Penny pinching NHS managers have introduced new viagra prescription guidelines which could limit thousands of couples to having sex once a fortnight.New policy documents advise GPs in parts of the country that patients in need of Viagra or similar drugs should be limited to two pills per month, down from the normal prescription of four.

Although the policy was described as a “recommendation” by NHS authorities, local medical committees told the GPs’ magazine Pulse in GPs slam secrecy over evidence for Viagra rationing restrictions it was being handed down to family doctors as an “edict”.

Erectile dysfunction medication is already stringently limited on the NHS and can only be prescribed to patients with certain conditions such as diabetes, multiple sclerosis and prostate cancer.

According to the NHS some 2.2 million prescriptions for erectile dysfunction drugs were issued last year, with 14.5 million tablets issued at a cost of about £78 million.

NHS guidance acknowledges that there “appears to be no clinical reason to restrict the number of tablets” but it adds that, according to research, the average person has sex four times a month.  The average frequency of sexual intercourse in the 40 to 60 age range is once a week.”

The new policy is aimed at economising on non-essential treatments, recommending that the minimum effective dose be prescribed “two times per month using the drug with the lowest acquisition cost.”

The guidance applies to sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis).

Richard Hoey, editor of Pulse, said: “Ask most doctors and they will say that being able to live a satisfactory sex life is a key part of health and wellbeing, but the NHS has never recognised that in its policy on treatment for erectile dysfunction.

“Limiting patients to drugs like Viagra just twice a month is to treat sex like an unnecessary luxury, and completely fails to recognise the degree of anguish it can cause some men with erectile dysfunction.”

Erectile dysfunction is very common in middle aged and older men, with an estimated 50 per cent of those between 40 and 70 experiencing the condition to some degree.

Viagra and other medications can be bought privately, but the cost of about £40 for eight pills can be prohibitive, and patients must also pay for a private prescription.

The new prescription guidelines were drawn up by South Central Priorities Committees, which covers primary care trusts (PCTs) in Milton Keynes, Oxfordshire, Berkshire East, Berkshire West and Buckinghamshire.

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

Caesareans are to be offered to all pregnant women who ask for them, new guidelines state, amid concerns that some are too scared to give birth naturally on Britain’s overstretched labour wards.A lack of support is leading to “traumatic” natural births, say experts, resulting in women fearing a repeat experience.

Studies show that up to 10 per cent of women in Britain suffer from a serious fear of natural childbirth, called tokophobia.

Now the National Institute for Curbing Expenditure (NICE) is recommending that women should always have the right to a caesarean, even if they have no physical or mental health need.

The guidelines, state: “For women requesting a CS [caesarean section], if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS.”

Malcolm Griffiths, a consultant obstetrician and gynaecologist at Luton and Dunstable Hospital, who chaired the guidelines development group, said most women were not interested in having a caesarean.

“It is a major operation, about as major as a hysterectomy,” he said.

Nonetheless, 25 per cent of births in Britain are now by caesarean. Between a third and a half of them are pre-planned.

Figures show that rates in Nordic countries are much lower, at about 15 per cent.

Many obstetricians want the UK rate to come down, but believe that is impossible without better midwifery services.

Mr Griffiths said: “I think probably key to the difference is support during labour, with one-to-one midwifery care and support in Nordic countries.”

Better midwifery care was “key to reducing the caesarean rate”, he added.

Nina Khazaezadeh, a consultant midwife at St Thomas’ Hospital in London and a member of the guidelines panel, said some women opted for caesareans because they feared childbirth after a “traumatic” first experience in an understaffed ward – a condition known as “secondary tokophobia”.

She said: “We might see a rise in secondary tokophobia where women have already had a birth that they have found very traumatic, and the perceived lack of support will have had an impact on their decisions for the next pregnancy.”

Cathy Warwick, chief executive of the Royal College of Midwives, said: “There is very clear evidence that one-to-one support in labour reduces caesarean rates”.

However, she welcomed the new Nice guidelines, saying it was “absolutely acceptable” that a woman who feared childbirth should be offered a caesarean.

Coincidentally, the RCM publishes a new report today claiming that England faces “massive midwife shortages” and needs another 5,000 of them.

Even though numbers have increased since 2001, they have “failed to keep pace with the rocketing number and increasing complexity of births”, it warns.

