Tuesday, October 22, 2013

Three glasses of wine could reduce chance of conception  -- if you already have serious fertility problems

Drinking three small glasses of wine a week could reduce some   women's chances of conceiving by two thirds, research has found

The study of women's drinking habits in the months before they began fertility treatment found that even low quantities of alcohol had a dramatic impact on the ability to conceive.

Research on couples who had already undergone around three failed cycles of IVF, found that women who abstained from all alcohol had a 90 per cent chance of achieving a successful pregnancy, over three years.

However, women who drank an average of just three small glasses of wine a week had a 30 per cent chance of conceiving over the same period.

Researchers said the same patterns were likely to hold true for couples trying to conceive naturally.

The study found that even women who drank just one or two glasses of wine a week - well within Government safe drinking limits for those trying to conceive - drastically jeopardised their fertility, with success rates of 66 per cent.

Government advice recommends that women trying to get pregnant should drink no more than 1 to 2 units of alcohol twice a week - the equivalent of up to two glasses of wine.

Researchers who led the study of 90 women, presented at the American Society for Reproductive Medicine's annual conference in Boston, US, said it was not clear why relatively small quantities of alcohol had such an impact.

Lead author Dara Godfrey, an IVF specialist from Reproductive Medicine Associates of New York, said: "My advice to patients is always to limit or abstain from alcohol. But whether they do or not its up to them. Alcohol definitely has a detrimental effect on pregnancy success."

Dr Godfrey said the same impact was likely to occur in women trying to conceive naturally, with the greatest effect likely to be felt among those who had several drinks on the same evening.

She said researchers had not identified the mechanism which meant alcohol reduced fertility, but that it was possible it jeopardises normal egg development.

Some fertility clinics recommend that clinics stop drinking for three months before they start IVF treatment, because it takes that long for an egg to develop.

Dr Allan Pacey, a fertility expert at the University of Sheffield said the differences in pregnancy rates between the groups were substantial, and consistent with advice to avoid alcohol if trying to conceive.

However, he said it was possible that there were other differences between the women who abstained from alcohol entirely, and those who had several drinks a week.

Dr Pacey said: "I would wonder whether alcohol could be a surrogacy marker for something else - that the women who have something to drink are more likely to be stressed."

Stress levels affect hormones such as cortisol which can interfere with reproductive cycles.

The university's research on sperm quality last year suggested that moderate intake of alcohol did not affect male fertility, he said.

"There is a certainly a bit of a difficulty in advising men that it is okay for them to drink if trying to conceive but women shouldn't touch a drop - that could create tensions in many a household," he said.


A jog in the park won’t cure serious depression

A study of over-prescription for depression and anxiety deserves analysis because it contains a mix of truth… and hidden agendas

GPs are turning us into a nation of pill-poppers, according to shock headlines last week. The research, commissioned by the charity Nuffield Health, found that GPs are 46 times more likely to prescribe medication for depression and anxiety ''rather than recommend other, medically proven alternatives such as exercise’’.

This feeds in nicely to the social narrative surrounding primary care: that GPs are too busy and harassed to listen and are only interested in pushing us out of the door clutching a prescription to keep us quiet. Dr Davina Deniszczyc, the medical director of Nuffield Health, said: ''The compelling evidence that physical activity can play an important role in both treating and alleviating early symptoms of mental ill health isn’t sufficiently filtering through to front-line and primary care services.’’

This study deserves a closer analysis because it contains a mix of truth… and hidden agendas. The newspaper reports indicated, correctly, that it was commissioned by a charity. But although Nuffield Health is technically a charity, it is actually a private hospital chain. It was criticised when it emerged that the group paid only £100,000 corporation tax in 2011, despite a turnover of £575 million, because of its ''charity’’ status. Its chief executive, David Mobbs, has a salary package of £860,000. It has 31 hospitals but also 60 membership gyms. So, a cynic could argue that it has a vested interest in, firstly, undermining people’s confidence in GPs and, secondly, commissioning research that promoted exercise. The study is, in essence, a nicely dressed up piece of covert marketing.

And it works as a marketing message because it does contain some truth. I should emphasise that I routinely prescribe antidepressants to patients with moderate to severe depressive illness, and they are effective. It is also true that sometimes antidepressants are prescribed to people for whom exercise would be beneficial, such as those with a mild depressive illness. But for many, their depression is so severe that the idea of a brisk jog in the park to lift their spirits is absurd. It can be a life-threatening illness that deserves prompt pharmacological intervention.

However, what the study failed to explore was why GPs were so ready to prescribe antidepressants. The real story here is about psychological therapy services. Historically, GPs have been reliant on antidepressants because access to the alternative – the ''talking therapies’’ – in the NHS is subject to very long waiting lists.

When I began training it was not unusual to hear of patients waiting for several years to receive therapy on the NHS. The response to this was the IAPT scheme – or Improving Access to Psychological Therapies, which evolved from a paper first tabled by health economist Lord Layard in 2005. He argued that, as well as humanitarian grounds, there was a sound economic argument for providing evidence-based therapies quickly and effectively for people with depression and anxiety, as it would reduce the cost of incapacity benefit. On the basis of his assessment, staff were recruited and trained and services were rolled out across the country providing cognitive behavioural therapy. At the end of the first three full financial years of operation in March 2012, more than one million people had used the service and 45,000 people had been moved off benefits as a result.

Unfortunately, it has been a victim of its own success. Those with only mild symptoms are seen quickly by specially trained professionals, but not doctors or psychologists, which limits the complexity of the cases they are able to deal with. So while money has poured into IAPT services to deal with minor complaints, waiting times for more complex cases have lengthened. There are reports of people with severe depression having to wait over a year. This is not to denigrate IAPT services – they do a great job. But, with the success of IAPT, the Government feels it has solved the problems of accessing “talking therapies” when there are still shamefully long waiting lists for those that need help the most.

GPs still prescribe antidepressants because, for some patients, the alterative is an insufferably long wait before they get any respite from their symptoms.


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