- Email: [email protected]
Surgical treatment of the infertile female
Aids
and Pregnancy. By Maternity Center Association. New York: Maternity Center Association, 1987. Brochure is available at $0.50 per brochure ($0.30 per brochure for orders of 100 or more), from: Publications Department, Maternity Center Association, 48 East 92nd St., NY, NY, 10128. (212) 369-7300 Reviewed by: Tom Lloyd, MS, CNM, Assistant Professor, Nurse-Midwifery/ Women’s Health Care Program, Oregon Health Sciences University, Portland, OR.
Aids and Pregnancy is a triple-folded, 8% by 11” brochure offered for sale and distribution by Maternity Center Association. Intended for “women who are either pregnant or are considering becoming pregnant,” the brochure addresses most of the general aspects of AIDS as they relate to children and preconceptional, pregnant, and breastfeeding women. The brochure is wellwritten and scientifically accurate. The copy obtained by this reviewer was accompanied by a press release. Without access to this release, one might assume that the target audience is health care professionals, rather than their clients. Two characteristics of the brochure contribute to this confusion. First, the text is rather lengthy, a probable necessity due to the many facets of AIDS that need to be presented in such a publication. However, many young women who encounter this brochure may find it difficult to read due to the volume of information included. A second aspect that
might limit its value to some high-risk women is the vocabulary level. Words and phrases such as “manifestation,” “direct inoculation” and “clinically significant illnesses attributable to .” are scattered throughout the text. Such choice of wording is an asset to the welleducated client. But a significant portion of the intended audience will probably need further clarification (if not actual assistance) in reading and understanding the brochure. Those able to read and comprehend this brochure will be well satisfied with its scope and accuracy. Having just seen the most recent AIDS report issued by the Center for Disease Control, this reviewer prepared a list of relevant questions before reading Aids and Pregnancy. With one exception, every question was addressed to a satisfacto y-or-better degree. However, the issue of false-positive screening results requires a more complete explanation than appears here. Although there is a statement that HIV-antibody screening “often has to be confirmed by a more accurate test,” the inevitability of false-positives and the potential impact of positive results are issues that deserve special attention in any information about AIDS. This reviewer recommends the brochure, because, as the release letter states, there is such “a lack of literature about AIDS written specifically for ” this audience. Although some patients may find the brochure somewhat difficult to read and comprehend, those who do not will benefit from a firm foundation on this crucial topic.
326 Copyright 0 1987 by the AmericanCollege of Nurse-Midwives
Journal of Nurse-Midwifery
Surgical Treatment of the Infertile Female. By Veasy C. Buttram, MD and
Robert C. Reiter, MD. Baltimore: Williams & Wilkins, 1985. 381 pages. $55.00, hardcover. Reviewed
by: Arnold H. Michael, MD, Chief of Gynecology, Baltimore County General Hospital, Randallstown, MD.
Drs. Veasy Buttram and Robert Reiter have undertaken to provide an up to date textbook on the employment of surgical efforts for the relief of infertility, and they have accomplished this aim. Neither an atlas of surgical procedures nor a cookbook, it is a comprehensive effort that starts from “scratch” with a detailed examination of the causes of infertility. There follows a well-illustrated description of the diagnostic methods, from the essential history and physical exam, semen analysis, BBT chart, HSG and laparoscopy, through the increasingly more technical studies to detect influences on ovulation. The authors constantly balance the medical and surgical approach to problems and indeed include much valuable material in the non-surgical management of endometriosis and polycystic ovary syndrome. However, the name of the book is “surgery” and in that area it excels. The conditions impairing fertility, which are amenable to surgical correction are considered in categories such as endometriosis, uterine (congenital) malformations, myomata, polycystic ovary syndrome, intrauterine and cervical pathology, and tubal disease. Each condition is meticulously classified. Its influ-
??Vol.
