MARCH 2017 HEALTHAWARENESS.CO.UK
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Fertility & Reproductive Health LIFESTYLE AND FERTILITY
Adam Balen of the British Fertility Society explores the issues UNDERSTAND THE NUMBERS
Find key statistics on fertility, IVF and sexual health ONLINE
The Doctor will see you now Dr Christian Jessen talks to us about the importance of sexual health when it comes to family planning PHOTO: ADAM LAWRENCE IVF
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IN THIS ISSUE
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We need to talk Professor Joyce Harper on the importance of reproductive health education P4
Know your body Professor Lesley Regan on lifestyle factors that could affect your fertility P6
Male fertility With the emphasis often focussing on women’s reproductive health, we explore the factors affecting male fertility
Lessons in reproductive health Knowing how to start a pregnancy is just as important as knowing how to stop one, believes professor Adam Balen, Chair of the British Fertility Society.
n just one generation, rates of childlessness in the UK have doubled. The reasons are complex: certainly young people are delaying starting families for socioeconomic reasons and fertility declines significantly with age – more so for women than men. There are a number of causes of infertility that may also be on the rise, for example sexually transmitted infections leading to tubal damage and environmental pollutants leading to a decline in male fertility. A leading cause of fertility problems in women is polycystic ovary Follow us
sex practices that give rise to damaging reproductive infections.
syndrome (PCOS), a hormonal condition characterised by irregular or absent ovulation and menstruation. Despite advances in treatments, one in five UK women today will never have a child and one in six couples may have problems starting a family. Two to three babies in every 100 born in the UK result from IVF treatments. However, perhaps, less well known are the modifiable factors implicated in infertility, for example, lifestyle choices such as smoking, excessive alcohol consumption, being under or over-weight and unsafe
Education is key
Adam Balen Chair, British Fertility Society
“Two to three babies in every 100 born in the UK result from IVF treatments” @MediaplanetUK
You may consider that the ‘ticking biological clock’ is well known among women today - but many couples still seek help with reproduction because they have delayed their decision to have a baby and are unaware of the degree to which fertility declines with age - as indeed does the chance of success with fertility treatments. Understanding how genetic and lifestyle factors combine to produce an individual @MediaplanetUK
picture of reproductive health is clearly a vital public education exercise. A new education initiative by the British Fertility Society (BFS) aims to ensure that young people understand how to look after their reproductive health, as well as grasp the important messages of safe sex and avoiding unwanted pregnancies. With the support of the British Fertility Society’s Fertility Education Initiative, it is hoped that young people in the UK will have a much better understanding of the impact of age and lifestyle on their plans to start a family at the right time. Please recycle
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Looking East for help with infertility By Ailsa Colquhoun
A growing body of evidence supports the role of traditional Chinese medicine in the treatment of fertility problems.
After several years of failing to conceive naturally, in September 2015, Ms Wang, 45, consulted a GinSen traditional Chinese medicine (TCM) clinic in Kensington, London. For Ms Wang this felt like a last-ditch attempt to get pregnant. With hormone tests and hot flushes – and her age – suggesting an impending end to her natural fertility, Ms Wang felt that there was no more time to waste. After careful consultation with Ms Wang, GinSen practitioners created a three-month treatment plan, combining acupuncture and herbal medicines. By November, Ms Wang was pregnant, and her baby was born the following August. She said: “I’ve got a cute baby now, and am over the moon. This is a great joy. I would like to say a huge thank you to all the staff at GinSen’s Kensington clinic.” Ms Wang is just one of a number of clients who have been helped by GinSen’s three London TCM clinics, which have specialised in the treatment of fertility problems since 2000. Founded
by practitioner Li Hua Li, GinSen bases its fertility treatment on the yin and yang theory of balance. Yin and yang is a 2000-year-old philosophy from the philosopher Lao Tzu, which states that a part can be understood only through its relationship to the whole; this is also known as synthetic or dialectical thinking. In TCM, doctors believe that acupuncture can enhance qi (energy flow), correct blood deficiencies and promote blood circulation. When applied to the pelvic area, this can stimulate the activity of reproductive organs. Another popular recommendation is herbal tea, which is considered to improve function in organs including the liver, spleen and kidneys, and to reduce stress, increase energy levels and boost metabolism.
How does it work? In the context of treating infertility, TCM takes the position that high quality eggs and sperm will result from a well-established supply of blood and energy. Used in both men and women, TCM can be used on its own or increasingly in combination with Western assisted fertility procedures, such as intrauterine insemination (IUI) and in vitro fertilisation (IVF).
