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Fertility and contraception in the human female
BOOKS Edited
by
LOUIS
M.
HELLMAN,
M.D.
AND RALPH
M.
WYNN,
M.D.
Book review Fertility
and Contraception male. J. A. Loraine
in
the
Human
In the first chapter, a brief description of the anatomy of the ovary is presented, followed by a more detailed account of the development of the follicle and corpus luteum. In the section on biologic and biochemical effects of gonadotropic hormones on the ovary, the authors commendably refrain from unwarranted transfer of animal experimental data to their description of human ovarian function. The terms “luteotrophic hormone” and “prolactin” do not appear in this discussion. Brief consideration of the current theories of action of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) is given and the references cited are current. The second chapter deals with morphologic and biologic changes in the ovary associated with the process of ovulation. Here, unavoidably, the authors present mainly animal studies. Several pages are devoted to discussion of the explosive versus the enzymatic mechanism of ovulation. The references are numerous, ranging from historical to current work. Chapter 3 is a valuable contribution in that it summarizes in organized form a wide variety of laboratory methods of hormone measurements in urine and blood. Estrogens, progesterone, pregnanediol, pregnanetriol, testosterone, and pituitary gonadotropins are discussed. Various methods are individually described; for a number of them the basic steps are listed. The authors have drawn upon their wide experience in this field to add pertinent comments on the relative merits and disadvantages of numerous methods. The treatments are brief and concise, in keeping with the authors’ intention to make
Fe-
and E. T. Bell. 354 pages. Baltimore, 1968, The Williams & Wilkins Company. $13.00. It is a distinct pleasure for a reviewer to evaluate a new, concise survey of the literature and current thinking by a team of unquestioned world authorities in a rapidly advancing field of global interest and significance. Drs. John A. Loraine and E. Trevor Bell have themselves made many significant contributions to our understanding of the physiology of reproduction. This treatise on human fertility and contraception is a most welcome reference work at this time of rapid advances in this field. This small book contains only 354 pages of text. The authors, in maintaining this size, have limited themselves to information and concepts that are, for the most part, generally accepted and noncontroversial It is unfortunate that they therefore also refrained from sharing their insight more fully on some of the problems faced I)y the clinician. The logical arrangement of the material and the excellent index combine to make this a very useful reference for the ofhce or laboratory. The book is divided into eleven chapters covering three major areas of interest. The first six chapters comprise slightly more than one half of the total number of pages and are de\,oted to reproductive physiology and anatomy in the normal and certain pathologic states. The remainder of the book devotes two chapters to infertility and three chapters to contraception. 1175
this volume a survey or reference work rather than a laboratory manual. The individual methods, are welt referenced, as are many of their modifications. Chapter 4, ‘LHormone Levels During the Normal Menstrual Cycle,” presents data on urinary excretion and blood levels of steroids and gonadotropins. Some of the figures date back to 1955, but all are timely, carefully selected, and representative. No glaring omissions are noted. In the fifth chapter the authors describe other hormonal effects during the menstrual cycle. A short discussion of endometrial biopsies is followed by rather detailed descriptions of cyclic changes in the character and chemistry of cervical mucus. The next section, which deals with vaginal cytology, contains the only color platrs in the book. Following a logical sequence, Chapter 6 prcscnts data on patterns of hormone excretion in various abnormal conditions. Urinary excretion of estrogens, pregnanediol, and gonadotropin are compared in various menstrual disorders such as anovulation, oligomenorrhea, dysmenorrhea, and amenorrhea. Amenorrhea associated with galactorrhea is given separate consideration, as is the Stein-Leventhal syndrome. Current concepts are presented without wasting much space on c‘onjecturc about cause or treatment of these poorly understood syndromes. Chapters 7 and 8 discuss induction of ovulation by clomiphene and gonadotropins, rcspectively. The literature on clomiphene therapy in the treatment of infertility is extensive. The pertinent data presented are representative and adequately illustrated with graphs of patterns of hormone excretion. The mc,rhanisnls of action are examined in some detail and, not surprisingly, no clear-cut conclusions are drawn from the conflicting data. Gonadotropins prepared from human menopausal ably to keep mechanism physiologic could well ness of these
pituitaries and those prepared from urine are discussed separately, probthe references in order. Since the of action, indications for use, and response seem to be identical, they be considered together. The usefulpreparations is unquestioned. Avail-
ability, however, is presently limited to a few investigators. In Chapter 9 the authors turn from stimulation of fertility to its control. Oral contraceptives are considered in great detail. It soon bccomes evident that the authors greatly favor population control. They nevertheless examine the side effects and possible harmful effects with commendable objectivity. Data are presented depicting the effect of oral cuntraceptives on hormclne csxcretion and suggesting that inhibition of 1.1-i is the major mechanism for the pr,‘\.ention of ovulation. The intrauterine contraceptive device ! IUD, is describrd in Chapter 10. Xn txxcellent bricaf history of the IUD is presented. Thr varior1.s available configurations are compared with r+ spect to t,ffectivrness and side effects. Compliratiorls, lh(soretical dangers, and contraindications IO the use of the IUD are discussed in detail. Possible mcchanismr, of action art’ briefly mmlioned. In the final chapter, the eleventh, the authors attack a most timely problem, overpopulation and contraception. It is this concern for man’s future that appears to have motivated the writing of this I)ook. The population growth curvzs and age distribution pyramids are familiar 10 all conccbrned about the prospect of a disastrously overcrowded planet. These c~,nccpts mllst 1~ disseminated l)y all available media of rommunication if catastrophe is to bc svcrtrd. The point is made that means arc now at hand fol such control if they are implemented. 111 gc~n~~ral, this book will bc useful to a broad range of readers. Physicians,
by
LOUIS
M.
