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Ovulation Induction and Controlled Ovarian Stimulation: A Practical Guide

This is an excellent handbook written by an acknowledged expert in the field. The chapters are well laid out and the language clear and accessible. A fascinating feature of the text for me was chapter one, a potted history of ovulation induction, which showcases the author's knowledge of the area. The emphasis throughout is on physiologically rational and evidence-based treatment choices but is leavened with the author's rich clinical experience. There is a striking lack of dogma. The necessity of treating women and couples as individuals for whom the most appropriate treatment should be chosen is made clear throughout.

Other chapters cover the physiology and pathophysiology of ovarian function and anovulation. The simplified diagnostic scheme for women with oligo/anovulation is clinically useful for practitioners. The author considers individual therapeutic agents used in ovulation induction and ovarian stimulation. The brief section on pulsatile gonadotrophin-releasing hormone should help to improve uptake of this unjustly neglected treatment option for women with hypogonadotrophic hypogonadism. Those looking for the final word on the role of insulin-lowering agents will be disappointed but the chapter provides an intelligent assessment of the current evidence and is well referenced for further study. The chapter on gonadotrophins presents a balanced view of the pros and cons of recombinant and purified urinary preparations, though a cost-effectiveness analysis is lacking. This is understandable, given the nature of the book.

Discussion of individual therapeutic agents sets the scene for further chapters examining their use in intrauterine insemination (IUI) and in vitro fertilisation (IVF). I suspect most clinicians will find this part of the book very useful as a reference and practical guide. The chapter on controlled ovarian stimulation for IUI does not directly tackle the question of whether stimulation is indicated in the presence of minor male factor infertility but the review of unexplained infertility is excellent. The signposting of mild ovarian stimulation regimens is especially welcome.

The chapter on controlled ovarian stimulation for IVF is an excellent, up-to-date appraisal of choices of preparation and the use of agonist/antagonist and stimulation regimens. The section on poor response is particularly well written and the one on ‘modified’ natural cycle IVF brings the chapter up to date with recent trends.

Significantly, the author devotes separate chapters to the two most important complications of supraphysiological ovarian stimulation: ovarian hyperstimulation syndrome and multiple pregnancy. The sections on preventing multiple pregnancy in ovulation induction and IUI cycles can be appreciated for their practical and evidence-based focus. It is striking that in this, as in his discussion of single embryo transfer, the author conveys a sense of caution and concern for women's safety above striving for a baby at any cost.

Raj Mathur, MD MRCOG, Consultant and Clinical Lead for Assisted Conception¹

^1. Addenbrooke's Hospital, Cambridge, UK

Taylor & Francis, 2005
ISBN 9781841844299
Paperback, 132 pages, £55.99

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