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Although the history of polycystic ovary syndrome (PCOS) was discussed in detail in Chapter 1, a brief review here is warranted. Stein and Leventhal were not only the first to describe the condition in 1934/5;[1] they also reported on a surgical treatment for anovulation, which resulted in two pregnancies. By 1964, Stein reported on a successful series of 108 anovulatory PCOS women treated by bilateral ovarian wedge resection (BOWR).[2]
Although the modern history of polycystic ovary syndrome (PCOS) started with the pivotal paper by Stein and Leventhal in 1935,[1] there are suggestions that the “syndrome” was referred to as early as in the time of Hippocrates (ca. 460–377 BC). Medical notes at the time referred to women “whose menstruation is less than three days or is meager, are robust, with a healthy complexion and a masculine appearance; yet they are not concerned about bearing children nor do they become pregnant” and suggest that they may have been describing women with PCOS.[2]
Polycystic ovary syndrome (PCOS) is one of the most common reproductive health problems of women, causing irregular periods and potential infertility amongst other challenging symptoms. Effective treatment remains a significant challenge and is largely achieved through hormonal medication and lifestyle changes. This third edition covers the aetiology, pathology, impact on fertility and effective medical and surgical management. The content has been thoroughly revised in line with updated guidelines and research developments in the field. A new chapter on the patient's perspective has been included, bringing valuable insight into the lived experience of the condition. Mood disorders and the psychological aspects of PCOS are also covered for the first time. This is a key reference for all clinicians involved in the care of patients with PCOS, including gynaecologists, IVF specialists and reproductive endocrinologists.
The term “polycystic ovary syndrome” (PCOS) has replaced the term Stein–Leventhal syndrome. Stein and Leventhal not only were the first to describe the condition but also developed and reported on a treatment, reporting on a successful series of 108 women treated by “wedge resection” [1]. In fact until the availability of clomiphene (clomifene) citrate (CC) in 1961 [2], this was the only option available to treat the infertility of women with this condition; characterized by obesity, oligomenorrhea, and anovulation. However, as treatment required laparotomy, and often resulted in periovarian adhesion formation, once medical treatment was available, initially CC, then human pituitary gonadotropins (hPG) [3], then urinary human menopausal gonadotropin (hMG) [4], wedge resection lost popularity, unless it was performed in conjunction with another surgical procedure that already required laparotomy.
With up to 60 per cent of women experiencing both physical and emotional symptoms during the menopause, including hot flushes, mood swings and loss of libido, managing these symptoms can be a complex task. Managing the Menopause is a highly practical, evidence-based reference, covering all forms of management in detail. Providing guidance on prescribing, as well as the advantages and disadvantages of various products and therapies, particular emphasis is given to addressing concerns over the long-term complications of Menopausal Hormone Therapy (MHT) use. The book contains new chapters on nutrition, ovarian tissue cryopreservation and migraine in the menopause and previous chapters have been fully updated to inform readers of the latest research. Treatment plans are included in the text, helping clinicians to support their patients quickly and effectively. A comprehensive review of the menopause that is easily understood at all levels, this is an essential guide for clinicians.
Up to the 1980s the ability to treat couples with male subfertility was limited. Treatable conditions included gonadotrophin therapy for men with hypogonadotrophic hypogonadism (which is estimated to be present in 1 in 200 infertile men), and the treatment of autoimmunity with high dose steroids with its side effects and complications (i.e. avascular necrosis of the head of the femur) [1].
Polycystic ovarian syndrome (PCOS) is one of the most prevalent endocrinopathies, affecting 5-10% of women of reproductive age. PCOS is one of the commonest causes of anovulatory infertility. The characteristic clinical features of PCOS include menstrual irregularity such as oligomenorrhoea and signs of hyperandrogenaemia including hirsutism, acne, and/or obesity. A recent study observed a significant and progressive correlation between body mass index (BMI) and both blood pressure and clinical features in women with PCOS. Clomifene citrate has been the standard treatment for induction of ovulation in women with anovulatory infertility for many years. The beneficial endocrinologic and morphologic effects of laparoscopic ovarian diathermy appear to be sustained for up to 9 years in most patients with PCOS. In vitro maturation (IVM) protocols are now a valuable alternative to conventional in vitro fertilization (IVF) as a strategy to prevent ovarian hyperstimulation syndrome (OHSS).
This helpful and practical handbook will be an essential resource for all clinicians dealing with problems of subfertility. It provides a comprehensive approach to infertility starting off from the initial history to diagnostic techniques of ultrasound, diagnostic surgery, as well as all forms of therapy, including ovulation induction, infertility surgery, andrology, donor insemination and reproductive technologies. The authorship is made up of experienced members of the Monash University affiliated Reproductive Medicine Clinics; one of the world's pioneering centres in IVF technology. The authors have distilled a wealth of expertise and 'hands on' experience in this area to provide an invaluable guide to all those involved in the treatment of infertility, from gynaecologists to physicians and postgraduate students specialising in reproductive medicine.
Polycystic ovary syndrome (PCOS) is one of the most common reproductive health problems of women. Despite this, its effective treatment remains a significant challenge to the medical profession. This second edition (published 2007) of a highly successful and well-reviewed book is a thorough update on the syndrome, its aetiology, pathology, impact on infertility, and effective medical management. Every chapter has been extensively referenced and completely revised and updated. New chapters cover: hyperinsulinemic insulin resistance; new treatments including in-vitro maturation; paediatric origins, including the Barker Hypothesis; adrenocortal dysfunction; polycystic ovary syndrome in non-western societies; surgical treatment of obesity associated with polycystic ovaries, and treatment with vitamins and minerals. The book is a reference text for all clinicians with an interest in reproductive endocrinology, including gynaecologists, IVF specialists and obstetricians.
HAT-South is a network of six identical, fully automated wide field telescopes, to be located at three sites (Chile: Las Campanas, Australia: Siding Springs, and Namibia: HESS site) in the Southern hemisphere. The primary purpose of the network is to detect and characterize a large number of extra-solar planets transiting nearby bright stars, and to explore their diversity. Operation of HAT-South is a collaboration among the Harvard-Smithsonian Center for Astrophysics (CfA), Max Planck Institute for Astronomy (MPIA) and the Australian National University (ANU). The network is expected to be ready for initial science operations in 2009. The three sites will permit near round-the-clock monitoring of selected fields, and the continuous data-stream will greatly enhance recovery of transits. HAT-South will be sensitive to planetary transits down to R≈14 across a 128 square-degrees combined field of view, thereby targeting a large number of dwarfs with feasible confirmation-mode follow-up. We anticipate a yearly detection rate of approximately 25 planets transiting bright stars.