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Fertility Issues

6 Aug, 12 | by shellraine, e-Media Editor

IVF twins: buy one get one free? (Mittal)  (published online 18 July)

The aim of IVF treatment should be to achieve a full-term singleton birth. This article explores the tensions that exist between IVF provision and the elective single embryo transfer (eSET) policy. The authors present a balanced contemporary review describing why twin pregnancies are undesirable yet may be a risk couples are willing to take. They go on to discuss the issues faced when considering strategies to reduce twin pregnancies and the tensions that exist with the eSET policy. Blanket eSET implementation appears not be a simple answer to avoid twin pregnancies. from Scott Wilkes, Associate Editor

1 in 7 couples in the UK have infertility problems

Most people growing up assume that, if and when they want children, they will be able to have them. They don’t expect to have problems with fertility, and assume that, if they do the wonders of modern fertility treatments, such as IVF and ICSI (intra-cytoplasmic sperm injection) will be able to solve them. However, in contrast to this, background figures point to 1 in 7 couples in the UK having fertility problems. This is according to new research published by the Health Experiences Research Group at the University of Oxford and available from healthtalkonline. The research team was founded by Ann McPherson (who sadly died in May 2011) and headed by Sue Ziebland and Louise Locock.

ESHRE 2012 Reports highlight fertility issues

UK still trails behind Europe in number of IVF cycles – yet it all started here.

As the number of babies worldwide born thanks to in vitro fertilisation (IVF) – breaks the 5 million barrier for the first time, figures show that the UK is still lagging behind many of its European neighbours in numbers of treatment cycles per year.  A report presented at ESHRE 2012 shows that the UK carries out 879 cycles/million inhabitants per year, which is significantly lower than many other countries including Denmark (2,726 cycles/million), Belgium (2,562 cycles/million) and Slovenia (1,840 cycles/million).

The pioneering treatment, which hit the headlines worldwide back in 1978 with the birth of Louise Brown in Oldham, has dramatically reduced the devastating burden of infertility, benefitting millions of couples both in the UK and worldwide.

However, for thousands of couples here, the dream of having a child of their own remains elusive: many are denied IVF because their Primary Care Trust or Health Board is reluctant to fund sufficient treatment. Around three quarters of all PCTs in England still don’t offer the 3 full cycles of IVF as recommended by the National Institute for Health and Clinical Excellence (NICE).

Leading national infertility charity supports new research on Single Embryo Transplant (SET)

Leading patient charity, Infertility Network UK (IN UK), has backed new research presented at the annual meeting of ESHRE, which shows that a policy of single embryo transfer reduces the risk of perinatal death in infants born after IVF and ICSI.

The report is based on analysis of more than 50,000 births recorded in the Australian and New Zealand Assisted Reproduction Technology Database from 2004-2008, where the introduction of  SET seems to have reduced overall perinatal mortality for IVF and ICSI babies.

Said Clare Lewis-Jones, Chief Executive of IN UK and Chair of Fertility Europe: “We welcome a move towards SET, and this report gives the medical profession more evidence to encourage patients to accept SET, which reduces the risks of multiple births to both mother and babies and gives the best possible outcome – one healthy baby.

“However, it must go hand in hand with full implementation of the NICE clinical guidelines which recommend up to three full cycles of treatment, including any frozen embryo transfers (FET). Other European countries which routinely offer five and six cycles of treatment have successfully implemented SET, and it is high time that patients in the UK are offered access to the level of treatment recommended by NICE nearly eight years ago!

“Many PCTs here still fall short of the recommendations and it is totally unacceptable and unethical for some PCTs to offer only one cycle of treatment and not to include FET for patients.”

News items from April

4 May, 12 | by shellraine, e-Media Editor

Better access to birth control would reduce stress on global resources

as reported by Nigel Hawkes in the BMJ. The rich should consume less and the poor should procreate less, says the Royal Society in a new report. The report was produced by a working party chaired by John Sulston, who headed the UK part of the Human Genome Project, and took 21 months to research and write.

Morning after pill courier service launched

A new service allows women (living in London) to order emergency contraception on the internet, so it arrives within two hours, rather than having to see their GP to obtain the drugs. For £20, women can order the drug by filling out an online form through the internet medical practice DrEd.com. The forms, which ask users to confirm they are aged over 18, will be assessed by doctors before pills are dispatched by courier. Currently they only offer Levonelle®, which can also be purchased in advance and by buying 2 packets for £24.00 at a saving of 37%.