32, No. 5, September/October
1987
0091/2182/87/$03.50
ence on fertility is defined and the methods of diagnosis are made clear before the surgical approach is described. The book abounds in tables of statistics on the incidence of conditions and success rates of treatments. Illustrations of surgical procedures, radiographic and sonographic views, laparoscopic photographs, and instrumentation for the most part are very clear. However, it is really too much to expect so complex a device as the “Garcia Claw” (an instrument for application of a silastic hood in salpingostomy) to be understood from small drawings. The book emphasizes proper utilization of basic surgical techniques, minimally invasive endoscopy, proper exposure, avoidance of injury, measures to prevent adhesions, utilization of magnification techniques, loupe, and microscope. Authors other than the editors discuss areas of special expertise; microsurgery, laser surgery, hysteroscopy, and in vitro fertilization with the same attention to detail evident in earlier chapters. An extensive bibliography deserves separate commendation. Classic articles describing historic approaches to the surgical procedures are included and provide a contrast to recently described techniques of intrauterine laser therapy or percutaneous oocyte retrieval (though not transcystic or (per) vaginal). The result is a source book on the subject of infertility that can be utilized by members of diverse disciplines. The student will learn the basics of disease and treatment. The resident will be oriented anatomically to learn procedures in the operating room. The teacher will find the organization of information invaluable for the didactic instruction of his students. The browser will enjoy hours of fascinating reading. Undoubtedly, copies of this volume will also be found on the shelves of law libraries as a valuable reference source. Having a Baby Without a Man. By Susan Robinson, MD, and H. F. Pizer, PA-C. New York: Fireside Press, 1985. 191 pages. $7.95, softcover, Reviewed
by: Cynthia S. Bechtel, CNM, Graduate student, University of Missouri, St. Louis, MO.
MSN.
Though the nuclear family may still be the norm, the portrait of the typical
Journal of Nurse-Midwifery
?? Vol.
American family is changing. High divorce rates have resulted in an increasing number of households headed by single parents, most of whom are women. In addition, single women and lesbians, who have categorically been deprived of biologic parenthood, are now choosing to have children independent of relationships with men. Having a Baby Without a Man is a valuable resource for any woman whose desire for biologic motherhood has been restricted because of marital status or sexual preference. For years, artificial insemination has been available to infertile married couples wishing to conceive, and this book does address that issue. However, according to obstetrician-gynecologist Susan Robinson and physician associate H. F. Pizer, that limitation is “narrow-minded and unfair.” They assert that advances in reproductive technology necessitate a redefinition of “family” and a subsequent acceptance of non-traditional (non-nuclear) family units. Preferring to use the term “alternative,” rather than “artificial,” insemination (AI), Robinson and Pizer discuss the medical, ethical, social, and legal implications of the AI process. Each of the chapters presents information clearly and concisely; the organization of the book proceeds logically from a brief history of AI to a concluding chapter on pregnancy and parenthood. Key points are extracted and summarized at the end of each chapter. The segments on reproductive anatomy and physiology and the fertility cycle are thorough; terms are explained and illustrated adequately, although the average reader may need to reread and assimilate the information before proceeding with subsequent chapters. There is extensive discussion of the AI process itself: choosing a sperm donor, timing the insemination, and specific instructions for performing the procedure, both in a health care setting and at home. Controversial topics such as selection of sex and genetic characteristics and the question of anonymous versus known donors are handled nonjudgmentally. One particularly good chapter, “Emotions,” discusses the stresses involved in conceiving by AI, regardless of the woman’s lifestyle. Robinson and Pizer urge single women and couples (both
32, No. 5, September/October
1987
heterosexual and lesbian) to consider the implications of Al and parenthood before becoming pregnant. Choosing AI, they say, is “making a deliberate decision to be different in a society that often responds negatively to nonconformity.” At several points in the book, the authors emphasize the commitment and responsibility of parenting; the final chapter provides a set of excellent questions for anyone considering motherhood. Hauing a Baby Without a Man is an attractive, affordable, and well-written book with a suitable blend of facts and “personal” accounts of women who have chosen alternative insemination. Illustrations are of good quality, clearly understandable, and appropriate, although an illustration of the AI procedure and the instruments used would be a helpful addition. There are some minor shortcomings in the book. The section on sperm donor selection includes a brief discussion of AIDS. Because knowledge about AIDS is changing so rapidly, the books information is obsolete; the authors certainly cannot be faulted for this. Some other references are also fairly old: for example, a 1968 resource states that only one divorce occurred in 800 AI couples. In view of current divorce statistics generally, one wonders whether more accurate data could have been reported. In the segment on insemination at home, the authors twice caution that anaphylactic reaction may result from an improperly performed procedure. Certainly explanation and discussion of this complication should have been included. Finally, the book is described as a guide book for anyone considering AI. Robinson and Pizer stress further reading and research yet provide no resource lists or bibliography aside from brief chapter notes. Hauing a Baby Without a Man is intended for consumers; CNMs will find it an adequate resource as well. The book’s tone is informal, compassionate, and nonjudgmental. Robinson and Pier believe in the importance of self-determinism; they advocate that alternative insemination be an option for any woman, regardless of her lifestyle. This book is a good starting-point and a handy reference for anyone considering alternative insemination or parenting in a nontraditional family.
