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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.”

CQC visits to Abortion clinics announced to media ahead of providers

23 Mar, 12 | by shellraine, e-Media Editor

This report from Jennie Bristow (editor, Abortion Review)

23 March 2012

UK: Health Secretary launches shock wave of inspections on abortion clinics

The Health Secretary, Andrew Lansley, yesterday announced to the UK media that the Care Quality Commission (CQC) would be carrying out a series of ‘unannounced inspections’ on abortion clinics throughout the UK to ensure that doctors are complying with the ‘spirit and the letter’ of the 1967 Abortion Act. Jennie Bristow reports.

This action, which Lansley confirmed in a statement to Parliament today, 23 March, is allegedly a response to concerns that doctors are ‘pre-signing’ the HSA1 abortion forms. ‘The process of pre-signing certificates where the doctor does not know who the woman is for whom that certificate may be used in relation to that abortion is in itself illegal. I am not prepared to tolerate a failure to respect the law,’ Lansley said in a press statement yesterday.

He further stated: ‘The CQC has agreed to undertake unannounced inspections to identify the scale of this problem and we will set up a special team comprising of all the necessary regulators… to look at how we stamp out bad practice in abortion clinics.’

The BBC gives a more measured explanation of the law regarding the HSA1 form. ‘Except in emergencies, the law says two doctors must certify an abortion. However, there is no requirement for them to have actually seen the woman – only that they should have seen and assessed the necessary clinical information about her case, which could have been taken by another doctor or nurse.’

Lansley’s concern is that this ‘second signature’ is being provided before the doctor has reviewed the relevant notes. This is not the practice of most abortion providers, including British Pregnancy Advisory Service (BPAS). However, launching a wave of CQC inspections on the basis of forms potentially being pre-signed in some other clinics is a strange and heavy-handed action, for three reasons.

First, the second doctor’s signature has been long understood to be a legal, rather than a clinical, safeguard; arising from attempts in the 1960s to pass a controversial new law in the form of the Abortion Act. As such, many politicians – including Lansley himself – have questioned whether it is necessary to retain this cumbersome and clinically irrelevant requirement in the 21st century.

As the BBC explains, ‘The requirement for two doctors’ signatures was criticised as long ago as 2007, when a report by MPs on the Commons science and technology committee recommended it be removed because of the potential for abortions to be unnecessarily delayed.’ And Andrew Lansley himself, during the debate about the abortion law that took place in 2008, said:

‘If a woman needs an abortion in terms sanctioned by the Abortion Act 1967, it must surely be better for it to be an early, medical abortion than a later, surgical one. I therefore hope that the House will consider whether the requirement for two doctors to consent to an abortion being performed, and the restrictions on nurses providing medical abortions, need to be maintained.’

So it is strange indeed that the Health Secretary, busily engaged as he is in controversial reforms of the entire health service, should now view strict adherence to the ‘two doctors’ requirement as a sudden issue of major clinical concern. His quote in yesterday’s press statement could not be more different from the temperate approach that he took four years ago. On 22 March 2012, Lansley argued:

‘I am shocked and appalled to learn that some clinics – which look after women in what are often difficult circumstances – may be allowing doctors to pre-sign abortion certificates. This is contrary to the spirit of the Abortion Act. The rules in the Abortion Act are there for a reason – to ensure there are safeguards for women before an abortion can be carried out.’

The second peculiarity of this shock wave of inspections is that the ‘evidence’ upon which they have been launched seems remarkably thin. It seems to have come out of police investigations launched on the back on the Daily Telegraph’s investigation into ‘sex selection’ abortions last month, which itself found little evidence that such abortions were carried out.

There may be more basis Lansley’s concerns than a flimsy newspaper investigation – but we do not know. And this is the third and most striking peculiarity of today’s Parliamentary statement: that the media were briefed about it before any of the clinics whose work it might concern.

Ann Furedi, chief executive of BPAS, said: ‘Abortion doctors provide an important service to women who are often in difficult circumstances. Their work is already intensely scrutinised, with clinics regularly inspected by the CQC.

‘Mr Lansley says he is shocked and appalled by the practices he has uncovered. BPAS is shocked and appalled that Mr Lansley has found it necessary to inform journalists of alleged breaches of the abortion law before he has informed those responsible for providing the services that have been investigated, and before the investigation is concluded.’

America and abortion

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

America finds itself in the throes of abortion furore again – in real life and virtually.

In a case that could potentially have long term consequences (whatever the result) in the same way as the Roe v Wade landmark legal decision did in 1973 Jennie McCormack’s fight is set to make its way up through the US justice system. As a financially struggling, single mother of three she found herself in an impossible situation when she became pregnant last year.  What marks her case out particularly, among the many other tragic tales, is that she lives in Idaho and the only solution she could find to her dilemma was to try and terminate the pregnancy herself when she heard about mifepristone being available via the internet.  Many women find themselves in similar difficult situations, particularly in conservative, ‘bible-belt’ states in America, of trying to acquire a legal abortion with the many hoops required to achieve this and the costs involved. The added problem in Idaho is that it has a law which bans women from carrying out their own abortion, though this has never been enforced before. Though the case was dropped for lack of evidence she could still be prosecuted and her lawyer has taken the decision to try and prevent this by bringing a suit on her behalf claiming the law is unconstitutional. As well as hoping to protect Jennie, herself, from prosecution they hope to set a precedent so that other women in Idaho and other conservative states will be free to access treatment via the internet and not have to suffer the additional anguish inflicted on them by the current situation in the US. Not that this will stop the persecution she is experiencing at the hands of her neighbours in small town Pocatello where she has been ostracised and subjected to all kinds of abuse so that she has become virtually a prisoner in her own home.

In an strange twist of art imitating life it seems that she may have found an unexpected ally in Buffy the Vampire Slayer (and for the uninitiated – mostly those who don’t have children – this is an award-winning, cult US TV series/feature film/computer game/comic strip phenomenen). She too finds herself pregnant and needing to access an abortion. As the Guardian newspaper highlighted last week: The new issue of the weekly Buffy comics sees Buffy taking some time off from staking vampires through the heart to deal with what publisher Dark Horse called “a rather personal problem”. The creator, Joss Whedon is quoted as saying he doesn’t usually get soapboxy but feels strongly the need to support the debate which is eroding a woman’s right to choose. This will bring home the dilemmas many women face in real life to a whole new audience and may facilitate some interesting parent/child TV dinner conversations.

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