Ms Li Hua Li Consultant, GinSen Traditional Chinese Medicine (TCM) Clinic, London
In recent years, Western scientists and medical specialists have researched acupuncture and Chinese medicine; as a result of the growing evidence base, they are beginning to accept the role of TCM in treating infertility, and have begun to include TCM in their treatment recommendations. For example, German researchers have reported almost 50 per cent better success rates when they use in vitro fertilisation (IVF) in combination with TCM, while a report published in the journal Fertility and Sterility found the pregnancy rate in a group receiving acupuncture was 42.5 per cent, compared to the 26.3 per cent success rate in
the control group, which did not receive the therapy. According to early results from a British trial, acupuncture more than doubles a woman’s chances of pregnancy through IVF. Trial researchers have urged the NHS to offer the treatment routinely to all fertility patients. One reproductive medicine expert said he had been sceptical before the trial, but that the results had “made a convert” of him. Others, however, remain unconvinced, attributing the improved pregnancy rates to the ‘placebo effect’. Over the past 17 years, GinSen clinics have succeeded in helping fertility patients aged between 3048 years: since 2006, the clinic has achieved an average fertility success rate of more than 55 per cent in the over-40 age group, treating both medically explained and unexplained fertility problems. Thanks to its proven track record, GinSen feels it can say with confidence that, in the future, science will provide more evidence of the value of acupuncture and TCM to western medicine. Find out more at ginsen-london.com 0207 751 5606
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Professor Joyce Harper Professor in Human Genetics and Embryology, University College London
Why reproductive health education is so important
Stop the rationing
Patient power can help change the politics of NHS fertility services, says Susan Seenan, Chief Executive, Fertility Network UK.
By Ailsa Colquhoun
uring the first trimester of a pregnancy many couples go to great lengths to avoid sharing their news. The reason why? Generally, it’s potentially to avoid the ‘miscarriage conversation’, says Joyce Harper, Professor in Human Genetics and Embryology at University College London. Yet, if we don’t start to talk about reproduction problems, “how will people ever understand the reasons why and, more importantly, know how to deal with them,” she asks. Within a few months, the British Fertility Society aims to share a range of resources on reproductive health for schools, young adults, healthcare professionals and parents. She says: “We want to ensure that reproductive health is on everyone’s agenda and that it becomes everyone’s responsibility – to ensure that when it comes to family planning, people can make fully informed choices. “There are still too many people in denial about their chances of getting pregnant or who think that medical advances can solve all their problems.”
By Ailsa Colquhoun
n Saturday 25 March, a patient day of action will invite everyone affected by the unfair rationing of NHS fertility services to write to their MPs. The call is for people to share their personal journeys with infertility, and to highlight the state of local NHS fertility services. Official NHS guidelines for fertility treatments are freely available, yet almost all (98 per cent) of England’s 209 local NHS clinical commissioning groups (CCGs) do not comply fully – and further cuts remain on the cards. Fertility Network UK, which is holding the day of action, believes that just over one in ten of England’s CCGs are
currently consulting on reducing IVF services. Susan Seenan, who heads the Fertility Network UK charity, says this postcode lottery stands in stark contrast to Scotland, Wales and Northern Ireland, where access criteria and provision are standardised and equally accessible. Improvements expected this year in Scotland look set to widen the gap further still. Fertility Network UK believes it is “entirely possible for England to implement NHS IVF recommendations.” Seenan says: “Fertility treatment is almost always the first – even, the only – option considered for decommissioning. All CCGs experience the same financial pressures, but some have found ways to ‘work smarter’.”
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Postcode lottery: Susan Seenan discusses why England needs to increase accessibility for fertility treatments. Photo: Thinkstock
The ones that do, she believes, share the realisation that to cull fertility services is a false economy; the NHS picks up the tab for any pre and post natal complications following fertility treatment abroad, where multiple embryo implantations are more common. “One triplet pregnancy will wipe out the savings achieved by decommissioning NHS fertility treatments,” Seenan points out.
