No abstract

This observational study compares the ratio of serum anti-Mullerian hormone (AMH) to the total antral follicle count (AFC) (as a marker of AMH production per follicle) in the various phenotypes of women with polycystic ovary syndrome (PCOS) and isolated polycystic ovarian morphology (PCOM). Two hundred and sixty-two women were recruited. Women with PCOS were divided into four phenotypes based on the diagnostic inclusion criteria of oligo-anovulation (OA), hyperandrogenism (HA) and polycystic ovarian morphology (PCOM). These included Group A (OA + HA + PCOM), Group B (OA + HA), Group C (HA + PCOM) and Group D (OA + PCOM). A ratio of serum AMH to total AFC was calculated and expressed as the AMH/AFC ratio which was compared in the phenotypes of PCOS and isolated PCOM. The median AMH/AFC ratios in PCOS-A, PCOS-D, PCOS-C and PCOM were 1.5, 1.6, 1.2 and 1.1, respectively. There were significant differences in the groups compared [F(3, 238) = 6.14, p = 0.000)]. The ratios were significantly higher in the oligo-anovulatory phenotypes PCOS-A and PCOS-D than the PCOM (p = 0.004 and 0.002, respectively). There was no significant difference in the ratio between ovulatory phenotype PCOS-C and PCOM (p = 0.59). The role of androgens and LH in per-follicle AMH production remains limited. The findings support the hypothesis of a key role for AMH in the mechanism of anovulation in PCOS.

At a time when religious beliefs, and matters of the spirit in general, are under such scrutiny, it is refreshing to see spirituality being openly advocated and explored in a field which, currently, offers very little in the way of research or data. In spite of this, Len Sperry is well articulated, and his ideas well realised, as he methodically outlines the practical uses of non-denominational spirituality within Psychotherapy. However, those looking for a narrative of some kind, will be left disappointed, as, for the most part, this is a text book at heartwhich, considering the explorative subject matter, can leave it feeling unwieldy at times.Throughout the book the author has successfully maintained a balance between theory and practice, with clear and concise interpretations of theories, both new and old, backed up with practical chapters that address issues that could arise during therapywith case scenarios and example questions. It is this balance, and level of depth, that make this book a valuable asset to trainees and experienced clinicians, whether it be to expand theoretical knowledge of the subject, or just to gain practical guidance.The field of spirituality in clinical practice is still very much in its infancy. Sperry openly highlights this fact by addressing various key issues in the development of this field, such as lack of consensus in terminology, that can be acknowledged and investigated by fellow researchers.That said, due to the lack of research literature in this area, the book relies rather more on theories than on research findings. This is most apparent in the chapter "Developmental models of the spiritual dimension", where the lack of references attests to a lack of evidence, and a heavy reliance upon the past experiences of the author.Additionally, the entire text is written in a descriptive, rather than evaluative, tone. Coupled with a noticeable lack of discussion of the stumbling blocks and shortfalls of the spiritual approach, it can leave the book feeling somewhat short-sighted. A clear example of this is the chapter on "Assessment and case conceptualisation" where there is a great detail of information on the scales that can be used, such as the "Index of core spiritual experience", but a lack of information on the reliability and the validity of these measurements.