Tag Archives: Pregnancy


imageAs a GP I regularly see young women who are anxious about not getting pregnant and if they have been trying for 12-18 months or sooner if over the age of 36yrs, despite having regular unprotected sex we consider that they may be infertile and need further investigation.
Around one in seven couples may have difficulty conceiving. This is approximately 3.5 million people in the UK.
About 84% of couples will conceive naturally within one year if they have regular unprotected sex.
For every 100 couples trying to conceive naturally:
84 will conceive within one year
92 will conceive within two years
93 will conceive within three years
For couples who have been trying to conceive for more than three years without success, the likelihood of pregnancy occurring within the next year is 25% or less.

There may be physical problems or often they are not conceiving due to a stressful, unhealthy lifestyle or for no apparent reason, which infact amounts to 15% of women. Hence, my first bit of advice is to advise a couple to have some quality time together and forget about babies and not infrequently within a couple of months they report back with a positive pregnancy test! One couple having been trying to conceive for several years and were due to go to India I suggested they forgot babies but to make sure they visited the Taj Mahal and looked into each other’s eyes. Needless to say 9 months later they were blessed with a beautiful son. I have watched some of these babies grow up and I couldn’t help but smile to myself when several of these, now grown up babies have approached me to do a work experience or help with their application to university or even medical school!  (recruiting preconception- has Jeremy Hunt heard about that!)

Moreover, over the decades, the availability of treatment and the type of women receiving it has changed dramatically. Dr Robert Forman worked with the British doctors who “created” Louise Brown, and is now medical director of the CRM Care London clinic, part of the country’s biggest fertility company, with seven “branches” in the UK and Ireland. Care now performs more than 7,000 cycles of treatment a year and boasts success rates of up to 50 per cent. When IVF started, it was purely for women with blocked fallopian tubes,” says Dr Forman. “One of the biggest changes over the years is that we are now increasingly treating people who are not technically infertile. It is single women who are opting for egg freezing or donor insemination, gay couples coming for treatment, as well as those who can conceive but have genetic testing of embryos, for instance, to screen out cystic fibrosis if they know they are carriers of that gene.” Recently we were delighted to facilitate a referral of a gay couple for successful IVF and for this family to be part of our practice and there are others in different situations who now feel confident to ask for support in preparing to conceive and then have their antenatal care within the practice.


However, infertility has become an industry and very costly to couples who take the route of IVF when in some cases a simple alternative could solve the problem. The NHS alone doesn’t carry all this demand: it only funds 41% of the IVF cycles in England and Wales, with more than half of people paying to sort out the problem for themselves – or at least trying to sort it out. We as GPs try to do as much before referral to avoid unnecessary IVF. As I read in one article about infertility,  “If you’re having sex three times a week, you have a much greater chance of success, rather than just waiting for that ovulation window. We need to talk about these things as well as IVF.” It would be useful to read the article on infertility in NHS choices website prior to consulting your GP before rushing off to ask for IVF independently.

Age-based infertility (rather than infertility that would exist regardless of age) is on the increase because it’s more socially acceptable, and indeed more possible, to delay motherhood than it was 30 years ago. This isn’t scaremongering, it is fact. Now they have recourse to a solution; but IVF is expensive and requires an average of four cycles to work – at roughly £5,000 a cycle, if it’s on the NHS – and the more that women “delay” their childbearing years (whether by design, accident or life circumstance), the heavier the demand for IVF. It was recently written in the press that schools are advising girls not to leave it ‘too late’ to have a baby.

Having conceived pregnancy is not always straight forward and employers are not always sympathetic  and women are expected to continue and cope with all that comes their way. There are many questions to be asked as women prepare to enter this new world of motherhood.

Eventually, the precious baby arrives but more and more mothers are isolated with no grandmother or extended family nearby to advise them how to deal with the numerous problems of caring for a baby ensue. We frequently see mothers in surgery coming to ask us for advice, which we are happy to help but attending a surgery or urgent care centre alongside ill patients is not ideal for a new mother and baby let alone being inconvenient for both. Hence, when Diana Hill an award-winning BBC science documentary film-maker.attended one of our Multi-Disciplinary Group meetings to talk about her company, “The Essential Parent Company” which she created with  Dr Rebecca Chicot a Cambridge PhD in Child Development and Parenting I felt it was an excellent resource to share with patients especially new mothers.

For a limited period of time there will be free access and if those viewing the videos give favourable comments there is a chance this may continue.


Professor Robert Winston, a pioneer of fertility and reproductive health pioneer has been a key advisor and provides expert information in maximising the chances of getting pregnant

With expert team of obstetricians, midwives, antenatal dietitiants and antenatal health experts The Essential Parent Company brings the most trusted advice to help you have a healthy and happy pregnancy, labour and birth.


