovary syndrome (PCOS) is the most common endocrine disturbance, affecting 10 15% of women in the UK. The definition of PCOS has been much debated, while its pathophysiology appears to be multifactorial and is still being actively researched. There is no doubt that PCOS has a significant effect on quality of life and psychological morbidity and, as many specialists are involved in its management, a multidisciplinary approach is required. The 59th RCOG Study Group brought together a range of experts who treat women with PCOS. This book presents the findings of the Study Group, including: a definition of PCOS the accuracy of diagnostic interventions the particular challenges of adolescent diagnosis and management the correlation to ethnicity current approaches to therapy the potential individualisation of therapy the role of the alternative therapies used to manage some aspects of PCOS."

Amenorrhea: A Case-Based Clinical Guide is a comprehensive review of the current knowledge regarding normal female reproductive physiology. Replete with interesting case vignettes and providing diagnostic algorithms and therapeutic strategies for amenorrhea, Amenorrhea: A Case-Based Clinical Guide is divided into three sections. The first section is composed of two chapters that provide a thorough review of basic science and clinical knowledge about the organ systems responsible for normal physiology of the menstrual cycle. The second section includes discussion about menstrual cycle disruption as it relates to hypothalamic-pituitary dysfunction, surgical and natural menopause, genetic defects, premature ovarian failure/insufficiency and the effects of caloric excess and restriction. The third section offers an update on the physiological effects of prolonged amenorrhea induced surgically or by hypothalamic dysfunction and also includes an original chapter that focuses solely on the impact of race and ethnicity on the prevalence and diagnosis of amenorrhea. Amenorrhea: A Case-Based Clinical Guide brings together chapters from renowned experts who offer state-of-the-art, clinically useful information in a case-based, reader-friendly fashion. This title will be a welcome addition to the bookshelves of all clinicians who practice in women's health settings.

Despite its universality in human female aging, the menopause and its biology are not completely understood. New biologic mechanisms by which sex hormones may be detrimental or confer protection are continually being discovered. We are now starting to understand that the role of the estrogen receptor is not identical in all tissues. Important nongenomic effects for sex hormones have also been described. Hormone replacement therapy (HRT) has produced effects on health risks: some are reduced, some are increased, and the rest remain uncertain. HRT is being used by an increasing number of women to alleviate climacteric symptoms in the perimenopausal period and to prevent osteoporosis and cardiovascular disease later. Positive effects on Alzheimer's disease and dementia on the one hand, and an increase in venous thrombosis on the other, are currently being reported by several groups. Both the preventive benefits and the risk of breast cancer seem to be linked to long-term and current use. HRT requires further testing through specific clinical trials, currently underway in the United States, before confident recommendations may be made about the full range of benefits and risks.

Human reproduction is the most dynamic of processes. The events which lead to the birth of a normal healthy infant have their origin long before actual fertilization. Indeed, the whole process can be looked upon as a continuum. Human fertilization and early development, once sequestered in the protective environment of the fallopian tubes and uterus, have now been exposed in the laboratory. These events have, over time, been extensively observed and catalogued in animal models. The tools of modem morphology and molecular biology have reopened issues long since considered settled as facets of early reproduction are reexplored. This volume, consisting of the proceedings of a workshop on uterine and embryonic factors in early pregnancy, has been designed to enhance that effort. Attention is focused largely on early embryonal development with special attention to the interrelationship between the embryo and the uterus in early pregnancy. Each of the contributing scientists brings with him or her the perspective of one specific discipline or another. The common denominator is the application of emerging techniques in modem molecular biology to problems pertaining to embryonal-uterine interaction. The goal is to consider specific areas of concern in a multidisciplinary way and to reexplore the factors behind early development and implantation. Uterine complement, the function of uterine macrophages immunoregulatory loops in the peri-implantation period, colony stimulating factors and interferon-like factors are reviewed and their interrelationship explored. Uterine angiogenesis factors as well as embryonic growth factors are also considered.