327
and Pregnancy. By Maternity Center Association. New York: Maternity Center Association, 1987. Brochure is available at $0.50 per brochure ($0.30 per brochure for orders of 100 or more), from: Publications Department, Maternity Center Association, 48 East 92nd St., NY, NY, 10128. (212) 369-7300 Reviewed by: Tom Lloyd, MS, CNM, Assistant Professor, Nurse-Midwifery/ Women’s Health Care Program, Oregon Health Sciences University, Portland, OR.
Aids and Pregnancy is a triple-folded, 8% by 11” brochure offered for sale and distribution by Maternity Center Association. Intended for “women who are either pregnant or are considering becoming pregnant,” the brochure addresses most of the general aspects of AIDS as they relate to children and preconceptional, pregnant, and breastfeeding women. The brochure is wellwritten and scientifically accurate. The copy obtained by this reviewer was accompanied by a press release. Without access to this release, one might assume that the target audience is health care professionals, rather than their clients. Two characteristics of the brochure contribute to this confusion. First, the text is rather lengthy, a probable necessity due to the many facets of AIDS that need to be presented in such a publication. However, many young women who encounter this brochure may find it difficult to read due to the volume of information included. A second aspect that
might limit its value to some high-risk women is the vocabulary level. Words and phrases such as “manifestation,” “direct inoculation” and “clinically significant illnesses attributable to .” are scattered throughout the text. Such choice of wording is an asset to the welleducated client. But a significant portion of the intended audience will probably need further clarification (if not actual assistance) in reading and understanding the brochure. Those able to read and comprehend this brochure will be well satisfied with its scope and accuracy. Having just seen the most recent AIDS report issued by the Center for Disease Control, this reviewer prepared a list of relevant questions before reading Aids and Pregnancy. With one exception, every question was addressed to a satisfacto y-or-better degree. However, the issue of false-positive screening results requires a more complete explanation than appears here. Although there is a statement that HIV-antibody screening “often has to be confirmed by a more accurate test,” the inevitability of false-positives and the potential impact of positive results are issues that deserve special attention in any information about AIDS. This reviewer recommends the brochure, because, as the release letter states, there is such “a lack of literature about AIDS written specifically for ” this audience. Although some patients may find the brochure somewhat difficult to read and comprehend, those who do not will benefit from a firm foundation on this crucial topic.
326 Copyright 0 1987 by the AmericanCollege of Nurse-Midwives
Journal of Nurse-Midwifery
Surgical Treatment of the Infertile Female. By Veasy C. Buttram, MD and
Robert C. Reiter, MD. Baltimore: Williams & Wilkins, 1985. 381 pages. $55.00, hardcover. Reviewed
by: Arnold H. Michael, MD, Chief of Gynecology, Baltimore County General Hospital, Randallstown, MD.
Drs. Veasy Buttram and Robert Reiter have undertaken to provide an up to date textbook on the employment of surgical efforts for the relief of infertility, and they have accomplished this aim. Neither an atlas of surgical procedures nor a cookbook, it is a comprehensive effort that starts from “scratch” with a detailed examination of the causes of infertility. There follows a well-illustrated description of the diagnostic methods, from the essential history and physical exam, semen analysis, BBT chart, HSG and laparoscopy, through the increasingly more technical studies to detect influences on ovulation. The authors constantly balance the medical and surgical approach to problems and indeed include much valuable material in the non-surgical management of endometriosis and polycystic ovary syndrome. However, the name of the book is “surgery” and in that area it excels. The conditions impairing fertility, which are amenable to surgical correction are considered in categories such as endometriosis, uterine (congenital) malformations, myomata, polycystic ovary syndrome, intrauterine and cervical pathology, and tubal disease. Each condition is meticulously classified. Its influ-
??Vol.
