Intended for healthcare professionals

Rapid response to:


Are we overusing IVF?

BMJ 2014; 348 doi: (Published 28 January 2014) Cite this as: BMJ 2014;348:g252

Rapid Response:

Re: Are we overusing IVF?

Esme Kamphuis and colleagues are concerned that the risks of IVF could outweigh the benefits as world IVF births increased from 2 million in 2005 to 5 million in 2013.1 At the same time the indication of “unexplained” subfertility increased 3-fold in the UK the UK and the Netherlands.

This is failure to use real “Evidence Based Medicine”. All doctors surely have a duty to investigate patients using the best tests available. Since the 1970s it has been possible to investigate couples with “unexplained” infertility or recurrent miscarriages and find numerous nutritional deficiencies and hidden infections.

Commonly zinc, magnesium, selenium, chromium, and copper with poor superoxide dismutase function, and B vitamins are deficient. Toxic metals like cadmium from smoking, nickel from stainless steel and dental braces, and aluminium from cans are often increased. Endocervical infections or prostatitis often need to be treated.2-4

It is wrong that the NICE Fertility (update) guidance summary does not mention the importance and value of preconception care. It is obvious that the nutritional and toxic metal status of both parents should be assessed biochemically and deficiencies supplemented before conception and during pregnancy for the health of the child.

It is unrealistic to believe that giving teenagers and women progestogens for years, especially progestogen containing IUDs, will not increase fertility problems - including blocking tubes, increasing endometriosis and causing biochemical perturbations.

1 Kamphuis EI, Bhattacharya S , van der Veen F, Mol BW, Templeton A, for the Evidence Based IVF Group. Are we overusing IVF? BMJ 2014;348:g252.

2 Barnes B, Grant ECG et al. Nutrition and preconception care.Lancet1985;2:1297.

3 Grant ECG. The declining health of the pill generations. J Nutr Med 1994;4:283-86.

4 Ward N. Preconceptional care and pregnancy outcome. J Nutr Med 1995;5:205-6.

Competing interests: No competing interests

01 February 2014
Ellen CG Grant
Physician and medical gynaecologist
Kingston-upon-Thames, KT2 7JU, UK