Nearly one-half of an American woman's life is spent after the cessation of reproductive function. A woman of 40 years has an additional life expectancy of nearly 40 years; a woman of 75, over 11 years. This pattern of longevity is likely to continue, so that by the year 2000, it has been estimated, 30 percent of the female population will be postmenopausal. While it is difficult to separate the results of aging from those of estrogen deprivation, it is important that we try to do so, since the results of the latter are amenable to treatment. The medical infirmities resulting from estrogen deprivation take a high toll among postmenopausal women. Nearly 200,000 hip fractures occur annually in this group, resulting in 15,000 deaths and a high morbidity rate. Sleep disorders, compromised sexuality, psychomotor alterations of the climacterium, and urinary tract disorders all contribute to a lowered quality of life. Appropriate treatment of these disturbing postmenopausal conditions requires an understanding of the underlying bio chemical, endocrinologic, psychologic, and pathophysiologic al terations of estrogen deprivation. Toward this end, the reader will find herein chapters dealing with estrogen metabolism in the postmenopausal female, end-organ response to estrogen deprivation, and bone metabolism and osteoporosis. Next, the reader will find chapters dealing with specific or gans, organ systems, or conditions related to the quality of life; for example, sexuality, urinary tract problems, sleep disorders, the breast, sports and exercise, the climacteric, and the psycho biology of the menopause."

This acclaimed text continues to focus on the essential techniques for effective surgical management of patients with ovarian cancer and related peritoneal surface malignancies. With a wealth of accompanying illustrations and operative videos; this fourth edition reflects the evolution - and controversies - in the use of minimally invasive and robotic surgery and the introduction of HIPEC treatment options.

''A valuable resource for those concerned with experimental teratology and risk assessment and those requiring general information about the causes of birth defects. The treatment of these issues is sophisticated, succinct, and logical.'' --- American Scientist, from a review of a previous volume The current volume covers intergenerational factors in pregnancy outcome, the thresholds for developmental toxicants, and four other subjects.

This is the definitive reference on the medical, surgical, legal, and ethical aspects of establishing and maintaining an office-based egg donation program. The editor has assembled an international list of authors with known expertise in this rapidly expanding field. The clinical procedures are clearly depicted in the book's many line drawings and photographs.

Peritoneoscopy and culdoscopy were first introduced in the second edition of TeLinde's Operative Gynecology in 1953. TeLinde noted, "In many instances we find peritoneoscopy to be a useful procedure. Nevertheless it often left something to be desired." During the subsequent four decades, enormous progress has allowed the expansion of the application of laparoscopy and hysteroscopy throughout gynecol- ogy. Thus, it is appropriate and quite useful to have a text devoted solely to this rapidly advancing specialty. In its second edition, the text Practical Manual of Operative Laparoscopy and Hys- teroscopy is a complete and honest overview of the field providing the reader with a critical appraisal of the current literature on technique, development, and long- term follow-up. Refreshingly, the authors include not only the American experi- ence but also advances from Europe and Asia. Ricardo Azziz and Ana Alvarez Murphy have carefully organized the text into general concepts and laparoscopic and hysteroscopic operative techniques. The editors have selected authors of national and international stature to prepare chap- ters in their areas of expertise. The edited text carefully analyzes the advantages and disadvantages of each operative technique so as to allow readers insight as to the proper place for a particular endoscopic technique in their surgical practices.