32, No. 5, September/October
1987
0091/2182/87/$03.50
ence on fertility is defined and the methods of diagnosis are made clear before the surgical approach is described. The book abounds in tables of statistics on the incidence of conditions and success rates of treatments. Illustrations of surgical procedures, radiographic and sonographic views, laparoscopic photographs, and instrumentation for the most part are very clear. However, it is really too much to expect so complex a device as the “Garcia Claw” (an instrument for application of a silastic hood in salpingostomy) to be understood from small drawings. The book emphasizes proper utilization of basic surgical techniques, minimally invasive endoscopy, proper exposure, avoidance of injury, measures to prevent adhesions, utilization of magnification techniques, loupe, and microscope. Authors other than the editors discuss areas of special expertise; microsurgery, laser surgery, hysteroscopy, and in vitro fertilization with the same attention to detail evident in earlier chapters. An extensive bibliography deserves separate commendation. Classic articles describing historic approaches to the surgical procedures are included and provide a contrast to recently described techniques of intrauterine laser therapy or percutaneous oocyte retrieval (though not transcystic or (per) vaginal). The result is a source book on the subject of infertility that can be utilized by members of diverse disciplines. The student will learn the basics of disease and treatment. The resident will be oriented anatomically to learn procedures in the operating room. The teacher will find the organization of information invaluable for the didactic instruction of his students. The browser will enjoy hours of fascinating reading. Undoubtedly, copies of this volume will also be found on the shelves of law libraries as a valuable reference source. Having a Baby Without a Man. By Susan Robinson, MD, and H. F. Pizer, PA-C. New York: Fireside Press, 1985. 191 pages. $7.95, softcover, Reviewed
by: Cynthia S. Bechtel, CNM, Graduate student, University of Missouri, St. Louis, MO.
MSN.
Though the nuclear family may still be the norm, the portrait of the typical
Journal of Nurse-Midwifery
?? Vol.
American family is changing. High divorce rates have resulted in an increasing number of households headed by single parents, most of whom are women. In addition, single women and lesbians, who have categorically been deprived of biologic parenthood, are now choosing to have children independent of relationships with men. Having a Baby Without a Man is a valuable resource for any woman whose desire for biologic motherhood has been restricted because of marital status or sexual preference. For years, artificial insemination has been available to infertile married couples wishing to conceive, and this book does address that issue. However, according to obstetrician-gynecologist Susan Robinson and physician associate H. F. Pizer, that limitation is “narrow-minded and unfair.” They assert that advances in reproductive technology necessitate a redefinition of “family” and a subsequent acceptance of non-traditional (non-nuclear) family units. Preferring to use the term “alternative,” rather than “artificial,” insemination (AI), Robinson and Pizer discuss the medical, ethical, social, and legal implications of the AI process. Each of the chapters presents information clearly and concisely; the organization of the book proceeds logically from a brief history of AI to a concluding chapter on pregnancy and parenthood. Key points are extracted and summarized at the end of each chapter. The segments on reproductive anatomy and physiology and the fertility cycle are thorough; terms are explained and illustrated adequately, although the average reader may need to reread and assimilate the information before proceeding with subsequent chapters. There is extensive discussion of the AI process itself: choosing a sperm donor, timing the insemination, and specific instructions for performing the procedure, both in a health care setting and at home. Controversial topics such as selection of sex and genetic characteristics and the question of anonymous versus known donors are handled nonjudgmentally. One particularly good chapter, “Emotions,” discusses the stresses involved in conceiving by AI, regardless of the woman’s lifestyle. Robinson and Pizer urge single women and couples (both
32, No. 5, September/October
1987
heterosexual and lesbian) to consider the implications of Al and parenthood before becoming pregnant. Choosing AI, they say, is “making a deliberate decision to be different in a society that often responds negatively to nonconformity.” At several points in the book, the authors emphasize the commitment and responsibility of parenting; the final chapter provides a set of excellent questions for anyone considering motherhood. Hauing a Baby Without a Man is an attractive, affordable, and well-written book with a suitable blend of facts and “personal” accounts of women who have chosen alternative insemination. Illustrations are of good quality, clearly understandable, and appropriate, although an illustration of the AI procedure and the instruments used would be a helpful addition. There are some minor shortcomings in the book. The section on sperm donor selection includes a brief discussion of AIDS. Because knowledge about AIDS is changing so rapidly, the books information is obsolete; the authors certainly cannot be faulted for this. Some other references are also fairly old: for example, a 1968 resource states that only one divorce occurred in 800 AI couples. In view of current divorce statistics generally, one wonders whether more accurate data could have been reported. In the segment on insemination at home, the authors twice caution that anaphylactic reaction may result from an improperly performed procedure. Certainly explanation and discussion of this complication should have been included. Finally, the book is described as a guide book for anyone considering AI. Robinson and Pizer stress further reading and research yet provide no resource lists or bibliography aside from brief chapter notes. Hauing a Baby Without a Man is intended for consumers; CNMs will find it an adequate resource as well. The book’s tone is informal, compassionate, and nonjudgmental. Robinson and Pier believe in the importance of self-determinism; they advocate that alternative insemination be an option for any woman, regardless of her lifestyle. This book is a good starting-point and a handy reference for anyone considering alternative insemination or parenting in a nontraditional family.
327