The number of births has risen by 22 per cent in a decade, with midwives having to deal with 120,000 more in 2010 than in 2001.

Mothers also tend to be older and heavier than in the past, which both raise the chance of complications.

Belinda Phipps, chief executive of NCT, said: “Most women want a straightforward birth, some need a caesarean. When women are treated with respect, and are offered support and information tailored to their concerns, very few of them will choose a caesarean birth unless there are clear health reasons.

“However, our services fail women badly at the moment, with midwifery numbers well below the level required to guarantee safe and satisfying care.”

She went on: “If caesarean rates go up following the change to the guidelines, it will be evidence that women are not getting the quality of midwifery support they need.”

The guidelines do recommend that a woman requesting a caesarean should be made to talk about her fear of childbirth before an operation is granted.

From: http://www.telegraph.co.uk/Caesareans-to-be-offered-to-all-amid-fears-over-midwife-shortages

Single women are being offered fertility treatment by almost a fifth of NHS trusts casting doubt on the Government’s family friendly credentials.Women not in relationships are receiving publicly funded IVF despite official guidance that suggests support should go to couples who have been trying without success to have a baby for several years.

Meanwhile in other parts of the country married couples are being denied help in starting a family, forcing them to spend thousands of pounds on private treatment.

It comes after a Labour nanny state law removed the requirement for fertility doctors to consider a child’s need to have a male role model before going ahead with IVF.

Critics say the Government, which David Cameron promised would be “the most family friendly we’ve ever had in this country”, should tackle the postcode lottery of IVF provision and ensure that the needs of children are put first.

Frank Field, the Labour MP who carried out a high-profile review into poverty and life chances last year, said: “It’s clearly wrong that while couples in stable relationships can’t get IVF and in other areas, single women can.

“It’s really important that Government ministers speak up for children who are the ones left out of this. It needs someone in a position of authority to reflect what most taxpayers think.”

The Rt Rev Michael Nazir-Ali, the former Bishop of Rochester who once chaired the ethics committee of Britain’s fertility watchdog, said: “The irony is that at the very time research is showing the need for both parents, we are writing fathers out of the legislation.

“It’s one thing for a mother to find herself a single parent because of tragic circumstances. It’s quite another to plan for a situation where the child comes into the world without having a father or any possibility of having a father.”

Most local health authorities stipulate that couples must have been in a relationship for two or three years to qualify for IVF treatment.

That requirement is based on guidance issued in 2004 by the National Institute for Curbing Expenditure (Nice), the NHS rationing body,.

It states: “Couples in which the woman is aged 23–39 years at the time of treatment and who have an identified cause for their fertility problems … or who have infertility of at least three years’ duration, should be offered up to three stimulated cycles of in vitro fertilisation treatment.”

The document does note that the guidelines do not address social criteria “for example, whether it is single women or same-sex couples who are seeking treatment”.

However the Human Fertilisation and Embryology Act 2008 removed the reference to “the need for a father” when considering the welfare of the child when considering fertility treatment, replacing it with “the need for supportive parenting”.

Gareth Johnson MP, who chairs the All Party Parliamentary Group on Infertility, said that trusts offering the service to single women were going against one of the guiding principles of IVF, “that you are treating an infertile couple, not an infertile individual”.

Mr Johnson, the Conservative MP for Dartford, said: “Speaking in a personal capacity, if you are going for IVF, you are trying to create a baby, so there should be some evidence of a stable background, which you would expect to be a couple.”

Earlier this year he led an APPG report that found startling differences between what health authorities offered in terms of IVF.

It found three-quarters of Primary Care Trusts were failing to offer three cycles of IVF, as stipulated by Nice. Each cycle comprises a woman’s ovaries being stimulated to produce eggs, which are then fertilised in vitro and implanted in the womb. Spare eggs should be frozen for use if the first attempt fails.

The report found five trusts offered no IVF at all – Warrington, West Sussex, Stockport, North Staffordshire and North Yorkshire and York. Since then, NHS West Sussex has decided to start funding IVF again.

Many trusts have also started putting in place further barriers to IVF funding – for example demanding obese women lose weight – in part to limit demand as health budgets tighten.

Against a background of increasingly scarce provision, as the NHS tries to save £20billion by 2015, Mr Johnson said the decision to offer IVF to single women was misplaced.

From: http://www.telegraph.co.uk/Single-women-being-offered-IVF-on-the-NHS

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

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

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