"Drugs During Pregnancy and Lactation, 3rd Edition" is a quick and reliable reference for all those working in disciplines related to fertility, pregnancy, lactation, child health and human genetics who prescribe or deliver medicinal products, and to those who evaluate health and safety risks. Each chapter contains twofold information regarding drugs that are appropriate for prescription during pregnancy and an assessment of the risk of a drug when exposure during pregnancy has already occurred. Thoroughly updated with current regulations, references to the latest pharmacological data, and new medicinal products, this edition is a comprehensive resource covering latest knowledge and findings related to drugs during lactation and pregnancy.
Provides evidence-based recommendations to help clinicians make appropriate recommendationsUniquely organized and structured according to drug class and treatment indications to offer authoritative clinical content on potential adverse effects Highlights new research developments from primary source about working mechanism of substances that cause developmental disorders
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Recent work in quantitative biology has shown theoretically why Fisher's Fundamental Theorem of Natural Selection does not preclude genetic influences on fertility, sexuality, and related processes. Genetic Influences on Human Fertility and Sexuality takes the next step, and presents a number of successful empirical searches for such genetic influence on a broad range of processes, such as puberty, marriage, sexual behavior, and twinning. Employing a broad range of methodological approaches, including molecular and behavioral genetics, this book weaves a new theoretical framework that shows how genes can help relate fertility planning to fertility outcome, and how puberty, sexuality, marriage, and reproduction can be conceptually linked through the genes that contribute to individual differences in the human process.

This book offers a progress report on efforts to meet the challenges faced by ovarian cancer patients and their doctors. It provides a current perspective on therapeutic developments as a partnership between laboratory-based and clinical-based researchers.

From a review of an earlier volume: 'Both the experimental and the human aspects of teratology are presented in this comprehensive text by a stellar group of internationally recognized scientists and clinicians....A valuable resource for those concerned with experimental teratology and risk assessment and those requiring general information about the causes of birth defects. The treatment of these issues is sophisticated, succinct, and logical.'-American Scientist

Recently, attention has been called to the role that microvascular organization plays in the functional morphology of all organs and tissues, both in normal and pathological conditions. Since its development by Murakami, the corrosion cast method for scanning electron microscopy has come to be considered one of the most efficient means in clarifying the three-dimensional features of the microcirculation of organs and tissues. Scanning Electron Microscopy of Vascular Casts: Methods and Applications was planned to supply fundamental and new information regarding microcirculation studies to general biologists, anatomists, pathologists and clinicians. The contributions to this volume, contain original findings and excellent electron micrographs obtained by using recently improved corrosion cast methods. The rich variety of papers in this book will be useful to many, and will provide both the basic and clinically oriented readers with good ideas, suggestions, and original and worthwhile information.

The title "Stem Cells from Cord Blood, In Utero Stem Cell Develop ment, and Transplantation-Inclusive Gene Therapy" suggests that more than one topic is combined in one workshop. Indeed, at first glance the recovery of stem cells from cord blood has to be seen as separate from the attempts to achieve effective in utero therapy by stem cell trans plantation, because the first issue deals with an innovative stem cell source as an alternative to bone marrow, which is already spreading rapidly in medical practice, whereas the second topic is still strictly ex perimental and only investigated in medical centers with the appropri ate background. It is, however, not only justified, but helpful to com bine the two topics in one workshop and consequently to cover them in the same volume of the Ernst Schering Research Foundation Work shop series, because they are intimately related and both based on the new insights into the biology of stem cells. Professor Werner Arber, the Nobel Laureate from the University of Basel, pointed out in his In- Professor Dr. W. Holzgreve VI Preface The participants of the workshop troductory Lecture that our understanding of hematopoietic stem cells as descendents of totipotent cells and our current approaches to using them in post-and prenatal therapy have been furthered significantly by genetic engineering technologies which are "artificial contributions to the process of biologic evolution.""

This concise, truncated version of Nagy, Varghese and Agarwal's Practical Manual of In Vitro Fertilization is comprised of select clinical chapters for a portable, affordable and up-to-date resource. Gamete Assessment, Selection and Micromanipulation in ART covers a variety of topics, including: - Human oocyte evaluation - Sperm evaluation and selection - Micromanipulators and micromanipulation - Biopsy procedures on oocytes and embryos - Molecular insights in IVF Practical for both clinicians and researchers alike, Gamete Assessment, Selection and Micromanipulation in ART brings together all of the need-to-know information about these important topics in reproductive medicine.

