Dr. Arundhati Gundu Tilve works as an Assistant Professor in the Department of Obstetrics and Gynaecology at BYL Nair Charitable Hospital in Mumbai. She has completed her graduation from Terna Medical College and postgraduation from Dr. Babasaheb Ambedkar Memorial Hospital, Byculla. She has had an excellent scholastic career with gold medals in the DGO examinations. She has a deep interest in emergency obstetrics and is an avid fiction reader.
The book ‘Decoding Polycystic Ovarian Syndrome’ is in its first edition. It is a comprehensive guide for postgraduate students and practicing physicians and those wanting to specialise in reproductive medicine. The book has 20 chapters. The first three chapters of the book are dedicated to the historical aspect of the syndrome, its prevalence, and the rising incidence and pathophysiology. The changing diagnostic guidelines over the years and at different reproductive ages along with the different phenotypic presentations have also been highlighted.
‘Ultrasound in PCOS’ not only enlightens the reader about the basic ovarian morphology but also about stromal echogenicity, its vascularity and the correlation between them and high LH and insulin levels.
PCOS remains a major factor causing subfertility. The chapters on ovulation induction and assisted reproductive technology are concise, detailed and serve as a template for management. The case scenarios and images of complications in assisted reproductive technology make it immensely helpful, serve as a guideline to handle such situations and keep the reader interested.
Invitro maturation (IVM), intracytoplasmic sperm injection (ICSI), frozen cycles are new frontiers for infertile PCOS patients and conveyed well through the means of images, algorithms and tables.
Chapter ten focuses on the comparison of the hormonal profiles and long-term consequences of the lean and obese phenotypes. Implications of PCOS at the critical age of adolescence and its management along with the effects on pregnancy and lactation are elaborated in chapters 11 and 12. Treatment of polycystic ovarian syndrome usually stops as soon as conception takes place. However, the importance of continuing the management in all trimesters of pregnancy and lactation is eloquently put by the authors.
An area of special concern, forgotten by most clinicians, is the impact of PCOS on body image and stigmatization of afflicted women due to inability to conform to societal norms of appearance and reproductive inability. The age group affected by this syndrome and the rise of eating disorders points to a strong association between the two. Long-term sequelae of PCOS have been stressed upon to improve overall women’s’ health and timely intervention and lifestyle modifications. The inclusion of medico legal aspect of PCOS is completely irrelevant and not required.
The chapter dedicated to laparoscopic ovarian drilling is well worded and informative with a good use of images and algorithms. Hirsutism is dealt with appropriately and the treatment described succinctly. Although evidence based, ‘Adjuvants in PCOS’ leave the reader confused about the plethora of medication available for decreasing insulin resistance and increasing ovulation and pregnancy. So also is the case with metformin which goes from hero to zero by the last chapter of the book.
The book becomes very repetitive only because each chapter begins with a similar introduction, statistics and pathophysiology which could have been avoided by the editors. The key points at the end of each chapter drive home the message and serve as a good revision.
This book will find a home on the bookshelves of many gynaecology residents, experts and those in between.
