EU_Obs&Gyn_Foreword2.qxp 30/4/09 10:20 Page 6
Foreword
Stephen Kennedy is a Clinical Reader and Head of Department in the Academic Unit of Obstetrics and Gynaecology
at the University of Oxford and an Honorary Consultant at the John Radcliffe Hospital in Oxford. He jointly heads an
international group that aims to identify disease susceptibility genes in endometriosis. He sits on the Board of the
World Endometriosis Research Foundation (WERF) and is an Associate Editor of the Journal of Endometriosis and
Evidence-based Medicine.
W
elcome to this issue of European Obstetrics & Gynaecology, which spans a wide range of topics and
focuses on some highly controversial issues such as fertility preservation in women undergoing therapy
for malignancy and the role of assisted reproduction technology in the management of infertility.
The prospect of offering women with cancer who are likely to be sterilised by their life-saving chemo- or radiotherapy
is an exciting development, albeit one that is still experimental as very few pregnancies have resulted worldwide from
fertility preservation programmes. Therefore, research is needed to determine whether transplantation of cortical tissue
is the best approach or whether we should be aiming to transplant whole ovaries with the potential added value of
restoring endogenous sex hormone production. Whether such techniques should be offered to women who wish to
delay child-bearing for non-medical reasons is a question that needs to be answered over the coming decade through
dialogue between the medical profession, legislators and society at large.
Many of the articles deal with our increasing attempts as clinicians to try to improve the overall quality of women’s
lives as a primary treatment outcome rather than focusing simply on traditional end-points, such as disease
regression. This applies to topics as diverse as the use of hormone replacement therapy (HRT) in women after a
gynaecological cancer and the management of non-life-threatening conditions such as stress incontinence. Chronic
pelvic pain is another healthcare problem that benefits from adopting a less ‘medical’ model, especially given the
doubts that exist about whether the association between certain diseases is genuinely causal. This uncertainty leads
us to the question of whether the development of a non-invasive test for the diagnosis of endometriosis is necessarily
warranted or in the best interests of women. Highly sensitive and specific tools already exist to diagnose clinically
significant disease. However, it is unclear whether a biomarker to detect peritoneal lesions would alter the natural
history of the condition, prevent disease progression or improve quality of life. In fact, one could argue that a
biomarker might lead to large numbers of women being subjected to laparoscopic surgery and/or treatment with
expensive drugs that have significant side effects when empirical treatment with much less costly medication, such
as the combined oral contraceptive pill, may result in symptomatic relief and a better quality of life.
There are four articles that deal with issues that extend far outside the confines of our speciality: single-embryo transfer,
obesity (two articles) and human papillomavirus (HPV) testing. The first, single-embryo transfer, is important because of
the long-term effects of multiple pregnancy on parents, healthcare systems and those at risk of being born prematurely.
The lack of regulation in most countries combined with vested interests in the fiercely competitive business of in vitro
fertilisation (IVF) means that we are obliged to publicise the benefits of single-embryo transfer. The subject of obesity
features in articles about the relationship between polycystic ovary syndrome (PCOS)/infertility and diabetes in
pregnancy. Given the worldwide pandemic of obesity and the resulting morbidity from cardiovascular and metabolic
diseases, it is vitally important to understand better the relationship between obesity and reproductive physiology.
The development of measures to prevent cervical cancer is one of the most exciting achievements in gynaecology
in the last 50 years: there is a real prospect of being able to eliminate the disease as vaccination becomes more
acceptable within society and take-up rates rise.
Finally, some articles address the need to provide answers to questions that continue to confuse clinicians and patients
alike because of the lack of high-quality evidence in the literature. For example, is there a role for reproductive surgery
given how successful IVF has become? How are rare cancers best treated? Should women be given luteal-phase
supplements during ovarian stimulation?
This issue of European Obstetrics & Gynaecology is a stimulating read and I am sure that the content will help clinicians
improve the overall quality of their practice. The authors are to be congratulated for their contributions. ■
6 © TOUCH BRIEFINGS 2009
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