The 15th International Symposium of the Japan Human Cell Society on Cell and Molecular Biology of Endometrial Carcinoma brought together leading researchers from Japan and around the world. The papers collected here are the work of twenty-two leaders in their field and are organized in ten major categories. The first section, in vitro experimental systems, takes up the pioneering work by Kuramoto in 1968 and Nishida in 1980 in establishing, respectively, the HEC-1 and hormone-responsive endometrial carcinoma cell lines. Other topics include apoptosis, proliferation, and growth factors; cell cycle regulators; signaling pathways; angiogenesis; carcinogenesis; hormones and hormone receptors; genes and gene expression; endometrial receptivity; and chemo-resistance and -sensitivity. Presenting the latest work in the cell and molecular biology of endometrial carcinoma, this volume is a valuable resource for gynecologists, pathologists, and molecular biologists.

Millennium Development Goals (MDGs) 4 and 5, created under the auspices of the United Nations, challenged political, financial, medical and civil society leaders to improve both child and maternal health. The 58th RCOG Study Group brought together a range of experts - including midwives, obstetricians and gynaecologists, anaesthetists and paediatricians - to provide an up-to-date review of progress to date and the challenges around meeting these MDGs. This book presents the findings of the Study Group, with sections covering: the size of the problem clinical problems and solutions - maternal clinical problems and solutions - neonatal training and development specific challenges in specific countries (Afghanistan, Zimbabwe, Egypt and Sri Lanka)."

Care for Children Born Small for Gestational Age is a comprehensive handbook that serves to synthesize the extensive recent literature in the area to provide a practical resource aimed at a wide range of healthcare professionals, including obstetricians, midwives, neonatologists, and primary care physicians. This comprehensive handbook includes an in-depth survey of the prevention, diagnosis, treatment and long-term monitoring of children born small for gestational age, as well as related conditions such as intrauterine growth restriction, metabolic syndrome and type 2 diabetes. Additionally, the short and long-term psychiatric and social consequences of this condition are addressed.

The pregnant host is at risk for any of the viral diseases her nonpregnant counterpart acquires. Additionally, pregnancy heightens our concerns regarding specific viral diseases be cause of their potential for enhanced adverse effects on both maternal and fetal well-being. All too often the obstetrician relinquishes responsibility for the management of the gravida infected by a viral pathogen, and those expert in infectious diseases are confounded by the influence of pregnancy on these conditions. A major goal of this textbook is to narrow the gap between the two aforementioned management dichotomies in the virally infected pregnant woman. Weare at the infancy of our understanding of viral infections in pregnancy. The current and anticipated advancements are due in large part to a burgeoning oftechnological achievements in the areas of immunodiagnostics, molecular biology, and pharmacotherapeutics. Our in utero diagnostic capabilities, both invasive and noninvasive, have also allowed us new opportunities to study the effects of various maternal infectious disease processes on the developing fetus. New insights have been recognized pertaining to the maternal-fetal interface, the placenta, in that this structure is now acknowledged to function as both a mechanical and an immunological barrier to vertical transmission of infection. These observations suggest that there will be an outpouring of new data in the next several years that clinicians will need to master to maintain an appropriate level of expertise in the care of their patients.

It is in the surgical aspect of their specialty that the gynecologists' work may be most frequently judged by their peers or by the litigious society that currently exists. Great and commendable progress has been made over the past 30 years in the basic scientific, endocrinologic and obstetric aspects of the specialty, but this has occurred with a commen surate de-emphasis of surgical procedures and surgical training, a decline in devotion to technical detail and perfection, and a tendency to take surgery for granted. Obstetric and gynecologic residency programs provide increasing numbers of specialists with average competence in the performance of the common, rather standardized gynecologic operations. In general, technical skill in the extirpative operations can be acquired far more readily than proficiency in the art of reconstructive surgery. At present, for a number of reasons, gynecologic surgical training is most deficient in regard to the surgical correction of severe forms of obstetrically damaged genital tract supports. The operations for pro lapse defy standardization and require great technical individualization; this must be based on the surgeon's judgment developed through expe rience, a thorough understanding of normal pelvic anatomy, and recog nition of the deficiency responsible for the prolapse in individual cases.