HELLMAN,
M.D.
AND RALPH
M.
WYNN,
M.D.
Book review Fertility
and Contraception male. J. A. Loraine
in
the
Human
In the first chapter, a brief description of the anatomy of the ovary is presented, followed by a more detailed account of the development of the follicle and corpus luteum. In the section on biologic and biochemical effects of gonadotropic hormones on the ovary, the authors commendably refrain from unwarranted transfer of animal experimental data to their description of human ovarian function. The terms “luteotrophic hormone” and “prolactin” do not appear in this discussion. Brief consideration of the current theories of action of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) is given and the references cited are current. The second chapter deals with morphologic and biologic changes in the ovary associated with the process of ovulation. Here, unavoidably, the authors present mainly animal studies. Several pages are devoted to discussion of the explosive versus the enzymatic mechanism of ovulation. The references are numerous, ranging from historical to current work. Chapter 3 is a valuable contribution in that it summarizes in organized form a wide variety of laboratory methods of hormone measurements in urine and blood. Estrogens, progesterone, pregnanediol, pregnanetriol, testosterone, and pituitary gonadotropins are discussed. Various methods are individually described; for a number of them the basic steps are listed. The authors have drawn upon their wide experience in this field to add pertinent comments on the relative merits and disadvantages of numerous methods. The treatments are brief and concise, in keeping with the authors’ intention to make
Fe-
and E. T. Bell. 354 pages. Baltimore, 1968, The Williams & Wilkins Company. $13.00. It is a distinct pleasure for a reviewer to evaluate a new, concise survey of the literature and current thinking by a team of unquestioned world authorities in a rapidly advancing field of global interest and significance. Drs. John A. Loraine and E. Trevor Bell have themselves made many significant contributions to our understanding of the physiology of reproduction. This treatise on human fertility and contraception is a most welcome reference work at this time of rapid advances in this field. This small book contains only 354 pages of text. The authors, in maintaining this size, have limited themselves to information and concepts that are, for the most part, generally accepted and noncontroversial It is unfortunate that they therefore also refrained from sharing their insight more fully on some of the problems faced I)y the clinician. The logical arrangement of the material and the excellent index combine to make this a very useful reference for the ofhce or laboratory. The book is divided into eleven chapters covering three major areas of interest. The first six chapters comprise slightly more than one half of the total number of pages and are de\,oted to reproductive physiology and anatomy in the normal and certain pathologic states. The remainder of the book devotes two chapters to infertility and three chapters to contraception. 1175
this volume a survey or reference work rather than a laboratory manual. The individual methods, are welt referenced, as are many of their modifications. Chapter 4, ‘LHormone Levels During the Normal Menstrual Cycle,” presents data on urinary excretion and blood levels of steroids and gonadotropins. Some of the figures date back to 1955, but all are timely, carefully selected, and representative. No glaring omissions are noted. In the fifth chapter the authors describe other hormonal effects during the menstrual cycle. A short discussion of endometrial biopsies is followed by rather detailed descriptions of cyclic changes in the character and chemistry of cervical mucus. The next section, which deals with vaginal cytology, contains the only color platrs in the book. Following a logical sequence, Chapter 6 prcscnts data on patterns of hormone excretion in various abnormal conditions. Urinary excretion of estrogens, pregnanediol, and gonadotropin are compared in various menstrual disorders such as anovulation, oligomenorrhea, dysmenorrhea, and amenorrhea. Amenorrhea associated with galactorrhea is given separate consideration, as is the Stein-Leventhal syndrome. Current concepts are presented without wasting much space on c‘onjecturc about cause or treatment of these poorly understood syndromes. Chapters 7 and 8 discuss induction of ovulation by clomiphene and gonadotropins, rcspectively. The literature on clomiphene therapy in the treatment of infertility is extensive. The pertinent data presented are representative and adequately illustrated with graphs of patterns of hormone excretion. The mc,rhanisnls of action are examined in some detail and, not surprisingly, no clear-cut conclusions are drawn from the conflicting data. Gonadotropins prepared from human menopausal ably to keep mechanism physiologic could well ness of these
pituitaries and those prepared from urine are discussed separately, probthe references in order. Since the of action, indications for use, and response seem to be identical, they be considered together. The usefulpreparations is unquestioned. Avail-
ability, however, is presently limited to a few investigators. In Chapter 9 the authors turn from stimulation of fertility to its control. Oral contraceptives are considered in great detail. It soon bccomes evident that the authors greatly favor population control. They nevertheless examine the side effects and possible harmful effects with commendable objectivity. Data are presented depicting the effect of oral cuntraceptives on hormclne csxcretion and suggesting that inhibition of 1.1-i is the major mechanism for the pr,‘\.ention of ovulation. The intrauterine contraceptive device ! IUD, is describrd in Chapter 10. Xn txxcellent bricaf history of the IUD is presented. Thr varior1.s available configurations are compared with r+ spect to t,ffectivrness and side effects. Compliratiorls, lh(soretical dangers, and contraindications IO the use of the IUD are discussed in detail. Possible mcchanismr, of action art’ briefly mmlioned. In the final chapter, the eleventh, the authors attack a most timely problem, overpopulation and contraception. It is this concern for man’s future that appears to have motivated the writing of this I)ook. The population growth curvzs and age distribution pyramids are familiar 10 all conccbrned about the prospect of a disastrously overcrowded planet. These c~,nccpts mllst 1~ disseminated l)y all available media of rommunication if catastrophe is to bc svcrtrd. The point is made that means arc now at hand fol such control if they are implemented. 111 gc~n~~ral, this book will bc useful to a broad range of readers. Physicians,