Book Review

A Textbook of in Vitro Fertilization and Assisted Reproduction: Based on the Teaching Courses of Bourn Hall Clinic, Cambridge, and the Hallam Medical Centre, London

N Engl J Med 1993; 329:144-145July 8, 1993

Article

A Textbook of in Vitro Fertilization and Assisted Reproduction: Based on the Teaching Courses of Bourn Hall Clinic, Cambridge, and the Hallam Medical Centre, London
Edited by Peter R. Brinsden and Paul A. Rainsbury. 451 pp., illustrated. Park Ridge, N.J., Parthenon, 1992. $110. ISBN: 1-85070-323-X

The cover of A Textbook of in Vitro Fertilization and Assisted Reproduction promises to detail the teachings of the Bourn Hall Clinic -- the in vitro fertilization (IVF) clinic founded by Drs. Patrick Steptoe and Robert Edwards in 1980, two years after the birth of the world's first “test-tube” baby in their clinic. But you can't judge a book by its cover. Indeed, this book covers more than simply laboratory techniques of assisted reproduction. After an introductory chapter detailing the history of Bourn Hall Clinic and Hallam Medical Centre, six chapters describe various aspects of infertility and infertility evaluations. Thereafter, a chapter is devoted to each aspect of IVF, from ovulation induction to embryo transfer. The second half of the book includes novel chapters describing current research developments in IVF, the use of computers in assisted reproduction, and approaches to counseling for the infertile couple.

This ambitious approach may at first be disappointing to the reader expecting immediately to delve into the subject of IVF. For example, the chapter “Patient Selection and Management” covers the basic infertility evaluation; however, the authors do not explain how the various test results serve as inclusionary or exclusionary criteria for assisted reproduction. By contrast, a chapter on endoscopy suggests the steps necessary before assisted reproduction techniques can be used; all recommendations are backed by data, much of it from work by the authors. Beautiful endoscopic photographs highlight the lucid description of pelvic pathology.

The reader's expectations concerning assisted reproduction techniques are finally met in chapter 6 with a discussion of superovulation regimens. Tables, thankfully not overburdened by extraneous columns, graphs simple enough to drive the point home, and figures comparing and contrasting four regimens all serve to reinforce the text. A chapter whose subject threatens to be very boring thus remains quite interesting. Ultrasonography is also discussed in detail. One chapter considers ovarian changes throughout a spontaneous and a stimulated cycle. Another chapter (actually later in the book) details ultrasound management of pregnancy, nicely listing the specificity, sensitivity, and predictive value of sonography. Surprisingly, however, the photographs fail to reproduce well. They are fuzzy and lack illustrative arrows or marks that would assist readers unfamiliar with sonography.

Chapters by K.T. Elder and S.M. Avery describe gamete handling in the Bourn Hall Assisted Reproduction Technologies Laboratory, perhaps the litmus test of a program. The explanations are so lucid and detailed that they can almost serve as a laboratory protocol book. Here, the photographs are clear and appropriately chosen to demonstrate the excellent points raised. I cannot help feeling that the authors of these chapters really want to communicate their message.

As if to mimic the IVF procedure itself, the book's most dazzling chapters are those describing the embryo and microsurgical fertilization. The chapter “Embryo Selection” begins with a delightful discussion postulating reasons why the efficiency of IVF has not changed appreciably in the past 10 years. Thoughtful remarks by C.L. Mills relate embryo quality and grading to pregnancy rates after IVF. Up-to-date suggestions are made for embryo improvement and a better embryo-scoring system. The beautifully written chapter on micromanipulation contains a particularly clear, concise description of fertilization. The authors' expertise is evident in discussions comparing the different methods of sperm injection.

Finally, several chapters describe oocyte-donation and IVF-surrogacy policies in Great Britain. However, the policies of other countries are not discussed. These chapters reflect extensive clinical experience, but few references or allusions to scientifically collected data are provided. In these chapters, unlike most others in the book, the authors fail to distinguish between procedures performed for scientific reasons and those performed out of habit. For example, why is estrogen given for 14 weeks to an agonadal woman during her pregnancy with a donated oocyte?

Overall, the book would benefit from heavier-handed editors. For example, the several chapters dealing with male-factor infertility are repetitious, especially with respect to the rationale for antibody testing and sperm preparation. Although some repetition is unavoidable and even salutary, details of ovulation-induction regimens and hormone replacement before embryo transfer need to be given only once.

The editors' purpose was to promulgate the curriculum of the Bourn Hall teaching course. They have met their goal. Unlike so many textbooks of high-technology procedures, this book can be read by both the uninitiated and the experienced. Detailed procedures should satisfy the laboratory staff; counseling and ethical recommendations address areas of concern to the clinical staff. Medical protocols will serve as a reference for uninitiated physicians, and the intertwined discussions of novel proposals and theories will spur the interest of those already familiar with assisted reproduction. In conclusion, this book, from arguably the world's most experienced assisted reproduction program, belongs on the shelves of reference libraries and clinicians alike.

Sandra A. Carson, M.D.
University of Tennessee at Memphis, Memphis, TN 38119

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