With expert partners The Royal College of Paediatrics and Child Health, UNICEF UK Baby Friendly as well as midwives, paediatricians, sleep experts, paediatric dietitians, development psychologists and The Essential Parent Company present trusted video demos and advice to help have a safe, happy and healthy baby. With advice on feeding, sleeping, crying and everyday care and health they aspire to give a one stop hub for warm, expert advice.




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Posted by on October 18, 2015 in Training and Advice


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100 days of coughing after a 100 years

Eight months ago I wrote my 100th blog about a lady who had become a centenarian and how we had celebrated her birthday and since then she has followed my blogs and I have even introduced her to TED talks which she finds most interesting!

The telephone went yesterday to inform me that she was in hospital with what in some countries is known as
the 100 days’ cough or cough of 100 days.

The red dots are Bordatella pertussis bacteria, the cause of whooping cough.

We know it as whooping cough, or Pertussis..It is a highly contagious bacterial disease caused by Bordetella pertussis.

Although, in isolation and distressed by the severe coughing fits, which often produce the namesake high-pitched “whoop” sound when air is inhaled after coughing she has been in good spirits and no doubt full of questions due to her interminable curiosity.

What causes whooping cough

The bacterium infects the lining of the airways, mainly the windpipe (trachea) and the two airways that branch off from it to the lungs (the bronchi).
When the Bordetella pertussis bacterium comes into contact with the lining of these airways, it multiplies and causes a build-up of thick mucus. It is the mucus that causes the intense bouts of coughing as your body tries to expel it.
The bacterium also causes the airways to swell up, making them narrower than usual. As a result, breathing is made difficult, which causes the ‘whoop’ sound as you gasp for breath after a bout of coughing.

How whooping cough spreads

People with whooping cough are infectious from six days after exposure to the bacterium to three weeks after the ‘whooping’ cough begins.
The Bordetella pertussis bacterium is carried in droplets of moisture in the air. When someone with whooping cough sneezes or coughs, they propel hundreds of infected droplets into the air. If the droplets are breathed in by someone else, the bacterium will infect their airways.
This is why it is highly contagious. I remember in 1979 I was working as a paediatric doctor and there had been a whooping cough vaccination scare resulting in a sharp increase in cases. It was pitiful to see the numerous admissions of babies and young children with distressing bouts of coughing. It is clear how when a vaccination is introduced how the incidence of the disease falls so rapidly but rises again if vaccination uptake declines.
Whooping cough.

If whooping cough is diagnosed during the first three weeks (21 days) of infection, a course of antibiotics may be prescribed. This is to prevent the infection being passed on to others.
It is important to take steps to avoid spreading the infection to others, particularly babies under six months of age.
Children with whooping cough should be kept away from school or nursery for five days from the time they start taking a prescribed course of antibiotics. The same advice applies to adults returning to work.
As a precaution, household members of someone with whooping cough may also be given antibiotics and a booster shot of the vaccine.
Antibiotics will not usually be prescribed in cases where whooping cough is not diagnosed until the later stages of infection (2-3 weeks after the onset of symptoms).
By this time, the Bordetella pertussis bacterium will have gone so you will no longer be infectious. It is also very unlikely that antibiotics will improve your symptoms at this stage.

Children are vaccinated against whooping cough with the 5-in-1 vaccine at two, three and four months of age, and again with the 4-in-1 pre-school booster before starting school at the age of about three years and four months.

Vaccination in pregnancy
In the UK, all pregnant women are offered vaccination against whooping cough when they are 28-38 weeks pregnant. Getting vaccinated while you’re pregnant could help to protect your baby from developing whooping cough in its first few weeks of life.

The immunity you get from the vaccine will pass to your baby through the placenta and provide passive protection for them until they are old enough to be routinely vaccinated against whooping cough at two months old.

Is the whooping cough vaccine safe in pregnancy?
It’s understandable that you might have concerns about the safety of having a vaccine during pregnancy, but there’s no evidence to suggest that the whooping cough vaccine is unsafe for you or your unborn baby.

Pertussis-containing vaccine has been used routinely in pregnant women since October 2012 and its safety has been carefully monitored by the Medicines and Healthcare Products Regulatory Agency (MHRA). The MHRA’s study of nearly 20,000 vaccinated women found no evidence of risks to pregnancy or babies.
To date, 50-60% of eligible pregnant women (over half a million) have received the whooping cough vaccine with no safety concerns being identified in the baby or mother.
Vaccination against whooping cough in pregnancy is also routinely recommended in the US and New Zealand.
The pregnancy vaccination programme has been very effective in protecting babies until they can have their first vaccine when they are two months old.
During 2012, 14 babies died from whooping cough, all of whom were born before the vaccination in pregnancy programme was introduced, and developed whooping cough before they could be vaccinated themselves. The number of infant deaths from whooping cough fell to three in 2013 – all three babies were too young to have been vaccinated themselves and none of their mothers had been vaccinated in pregnancy.

Further questions can be answered using the following link:-


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