The ‘morning after pill’ which was being offered over the phone in a controversial new scheme over the Christmas period is “not effective” when a woman is most fertile, a consultant gynaecologist has warned.Dr Kate Guthrie said Levonelle One Step, the form of emergency contraception being offered by the British Pregnancy Advice Service (bpas), was “not effective” for up to five days around ovulation.

Dr Guthrie, a member of the Faculty of Sexual and Reproductive Health, was concerned that women could take the pill during these days and wrongly think they would avoid pregnancy.

She said: “There’s very clear evidence showing that it’s not effective in the couple of days running up to ovulation, and probably not very effective in the 36 hours afterwards.”

The aim of the bpas scheme is to cut the number of women seeking abortions over the festive season.

The idea is that women will be able to pop the pill on the morning after accidentally having unprotected sex, rather than having to get an appointment, which can be difficult over the Christmas break.

Part of the rationale is, as bpas puts it, “the sooner the morning after pill is taken after unprotected sex, the more effective it is.”

Dr Guthrie, who works in East Yorkshire, agreed with that, saying that Levonelle should always be taken within 72 hours of sex.

However, she was concerned that women would not be sufficiently informed of Levonelle’s limitations.

While she welcomed immediate access to emergency contraception, she said: “You have to know how effective or ineffective it is.”

Guidance from the faculty, published this August, states that Levonelle “has been shown to be no better than placebo at suppressing ovulation when given immediately prior to ovulation, and is not thought to be effective once the process of fertilisation has occurred”.

Dr Guthrie said that, if a woman has had unprotected sex at this time of the menstrual cycle, she should see a doctor about obtaining another form of emergency contraception.

The majority of women having IVF treatment still have two embryos implanted in the womb despite clinics being warned of the risks of multiple pregnancies and having targets to reduce them.Two thirds of women having IVF treatment have two embyos placed in the womb, increasing the likelihood of them having twins, figures from the regulator have shown.

It comes after the Daily Telegraph revealed that 100 feotuses were aborted last year because they were part of a multiple pregnancy which carries greater risks of birth defects and complications.

The latest figures from the Human Fertilisation and Embryology Authority have shown that multiple pregnancies are reducing and are down from over one quarter in 2008 to one fifth last year.

Clinics have been told that women under 37 should be advised that it is normally best for them to have one embryo put back into the womb at a time.

However the HFEA data show that 64 per cent of women had two embryos put back in the womb last year.

Only one in six opted for a single embryo and a similar proportion had no choice because only one embryo was produced.

In 2010, 45,264 women had a total of 57,652 cycles, an increase of almost six per cent on the previous year.

This year clinics were set a target that no more than 15 per cent of their births be twins or triplets.

Tony Rutherford, chairman of the British Fertility Society, said the multiple pregnancy rate has dropped significantly as the number of single embryo transfers has increased from nine per cent to almost one in four now.

But he added: “There has been significant improvements but it is nowhere near enough to reach the 10 per cent multiple pregnancy rate target set by the HFEA in 2007.

“The targets are achievable, the philospohy behind it is absolutely correct and by doing so we will protect the health of mothers and their babies following IVF.”

Mr Rutherford said in Sweden the single embryo transfer rate was 70 per cent and the multiple pregnancy rate was five per cent.

From: http://www.telegraph.co.uk/IVF-women-still-receiving-two-embryos-despite-twin-risk

All women who are trying to have a baby should take special ‘conception’ vitamin supplements after a study found fertility patients were twice as likely to get pregnant if they were taking them.The research involved women who were having treatment to boost their fertility but as there were no side effects from taking the vitamins, scientists said all women who are trying to conceive should consider them.

In the study half of women were given a multivitamin and mineral tablet to take each day and half were given folic acid, recommended by government to prevent abnormalities in the baby.

Four weeks later they then had a fertility drug treatment.

Women on the vitamins were more likely to conceive and 60 per cent were still pregnant three months later compared to 25 per cent on folic acid.

They were also likely to fall pregnant after fewer fertility treatments with three quarters conceiving on their first cycle, compared with less than one in five of those on folic acid, it was found.

The study conducted by researchers at Warwick University involving 56 women attending University College London and the Royal Free Hospital fertility units.

The women, who were mostly from an affluent background, all had healthy diets at the beginning of the study and later blood tests showed those on the multivitamin had higher levels of micronutrients than those only taking folic acid.

