This landmark two-volume work provides an unprecedented survey of the entire field of reproductive medicine. The volumes are beautifully designed, with richly detailed full-color illustrations throughout, and organized for ease of use and practical reference. The text is divided into three sections. The first provides a comprehensive review of the ontogeny and function of the reproductive axis and its normal embryology and physiology. The second section is a state-of-the-art review of the diagnosis and management of disorders of the reproductive axis, including disorders of sexual differentiation, disorders of puberty, disorders of the hypothalamic pulse generator, disorders of the pituitary gonadotroph, disorders of the ovarian follicle, end organ pathology, and hyperprolactinemic disorders. This section also includes detailed discussions of hormonal contraception, endocrine disorders during pregnancy, and the climacteric. The final section reviews all known factors responsible for infertility and describes current approaches to its diagnosis and management.
Reproductive Endocrinology, Surgery, and Technology is a two-volume work consisting of 2399 pages. There are three editors and over 190 contributing authors. From my own experience of editing a book less than one tenth the size of this one, I realize that the time interval from receiving the first chapter to actually publishing the edited book can be several years. With this in mind, I read each of the 31 sections (128 chapters) asking myself whether the information was basic and will remain current for many years or whether it was current when written but may soon be inaccurate or out of date because the subject is evolving rapidly.
The book has three parts; part I encompasses the normal embryology and physiology of the reproductive axis, part II reviews disorders of the reproductive axis, and part III comprises the diagnosis and treatment of infertility. Part I contains an in-depth review of normal reproductive physiology that is as comprehensive as any I have encountered. Whereas other reproductive-endocrinology textbooks will describe topics such as steroid-receptor antagonists, relaxin, growth hormone, and human placental lactogen within paragraphs, this book contains entire chapters on these subjects. I found that all but 3 of the 41 chapters on normal physiology contain information that is pertinent and useful today and likely to remain so for years to come.
Part II, on disorders of the reproductive axis, is logically and uniquely organized, beginning with disorders of sexual differentiation and concluding with a comprehensive review of the climacteric. An example of how well the editors have organized this part is the section on polycystic ovarian disease. It contains an overview of the disease as well as individual chapters on the hypothalamic, ovarian, and adrenal contributions to this syndrome. In addition, there are four chapters on induction of ovulation in patients with polycystic ovarian disease. At first glance this would appear to be overkill; however, the authors have covered such topics as clomiphene citrate and gonadotropin-releasing hormone therapy here, but they have not repeated these discussions in the section on infertility. Part II suffers only slightly more than part I from not being contemporary. Examples of evolving therapies for which there were little or no data at the time the book was written include current gonadotropins for ovulation induction, bisphosphonates for osteoporosis therapy, and "smart" estrogens for hormone-replacement therapy. As with any condition such as menopause for which there are rapidly evolving therapeutic strategies, the best resources for current therapies are peer-reviewed journals, not comprehensive textbooks.
Part III, on the diagnosis and treatment of infertility, contains insightful chapters on technology assessment, analysis of controlled trials, as well as the ethical and emotional implications of infertility. These topics are unique for a comprehensive textbook, and the content of these chapters will remain important no matter how much the technology evolves. However, part III, by the nature of its rapidly evolving topics, suffers the most from having been written more than three years ago. An example is the topic of laser surgery. Lasers are very well covered in this book; however, electrosurgery is only minimally covered in the chapter on laparoscopy, and an understanding of radio-frequency energy is more essential because it is used more than laser energy.
In compiling Reproductive Endocrinology, Surgery, and Technology, it is obvious that the editors were keenly aware of the problem of writing text that would not immediately be published. Each chapter concludes with a section entitled "Eye to the Future," which in most cases accurately directs the reader toward the recent advances in that subject. There are also several unique characteristics of this book that help ease reading and identification of specific information. Each chapter contains a table of contents, definitions, and a section on "major take-home points." The take-home-points section is presented in one of two formats: a paragraph summary of the major points or the more effective format of a numbered list of points. The take-home-points sections are valuable additions for those of us who got through high school using Cliffs Notes.
In summary, this is a well-edited, thoroughly referenced, comprehensive textbook that will remain a valuable reference for reproductive endocrinologists for several years. It is my hope, given the time and effort necessary to publish it, that the editors will begin working on the second edition in the near future.
Reviewed by Keith Isaacson, M.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