Pharmacists should provide oral contraceptive services, says NHS report

As reported by Jacqui Wise in the BMJ:
“A report from NHS South East London has recommended that trained community pharmacists provide oral contraceptive consultation services after a successful pilot scheme to widen access to contraception.  The part of the report that has received the most media coverage is a recommendation to “consider providing the service to women under 16 years where appropriate.” The report said that this may help reduce numbers of teenage pregnancies.”

Brook and fpa respond to proposal to introduce contraceptive pill in pharmacies

Responding to the proposal that the contraceptive pill should be available from pharmacies without a prescription to young people, including those under 16, the chief executives of Brook and FPA, Simon Blake and Julie Bentley said: “The majority of young people under 16 are not having sex, however we must ensure that those who are can access support and services when they need to. “Although Brook and FPA welcome proposals which could increase young people’s access to sexual health services and information, all the necessary safeguards must be in place to ensure young people can get the information and support they need. “This includes pharmacists having the appropriate clinical knowledge about contraception, being able to communicate effectively with young people, having the right type of environment including a confidential space, as well as the appropriate support and referral networks.”

Egg-Sharing in Fertility Treatment

Evaluating egg-sharing: new findings on old debates – as reported in BioNews
Egg-sharing refers to a scheme where a woman undergoing fertility treatment donates a portion of her eggs to an anonymously matched recipient in exchange for a reduction in treatment costs. As a very specific form of egg donation, egg-sharing has generated heated debate since its introduction in the UK in 1998. While proponents argue it provides a win-win solution, allowing two women to help each other conceive, critics talk of the potential ethical and psychological consequences. Until recently, there has been very little empirical data to inform these discussions. However, new research conducted by Gurtin and Golombok at the University of Cambridge Centre for Family Research, in collaboration with the London Women’s Clinic, hopes to redress this balance.

Men’s health expert presents to Members of European Parliament

A leading men’s health expert presented a report detailing the health challenges facing men across Europe MEPs and key European decision-makers at the European Parliament in Brussels.

Professor Alan White, Director of the Centre for Men’s Health at Leeds Metropolitan University was commissioned by the European Commission to produce a report which gives the first complete picture of the breadth of issues affecting men’s health across Europe.  Professor White brought together 36 leading researchers from 34 countries across Europe to undertake the research which highlights the state of men’s health in Europe as a serious public health concern. more info

Faculty Consultations

The CEU Guideline on “Barrier Methods-Contraception and STI prevention” is for consultation until 21st May. see FSRH website:

BASHH Mentoring Group is currently seeking new members:

BASHH would like new representatives to support coordination of mentors and mentees within North West regions and Wales. The successful candidates would also be involved in the activities that the Mentoring Group is currently taking forward nationally. Closing date for applications: 16th May 2012.  see BASHH website for more details

And finally – we hear reports that Virgin Care have obtained ‘preferred bidder’ status in the tender to run West Sussex sexual health services .

Journal: January 2012 and News

3 Feb, 12 | by shellraine, e-Media Editor

The January edition of the Journal of Family Planning and Reproductive Health Care includes a number of articles previously available at Online First (the Dinger/Shapiro VTE commentary, Advances in IUD training by Connolly & Rybowski and Brown’s study looking at young mens’ views on contraception) as well as:

  • a thought-provoking commentary by Raine-Fenning et al on pregnancy of unknown location (PUL) which points out that a recent recommendation from CMACE to abandon the term is at odds with current scientific evidence and clinical experience;
  • a commentary by Wilkins of the Men’s Health Forum on men and sexual health;
  • a study by Draper et al on 525 GP fittings over a period of 30 years confirms that routine IUD checks confer no benefit.  The paper suggested that current guidelines recommend annual checks though this is based on a statement from Australia dated 2007 and USA advice from 2000 and ignores more up to date FSRH and WHO guidance;
  • a questionnaire study of clinic attendees and staff about what we should call ‘attendees’. This appears to show that there is a preference to retain the term ‘patient’ but was based on the respondents picking from only 4 options (‘patient’, ‘client’, ‘user’ or ‘customer’ – ie didn’t include ‘women’ and ‘men’) or asking them what they would prefer to be called;
  • Kipp et al highlight the unmet need for effective methods of FP in HIV+ individuals in rural Uganda;
  • womens’ views of the use of their leftover LBC samples for research purposes (Cooper et al);
  • an important restrospective audit comparing unscheduled reattendance among women having EMA (early medical abortion) at home vs hospital (Astle et al);
  • a review of appropriate use of Co-cyprindiol in a general practice (Tandy);
  • a review of Clomifene use for ovulation induction in general practice (Wilkes & Murdoch)

Plus at Online First on 31 January 2012: Encouraging IUD uptake after medical TOP [Cameron et al.] 