Added costs The spiralling costs of psychological therapies among subfertile couples – counselling, etc – are another issue. A Fertility Network UK survey
“We hear about people who go to the GP with this or that medical complaint, but the root cause of their medical issues is depression about their inability to conceive”
finds that 90 per cent of people with fertility problems feel depressed and 42 per cent have had suicidal feelings. Seenan says: “We hear about people who go to the GP with this or that medical complaint, but the root cause of their medical issues is depression about their inability to conceive.” Unfortunately, little is known about the impact on same-sex couples who face a harder battle to prove unexplained fertility. Then, there is the administration – and the cost to the NHS – of dealing with individual funding requests by patients. “If you fit the NICE criteria for treatment, then appealing to
the CCG or submitting an individual funding request is one way to try to get the CCG to fund your treatment,” says Seenan, adding that template resources to help individuals appeal are on the Fertility Network UK website. But, most of all, and what “definitely works”, says Seenan, is to ensure that the voice of real people with fertility problems is heard. “CCGs which have retained fertility services tell us that they have listened to what people said. So, write to your MP, to the public health minister and to your local CCG to get it on the radar that blanket restrictions are unacceptable. People can make a difference to the politics.”
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Dr Christian Jessen Doctor and TV Presenter
Why sexual health is key to fertility By Ailsa Colquhoun
exually transmitted infections can blow a hole through your family planning – so let the testing begin, says Dr Christian Jessen. Deep within your reproductive organs and without any outward signs, sexually transmitted infections (STIs) such as chlamydia, gonorrhoea and syphilis can be wreaking havoc with your fertility. Dr Christian Jessen is all too familiar with the problems that STIs can cause. Inflammation of the womb, fallopian tubes and ovaries in women, and in men of the testicles and epididymis (sperm tubes) are all complications that can have life-changing consequences for fertility, yet affected people may never even notice that anything is wrong. Although some STIs can present quite quickly with symptoms such as pain when going to the loo or when having sex, unexpected bleeding or discharge, in other cases, the infection is more subtle; there may be few or even no symptoms for months, even years - and possibly none at all. Thanks to the candid nature of TV programmes such as Embarrassing Bodies’, sex is discussed in ways that 30 years ago would be unheard of. And, for that Dr Christian is rightly proud. He says: “Having sex is what we are put on this planet to do but if you are uninformed about how to do it safely, that is when you become vulnerable.” His message is clear: “Know that STIs are ingenious. If you have multiple partners and have not had safe sex, get a test every six to 12 months. Tests are quick and painless; they can be free and may even be done at home. If you get a positive result, the treatment is quick, easy and painless, and it can save a lot of heartache later on.”
Dr Christian Will See You Now, starts Monday 20th March, 8pm on W
How obesity and other lifestyle factors can affect fertility rates
Healthy lifestyle: Professor Regan promotes good health to aid fertility. Photo: Joey Thompson
By Professor Lesley Regan
I am a strong believer in the life-course approach to improving the health and wellbeing of girls and women, not least because of the very real need to shift the focus of healthcare provision away from treating illness towards prevention by promoting good health.
To do so successfully, we need to place women at the centre of their care; educating and empowering them to actively seek healthier lifestyles. This is particularly important for girls and women approaching and during their reproductive years, helping them to take control of their fertility. Benefits from adopting this approach at a young age will also reap rewards for women in their post-reproductive years. Helping girls and women understand that they can take ownership of their own health also benefits their families and society as a whole. For those planning a family, there are many factors at play which can impact fertility. Trying for a baby can be a stressful time for many couples and the time it takes can vary. A young, healthy couple have a 25 per cent to 30 per cent chance of
Professor Lesley Regan President, Royal College of Obstetricians and Gynaecologists
conceiving during the first few months and 80 per cent will conceive within one year. Obesity is a major health concern and has reached pandemic proportions globally. One in five pregnant women are obese – which increases their risk of miscarriage, stillbirth and neonatal death, gestational diabetes, blood clots, pre-eclampsia, more complicated labours, and severe bleeding after the birth.
Making changes Having a normal bodyweight increases the chances of conceiving naturally and reduces the risk of complications for both mother and baby. It is therefore very important that women actively maintain a healthy weight, exercise
and eat healthily prior to conception and limit weight gain during pregnancy in order to improve their own health and provide their baby with the best start in life. We need to eradicate the ‘eating for two’ myth once and for all! Women tend to be more concerned about health issues during pregnancy, which presents doctors and midwives with a unique opportunity to help expectant parents adopt lifestyle approaches, such as limiting alcohol, caffeine and stopping smoking, that helps them prevent future ill health for themselves and their children. I know that high quality sex and relationship education in schools can play a crucially important role in preserving and promoting fertility for men and women. There is strong evidence that good sex and relationship education helps to reduce unwanted pregnancy and sexually transmitted infections, such as chlamydia, that can adversely affect fertility. The reality is that if we want to create a healthy, productive society, we have to educate and support young men and women to make sensible and realistic lifestyle choices, that improve their chances of maintaining good health as they age.
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