Lead author Dr Rina Agrawal, consultant obstetrician and gynaecologist and Associate Professor in Reproductive Medicine, said: “All women considering pregnancy should take a specifically formulated prenatal micronutrient supplement to optimise their chances of conception.”

She said it is not known what components of the vitamin tablet had the effects on pregnancy but the Pregnacare Conception product used contained a range of vitamins, minerals, antioxidants and substances linked to ovarian function and blood flow to the reproductive organs.

The findings are being published in the Reproductive BioMedicine Online journal.

Dr Allan Pacey, Senior Lecturer in Andrology at the University of Sheffield said “The influence of nutrition on our fertility is of general interest to the public and professionals, but there are relatively few studies which have examined this systematically and few which have shown direct benefits of taking supplements to enhance things.”

“Therefore, on the face of it, this study is interesting but we should acknowledge that this is a relatively small number of patients and the study would need to be repeated in a larger trial before we could be certain of the results.

“I can’t help but thinking that for most people, just general dietary advice would achieve the same effect and a good basket of fresh fruit and vegetables from the greengrocer each week would have much the same effect if their diet was poor.”

Glenys Jones, a Nutritionist at the Medical Research Council’s Human Nutrition Research said: “This is an interesting study and supports the body of evidence that diet plays an important role in supporting women’s health and their fertility.

“However this study alone cannot result in the general recommendation that all women undergoing fertility treatment should take a preconception multivitamin as it is a very small single study and further large-scale research is required to investigate if this is reproducible in a larger more diverse group of women.”

Catherine Collins, Principal Dietician, St Georges Hospital NHS Trust said: “Although the researchers claimed their diets were nutritionally adequate no robust data was provided to confirm this – a major concern for any trial making nutritional claims.

“We know that broad-spectrum supplements can correct dietary deficiencies and boost blood levels of iron, B12, folic acid and vitamin D – as was shown in this study which suggests these women had low intakes pre-conception.

“As this study was of women with conception problems there’s no evidence to suggest every woman considering pregnancy should take them.

“Similarly, n-acetyl cysteine and arginine have been shown to improve the efficacy of IVF treatments in a small number of studies, but there’s no evidence to support their use in natural conception. However, the nutritional advice for women contemplating pregnancy remains unchanged – take folic acid supplements until 12 weeks of pregnancy and if you decide on a multi-nutrient supplement for nutritional insurance make sure it’s one suitable for pregnancy, as the vitamin A content is lowered to ensure safety of the developing baby.

From: http://www.telegraph.co.uk/Women-trying-to-conceive-should-take-vitamins-researchers

Childhood obesity appears to begin in a mother’s womb, a new study has concluded using state of the art technology to monitor fat levels in unborn babies.Researchers found some babies have similar build up of fat around their abdomen that adults aged in their 50s have.

The study of babies at Chelsea and Westminster Hospital, west London, used magnetic resonance imaging (MRI) scans to investigate links between childhood obesity and their mothers.

It reportedly found evidence that being overweight or obese in pregnancy could result in potentially harmful changes to a baby’s fat levels while still in the womb.

The study, led by Prof Neena Modi, one of Britain’s best experts on high-risk health problems in newborns found nearly a third of children had more fat than expected.

Of the 105 babies – 54 boys and 51 girls – a total of 31 babies had more adpose, or fat, tissue around their abdomen than normal.

Experts said the study was the first direct link that proved the weight of a mother-to-be was passed on to her child and showed that overweight mothers gave birth to fat babies.

“I was very surprised to be able to detect such a clear continuum of effect of maternal BMI (body mass index) on the baby,” said Prof Modi, head of neonatal medicine at Imperial College London.

“This is a very important finding indeed, opening the door to a new understanding of how a mother’s metabolism affects her baby.”

Newborn babies usually have about 700g of adipose tissue, but for each unit increase in maternal BMI, this increased by approximately 7g with a huge build-up in fat in the babies’ livers.

Meanwhile in adults, adipose tissue is found mainly under the skin, but also in deposits between the muscles, around the intestines and around the heart.

Prof Modi, who is also a consultant neonatologist at Chelsea and Westminster Hospital, told the Daily Mail that all women should be aware of the effects of being obese and what this means for their child.

“This shows how sensitive the baby is to the environment experienced within the womb and how lifelong effects may be initiated before birth,” she said.

Body mass index is calculated by dividing a person’s weight in kilograms by the square of their height in metres.

