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Learning more about infertility

BMJ 1998; 317 doi: (Published 22 August 1998) Cite this as: BMJ 1998;317:a

For women trying to become pregnant this week's journal offers a little advice—some for them and some for their clinicians. The first, possibly unwelcome, piece of advice is to avoid alcohol. On p 505 Tina Kold Jensen and colleagues report a follow up study of couples planning their first pregnancy, which showed that the more alcohol the women drank the less likely they were to conceive.

In couples attending infertility clinics the postcoital test of cervical mucus for progressively motile sperm is commonly used, yet its diagnostic and prognostic power is limited. S Guid Oei and collegues performed a randomised controlled trial in three Dutch infertility clinics comparing a series of investigations that included the postcoital test with a series that excluded it (p 502). They found that cumulative pregnancy rates were similar in both groups, though treatments were given more often in the group who had the postcoital test than in the control group. In the intervention group 38% of women with a normal result on postcoital testing conceived but so did 34% with an abnormal result. The authors conclude that it's hard to justify the test in standard infertility investigations.

A W Murphy and colleagues thought that encouraging the submission of abstracts by email for their scientific meeting might increase efficiency. Andthey did find that submissions didn't need retyping. But emails tended to come at the last minute, causing a log jam; translation of encoded documents was labour intensive; and referees'lack of email facilities caused problems. The true aficionado would say that these are merely the transitional problems of a new technology. David Morris might well agree: however, in his article on acquiring computer literacy (Career Focus, Classified supplement,p 2) he also points out that, like any other skill, acquiring it demands help and determination.

In another in their series of evidence based guidelines the North of England guideline development group tackle the £150m worth of non-steroidal anti-inflammatory drugs prescribed by general practitioners for joint pain thought to be due to arthritis (p 526). The strongest conclusions are that treatment should start with paracetamol, with ibuprofen substituted if that fails to relieve symptoms. Paracetamol is also the most cost effective drug. In a different sort of search for cost effective prescribing Tom Walley argues for a more intelligent system of prescription charges, with staged copayments according to the effectiveness of the drugs (p 487). He suggests that such a scheme offers some benefits to most stakeholders:government, patients, and even the pharmaceutical industry.

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