Sharon Cameron and her colleagues in Edinburgh created a fast-track referral service so that women who had undergone early medical abortion who wished to use intrauterine contraception afterwards could be seen promptly for IUD/IUS fitting. However, only about half the women who were given appointments actually attended. In their article they analyse the differences between the attenders and the non-attenders and suggest ways to enhance the uptake of these effective methods for the prevention of further unwanted pregnancies. While some women would benefit from IUD/IUS insertion at the place of abortion, provision of a fast-track service to the family planning clinic may yet remain the best strategy for maximising uptake of intrauterine contraception in this specific client group. from David Horwell, Advisory Editor, JFPRHC

Journal Fiction Book Reviews for April 2012:
The fiction book that has been reviewed for the next Journal is:
“Sense of an Ending” by Julian Barnes.  Read this and see if your views coincide with our reviewer.  If anyone has read “The Marriage Plot” by Jeffrey Eugenides and would like to review it and see their review in print in the April issue please submit a maximum of 400 words to journal@fsrh.org by 12 February at the latest.  In addition, let us know if there are any other books you have read recently that you feel would be of interest to readers.

New GMC Guidance
Two new documents have been published by the GMC: Raising concerns about patient safety and Leadership and management for all doctors 2012 which they “hope will contribute to a culture change within the health service – where raising and acting on concerns becomes part of every day practise in the UK.”

New mobile website for Brook
Brook, the young people’s sexual health charity, have launched a version of their website optimised for viewing on a mobile phone, funded by the JLS Foundation. See a screenshot of the new site below:

Horror in the 21st Century

28 Oct, 11 | by shellraine, e-Media Editor

As Halloween and Trick or Treat approach we face an even greater horror, as Monday 31st October 2011 is the day the world’s population is forecast to crash the 7 billion barrier only 12 years after it passed 6 billion.

Despite overall rates of fertility falling and the basic right of all women to manage their own fertility having been officially recognised at the Cairo Conference in 1994, 215 million women in ‘high fertility’ countries still don’t have access to voluntary contraception. In addition “millions of adolescent girls and boys have little access to sex education and information on how to prevent pregnancies or protect themselves from HIV.” UNFPA report – The State of World Population 2011

As the number of commentators that report and respond to this prediction increases will politicians and others in power finally listen to what ‘family planners’ have been saying for years and concentrate budgets where they can do some good. Or are we in danger of ignoring this situation until it is too late. This, of course, echoes the post of 4 weeks ago that reported Mary Robinson ‘s warning to the UN on the same issue on the 20 year anniversary of the Rio summit and declaration .

UK’s Breast Screening Programme to be Reviewed

The UK’s National Cancer Director, Professor Sir Mike Richards, has ordered an independent review as questions were raised by the Nordic Cochrane Centre’s systematic review over whether screening may do more harm than good. As this controversy could undermine the excellent effects that are achieved by screening it is important to investigate and resolve any uncertainties. As Sara Hiom of Cancer Research UK (who will jointly lead the Review) said “We mustn’t lose sight of the fact that the fundamental principle underpinning screening – that earlier diagnosis helps improve outcomes – is right and that screening does help save lives”.

MHRA warns against purchasing HIV and non-compliant tests over the internet

We also hear that non-CE marked tests which claim to diagnose HIV and other STIs, available from a UK-hosted website, could give inaccurate results according to a press release from the MHRA . This is aside from the fact that it is illegal to market HIV tests to the public. The HPA has also been involved in contacting all those known to have purchased the tests but warn others considering using the internet as a way of accessing anonymous testing to check that any product is compliant with regulations.

Good News: another new study confirms what we already knew that The Pill and pregnancy have the biggest impact on reducing ovarian cancer risk –  published in the British Journal of Cancer and part-funded by Cancer Research UK. The greatest protection was afforded by taking the pill for more than 10 years followed by ever users then getting pregnant and having more than one child.

Latest from JFPRHC

Latest from JFPRHC