The World Health Organisation classes a BMI between 18.5 and 25 as normal weight, between 25 and 30 as overweight and over 30 as obese.

In adults, high amounts of fat around the stomach and in the liver impair their control of blood sugar, leading to diabetes. Problems associated with obesity are set to cost the NHS up to £6.3 billion a year by 2015.

From: http://www.telegraph.co.uk/Overweight-mothers-give-birth-to-fat-babies-study-finds

Parts of England are facing big midwife shortages putting mothers and babies at risk midwives have warned.The Royal College of Midwives says a 22% rise in births over 20 years has led to shortfalls across England, but some areas are worse than others – it highlights the East Midlands and East.

The RCM wants 4,700 more midwives and says the prime minister has backed away from a pledge to raise numbers.

The Department of Health said record numbers of midwives were now being trained.

Midwives say births are becoming increasingly complex because of growing numbers of obese and older mothers-to-be, who often need extra support.

The Royal College of Midwives says the extra 4,700 midwives are needed across England to keep pace with the added pressures.

And it says a new analysis of midwife numbers across England reveals big variations – with limited shortages in some areas and serious shortfalls in others.

The calculations were done by measuring the number of midwives in an area against the number of babies born there. The RCM estimates that one midwife is needed for every 28 hospital births and 35 births in a midwife-led unit or at home.

The North East and North West of England had a shortfall of less than 10%.

But according to the figures, the East Midlands and East of England need 41% more midwives, and the South East is also more than a third short of staff.

The college says the disparity is down to different levels of investment in different areas; women living in places with bigger shortfalls are at risk of having less choice over how and where they give birth.

It says Scotland, Wales and Northern Ireland do not have midwife shortages at the moment.

“This is a real problem in England,” said Cathy Warwick, RCM General Secretary. “We believe women should have the same choice over giving birth wherever they live. Once you get to really critical shortfalls, maternity services won’t be safe.”

It’s a sentiment echoed by the head of midwifery at Wansbeck hospital in Northumberland, where they say they have enough staff to offer high-quality care.

Janice McNichol has delivered more than 1,000 babies in her career, and prides herself on making sure every mother has a positive experience.

“It’s about safety and quality of care,” she said. “Making sure midwives are there when mum needs them, to answer questions and help her through the process.”

The charity Action against Medical Accidents, AVMA, said the situation in some areas was desperate.

“Having a baby should be the happiest time in a couple’s life, but failure to deal with this problem is all too often turning it into a tragedy,” said AVMA chief executive Pater Walsh.

“Maternity services should be the NHS’s first priority for improving patient safety and having enough trained midwives is an absolute must.”

From:  http://www.bbc.co.uk/news/health-14859228

In a blow to the nanny state’s view of fatherdom, new research has found that there is a biological reason why so many men suddenly discover their caring side when they become fathers.A study found that men’s testosterone levels fell by around a third in the days and months after their partner gave birth.

The more caring side of a man’s character emerged as levels of the hormones fell, said scientists, who believe that the process is nature’s way of trying to ensure that fathers stay for the long  haul of child–rearing.

They found that men with higher testosterone levels – associated with dominant and aggressive behaviour – were both more likely to secure a partner and father children.

But after the birth itself  testosterone levels in these men dropped.

“Humans are unusual among mammals in that our offspring are dependent upon older individuals for feeding and protection for more than a decade,” said Christopher Kuzawa, a faculty fellow at the  Institute for Policy Research at Northwestern University in Chicago, and a coauthor of the study, published in the journal Proceedings of the National Academy of Sciences. “Raising human offspring  is such an effort that it is cooperative by necessity, and our study shows that human fathers are biologically wired to help with the job.”

Lee Gettler, an anthropology doctoral student who also worked on the study, added: “It’s not the case that men with lower testosterone are simply more likely to become fathers.  On the contrary, the men who started with high testosterone were more likely to become fathers, but once they did, their testosterone went down substantially.”

It was the act of child care that seemed to reduce testosterone, he explained.

“Our findings suggest that this is especially true for fathers who become the most involved with child care.”

The biggest effect appears to be temporary, in the period immediately after bringing home the baby, with levels rising slowly after that, although not returning to pre–fatherhood levels.