The mechanisms that initiate labour (i. e., the conversion of the quies cent uterus to an active and reactive organ at term) are poorly under stood. Of considerable importance are the factors that control preterm labour and preterm birth, with their devastating effects on society. This problem is the leading obstetrical issue. Preterm labour affects ap proximately 10% of all pregnant women (even higher numbers are re- Abb. I. The participants of the workshop VI Preface ported for less developed countries or where prenatal healthcare is a low priority) and it is the leading cause of morbidity and mortality of babies. Current practices to arrest preterm labour, once initiated, are in effective. In addition, procedures to stimulate labour and dilate the cer vix at term may not be used effectively. On October 19th - 21 st, 1992, a Schering Foundation Workshop took place in Berlin to discuss the "Basic Mechanisms Controlling Term and Preterm Labour." Leading scientists from Europe and North America were assembled to consider the fundamental systems which regulate the uterus and cervix during pregnancy. The topics in the sym posium ranged from key cellular events governing uterine contractility and cervical dilatation during labour to clinical advances and applica tions. This book contains the proceedings of the workshop. We were pleased to have been part of the workshop and to have been responsible for its organization."

The advent in the 1960s of the unique and exciting new form of energy called laser brought to medicine a marvelous tool that could accomplish new treatments of previously untreatable disorders as well as improved treat ment of mundane problems. This brilliant form of light energy is many times more powerful than the energy of the sun yet can be focused microscopically to spot sizes as small as 30 microns. Lasers can be directed into seemingly inaccessible areas by mirrors or fiberoptic cables or can be directly applied into sensitive areas such as the retina without damage to intervening structures. There has been a rapid proliferation in the use of lasers in all surgical specialties. Starting with bold ideas and experiments of "thought leaders" in each specialty, the application of lasers has evolved into commonplace usage. Beginning with the era when laser presentations and publications were an oddity, now nearly all specialty areas have whole sections of meetings or journals devoted exclusively to laser usage. Laser specialty societies within a specialty have developed and residency training programs routinely instruct trainees in laser techniques. Basic science and clinical experimentation has supported laser knowledge. Laser usage has also become international. Newer wavelengths and accessories have added to the armamentarium of laser usage. Despite the rapid growth in laser interest, no single source exists to instruct the many new laser users in proper, safe, and effective use of this new modality."

The state of health care is reflected by perinatal and neonatal morbidity and mortality as well as by the frequencies of long-term neurologic and developmental disorders. Many factors, some"without immediately recognizable significance to childbearing and many still unknown, undoubtedly contribute beneficially or adversely to the outcome of pregnancy. Knowledge concerning the impact of such factors on the fetus and surviving infant is critical. Confounding analyses of pregnancy outcome, especially these past two or three decades, are the effects of newly undertaken invasive or inactive therapeutic approaches coupled with the advent of high technology. Many innovations have been intro duced without serious efforts to evaluate their impact prospectively and objectively. The consequences of therapeutic misadventures character ized the past; it seems they have been replaced to a degree by some of the complications of applied technology. Examples abound: after ov eruse of oxygen was recognized to cause retrolental fibroplasia, its restriction led to an increase in both neonatal death rates and neurologic damage in surviving infants. Administration of vitamin K to prevent neonatal hemorrhagic disease, particularly when given in what we now know as excessive dosage, occasionally resulted in kernicterus. Prophy lactic sulfonamide use had a similar end result. More recent is the observation of bronchopulmonary dysplasia as a complication of re spirator therapy for hyaline membrane disease. The decade of the eighties opened with the all-time highest rate of cesarean section in the United States."