No abstract

The Health Education Authority's campaign, encouraging the use of periconceptional folic acid in the prevention of neural tube defects, started in February 1996 and is ongoing. Its effectiveness was assessed using a questionnaire, answered by patients not exposed to the campaign and by those that were. The study population was comprised of 337 women in approximately their 20th week of pregnancy, attending antenatal clinic for a routine fetal anatomy ultrasound scan. Data were collected on aspects of folate awareness, intake and sources of advice, before and after the campaign's start. Significant increases in preconceptional and total folate consumption, awareness of folate's benefits, and GP prescription were seen as the study went on. Unplanned pregnancy prevented compliance with periconceptional folate guidelines. We conclude that whilst the promotional campaign seemed to work in York, fortification of foodstuffs may need to be used to increase folate consumption in those with unplanned pregnancy.

Correspondence 4 Wexham Lodge,Objective To assess whether the Health Education Authority's recent promotion of periconceptional folic acid has been successful in increasing uptake sufficient to prevent neural tube defects.Design A retrospective questionnaire, completed by 162 patients in the early pregnancy clinic in Doncaster Royal Infirmary, an averagesized UK district general hospital. The study ran in February and March 1999.Methods and main outcome measures Data were collected on: supplementation and dietary intake of folic acid, both preconceptionally and after confirmation of pregnancy; awareness of the benefits of folic acid; source of information on folic acid; the reasons for not taking folic acid (if this was so); planned or unplanned pregnancy; previous pregnancies; previous neural tube defect in a pregnancy; smoking habit; and age.Results Eighty-one per cent of women were aware of the benefits of folic acid, but only 27% took it preconceptionally. Sixty-eight per cent took it after confirmation of pregnancy. A quarter of patients made an attempt to increase dietary folate. Unplanned pregnancy was a significant bar to uptake, with significant differences in awareness and consumption. Number of pregnancies had no effect. Older women were more likely to take postconceptional folate, but awareness and preconceptional use were the same as younger women.Conclusion Despite an extensive campaign commissioned by the Department of Health and run by the Health Education Authority, use of periconceptional folate will probably only prevent one-sixth of affected pregnancies. The adverse effects of fortification discussed in the body of this paper are small. It is now time for increased fortification of all cereal-grain products to be instituted in the UK in a similar manner to the United States.

No abstract

This retrospective study examines the influence of recombinant growth hormone (rGH) and dehydroepiandrosterone (DHEA) adjuvants on oocyte numbers, embryo utilization and live births arising from 3637 autologous IVF±ICSI treatment cycles undertaken on 2376 women across ten years (2011-2020) within a pioneer Australian facility. Despite using an FSH-dosing algorithm enabling maximal doses up to 450 IU for women with reduced ovarian reserve, younger women had significantly higher mean numbers of oocytes recovered than older women ranging from 11.1 for women <35 years to 9.4 for women aged 35-39 years reducing to 6.5 for women aged 40-44 years and 4.1 for those aged ≥45 years (p<0.0001). Overall, the embryo utilization rate was 48.5% and live birth productivity rate was 35.4 % across all ages and neither rGH nor DHEA showed any benefit on these rates, in fact, those women with nil adjuvants showed the highest live birth rate per initiated cycle (44.94% overall: p<0.0001, and 55.2% for the youngest group: p<0.001). Embryo utilization was increased by rGH in those women aged 40-44 years who had low ovarian reserve (p<0.0001), but this benefit did not translate into any improvement in the live birth rate, in fact those women who did not use adjuvants had the highest overall birth rate (p<0.0001). Similarly, other factors known to cause a poor prognosis, including low IGF-1 profile, recurrent implantation failure, and low oocyte numbers at OPU, showed no improvement in embryo utilization nor in live births from the adjuvants. The relevance of embryo quality was examined on 1135 women whose residual embryos after a single fresh-embryo transfer failed to develop to a suitable grade for cryopreservation. From 1727 cycles such women often displayed an improved embryo utilization rate with both rGH, and with DHEA or combined rGH+DHEA. Even so, live birth rates were not improved by either of the adjuvants excepting young women <35 years using rGH without DHEA (p<0.05). Examining poor prognosis sub-groups, indicated both rGH and DHEA or combined rGH+DHEA consistently improved embryo utilization in those women with low ovarian reserve (p<0.0001), or those with low IGF-1 levels (p<0.0001) or with recurrent implantation failure (p<0.02). All the poor-prognosis sub-groups showed low live birth rates and, notwithstanding the improvements in embryo utilization, the live birth rates were not significantly improved by the adjuvants, albeit the rates were closer to the nil adjuvant groups (not significantly different).