The team studied 624 men in their twenties in the Philippines and followed them for four–and–a–half years. Dr Allan Pacey, a male sexual health expert at Sheffield University, commented: “To see  dramatic changes in response to family life is intriguing. The observations could make some evolutionary sense if we accept the idea that men with lower testosterone levels are more likely to be monogamous with their partner and care for children.

“However, it would be important to check that link between testosterone levels and behaviour to be certain.”

The study found that testosterone levels fell on average by 34 per cent when men became fathers, with the biggest falls in those most involved in childcare.

Dr Pacey added that, as high levels of testosterone were also associated with a strong sex drive, lower levels could reduce the chances of a man ‘straying’. However, he cautioned that the paper did  not prove that.

He added: ‘Testosterone is the key hormone that defines male physiology. We know that levels correlate with a man’s sex drive, his risk–taking behaviour and social dominance. It has also been suggested that it may increase his attractiveness to women and help him find a mate.”

From: http://www.telegraph.co.uk/Men-biologically-wired-to-care-for-children

Nurses and midwives are being urged to get their flu jabs after figures reveal less than a third did last year.All front line healthcare workers are meant to be vaccinated to stop them going off sick with influenza and spreading the virus to patients.

Last year only 30% of hospital nursing staff in England got immunised compared with 43% of GP practice nurses, 38% of GPs and 37% of other doctors.

Nursing and midwifery groups say having the jab is a “professional duty”.

This is the first time the figures have given broken down by occupation.

The number of healthcare workers getting the vaccine had increased from 26.4% in the 2009 winter to 34.7% in 2010.

However, the majority of nurses who work with the most critically ill over the winter months and midwives who work with pregnant women, were left vulnerable to flu, its potentially life-threatening complications and passing it on to patients and family, says the Department of Health which released the figures.

The data also shows that only 25.2% of youngsters aged six months to two years in at-risk groups were vaccinated last winter, compared with 51.7% of those aged 16 to 65.

Those at risk include people with conditions such as asthma, diabetes, heart disease and liver disease, as well as the over-65s and pregnant women.

Last winter people in at-risk groups were 11 times more likely to die from seasonal flu than people with no underlying health problems.

Chief Medical Officer Dame Sally Davies said: “It is never too early to start thinking about flu. So as NHS staff return from their holidays, I urge them to plan ahead and get vaccinated.”

Dr Peter Carter, of the Royal College of Nursing, said while NHS staff should not be forced to get immunised, they had a professional duty to do so: “Patients and healthcare staff suffer when nurses are off sick.

“It is vital that nurses do all they can to take responsibility for their own health and of those around them. The RCN will be working with our members to ensure they have access to all of the relevant information to enable them to make the right decision about the uptake of the vaccine.”

Louise Silverton, of the Royal College of Midwives, said: “Midwives are strongly advised to encourage all pregnant women to be vaccinated against seasonal flu.

“In addition midwives as key health workers should themselves seriously consider being vaccinated to prevent transmission of influenza to the women for whom they care and also to their own families.”

A National NHS Staff Seasonal Flu Vaccination Campaign launches later this month and will use resources like Twitter and Facebook, as well as leaflets, to encourage more healthcare professionals to get vaccinated.

From: http://www.bbc.co.uk/news/health-14792570

Teenage pregnancy are “contagious”, according to a study which has found that younger sisters tend to follow the example set by their older siblings.When an older sister becomes a gymslip mum, the younger sister is twice as likely to do the same.

This “peer effect”, as Bristol University researchers called it, raised the chances of becoming a teenage mother from about one in five to two in five.

The effect was stronger when sisters were closer together in age, while it was also stronger in poorer households.

Being educated to a higher level decreased its effect, but the research found that the sibling effect “dwarfs” that of more years in school.

Professor Carol Propper said: “Previous research has shown that family background and raising the education of girls decreases the chances of teenage pregnancy.

“However, these findings reveal the positive sibling effect still dwarfs the negative effect of education. These findings provide strong evidence that the contagious effect of teen motherhood in siblings is larger than the general effect of being better educated.

“This suggests that more policies aimed directly at decreasing teenage pregnancy may be needed in order to reduce teen births.”

The analysis was based on census data from 42,000 Norwegian women born after the Second World War. Most gave birth in the 1970s and 1980s.

The study, a collaboration with academics at Bergen University in Norway, the Norwegian School of Economics and Imperial College London, has been published as a working paper by Bristol University’s Centre for Market and Public Organisation.

From: http://www.telegraph.co.uk/Teenage-pregnancies-contagious

A nationwide lottery offering couples the chance to win IVF fertility treatment was strongly criticised. At its launch, a UK-based charity offered people – couples or singles of both sexes – the chance to win £25,000 for a round of IVF treatment at a “top clinic”, in return for a £20 ticket.

The lottery is being organised by the charity To Hatch, founded by Camille Strachan, 38, to help people who are struggling to conceive. The winner of the lottery, which is licensed by the UK Gambling Commission, will be randomly selected by a computer in September. Further monthly draws are then planned.

Ms Strachan says she hoped the lottery “can ease the burden on the NHS and reduce the stress on some of those who are struggling.”

It is understood that a number of UK clinics have refused to participate, sparking rumours that a clinic in Barbados would be one of the destinations. Ms Strachan has declined to reveal which “top” clinics would offer the treatment.

The Human Fertilisation and Embryology Authority (HFEA) have criticised the move as “wrong and entirely inappropriate”. They described it as running “counter to the ethos that underpins our regulatory system and clinical practice”.

Dr Allan Pacey, a fertility expert at the University of Sheffield and a spokesperson for the British Fertility Society, said: “In my view it’s a slippery slope to be dishing out healthcare like this, particularly when it comes to children. My mother and father used to say they found me under a gooseberry bush – can you imagine telling a child that he or she was won in a raffle?

“Ethics aside, I think it is precisely the current postcode lottery of NHS funding which makes this charity think it can make this venture a success. Couples either find they can’t get access to NHS treatment or they get only a single attempt and therefore need to fund any further treatment privately if that is unsuccessful.”

Despite criticism of the charity, public responses on internet chat forums were mixed. Although the majority expressed misgivings, hundreds of people indicated on Facebook and Twitter that they intended to buy tickets.

Many took the view that the lottery is a good idea, given what is widely perceived as a cut in the provision of IVF treatment on the NHS.

A spokesman for the Gambling Commission, which regulates lotteries, said: “The commission plays no statutory role in judging ethical questions that fall outside of the Gambling Act 2005. A licence is granted if all the criteria are met.”

From: http://www.independent.co.uk/fertility-doctors-attack-unethical-16320-ivf-raffle

Maternity services across the UK need a radical rethink, the Royal College of Obstetricians and Gynaecologists says.
It wants the number of hospital units cut to ensure 24-hour access to care from senior doctors and says more midwife-led units are needed for women with low-risk pregnancies.

The National Childbirth Trust welcomed the report but says the proposals do not go far enough.

NHS managers said maternity care desperately needed to be reorganised.

Too many babies are born in traditional hospital units, says the college, which also warns the current system is neither acceptable nor sustainable in its report on maternity care.

The college estimates there are about 1,000 too few consultants to provide adequate round-the-clock cover for hospital units.

Dr Falconer said: “There is no doubt if you look at the worst scenario of serious complications, you need the right person, a senior person, there immediately.”

Previous attempts to re-organise maternity care around a smaller number of hospital units have proved controversial, but Dr Falconer said if women could be convinced of the greater safety they would be prepared to travel to have their babies.

The need for change would be largely in cities or large towns, because in rural areas it might be more important to support smaller units.

The report estimates that across the UK there are 56 units with fewer than 2,500 deliveries of babies a year.

In order to take the pressure off busy hospitals, the college is also calling for an increase in the number of midwife-led units.

Midwives have welcomed the report, saying it could improve the experience for about a third of women who have straightforward deliveries.

The proposals for maternity are part of a wider vision of delivering all women’s gynaecology and obstetrics care in networks, similar to the model which has helped improve cancer treatments in England.

The National Childbirth Trust said the idea of having a network to provide joined-up care for women was one it could support but it would prefer care during pregnancy and maternity to be concentrated in one NHS organisation in each area.

The NHS confederation, which speaks for managers, described maternity care as a classic example of a service which desperately needed to be reorganised.

Chief executive Mike Farrar said politicians needed to be prepared to speak up for change.

“Where the case for change is clear, politicians should stand shoulder-to-shoulder with managers and clinicians to provide confidence to their constituents that quality and care will improve as a consequence of this change.”

Although Scotland has reorganised some of its maternity services, there are likely to be pressures for change elsewhere in the UK.

In North Wales maternity care across three hospitals is expected to change after an initial review recently concluded improvement was needed.

From: http://www.bbc.co.uk/news/health-14145862