407260LBH Health Matters.indd - London Bridge Hospital

those women who have already hadbreast cancer on one side, and who,as a consequence, have a much higherrisk of developing breast cancer in theopposite breast in the future. Breastduct microendoscopy can be carriedout under a local anaesthetic, and is,surprisingly, not a painful procedure.The technology is still very new, andits place in the screening of high-riskwomen for pre-invasive malignancy isstill a few years away. Although we havebeen able to make significant advances,and in many respects still lead thefield in this exciting new development,research funding through the NHS is inreality very poor, and the developmentsare much slower than we would like.As is often the case, we may have torely on better-funded research in thebigger universities in the United Statesto carry this forward. Without significantfunding, we may still be able to make acontribution through daring innovation.Our team at Guy’s & St Thomas’ arecurrently in the final stages of adaptingour breast microendoscopy system intoa powerful microscope, that we believewill not only be able to examine thelining of the milk duct, but will be able tomagnify sufficiently to see the individualcells. This would be a world first, and anastonishing feat when you consider thatwe will be examining living tissue, wherebreast diagnosis currently only usestissue that has been removed from thebody and fixed in formalin.Breast duct microendoscopy is certainlya dramatically different new way ofexamining the breast. It has been madepossible by continued developments inmicro-optical engineering, and has beenpioneered here in London. It remainsto be seen, however, whether thistechnical innovation can be translatedinto practical ways of improving thediagnosis of pre-cancerous changes inthe breast. It is an example of just one ofthe directions in which the diagnosis andtreatment of breast cancer has improvedso much over the last twenty years.Mr Nicholas Beechey-NewmanConsultant Breast SurgeonAdvice to CouplesConcerned aboutDelays in ConceptionApproximately 1 in 8 couples will report some delay in conceiving. Thiscan lead to a great deal of anxiety and some simple advice may help toallay anxiety and help them achieve a pregnancy.Couples concerned about their fertility can be reassured that it can take up to ayear or more to conceive, and should be advised that approximately 60% of womenwill conceive within 6 months and 85% within 1 year. Investigations are thereforenormally commenced when a couple have been trying to conceive for one year ormore without success. Investigations can be considered earlier (6 months), if there arespecific reasons for concern, such as couples where the woman is 35 years or older.A history of irregular periods may suggest problems with ovulation. A history of pelvicinflammatory disease or pelvic surgery will increase the possibility of damage to thefallopian tubes and early referral for further investigations should be considered.Many couples trying for a pregnancy try to schedule sexual intercourse aroundthe time of ovulation in an attempt to maximise the possibility of conception.Timing ovulation, can be very difficult, even when using the home testing kits. In anycase, trying to time sex is rarely helpful and is not recommended, as it can lead toincreased stress. Once ovulation takes place, the egg will survive for 24 hours butsperm can survive for up to seven daysafter ejaculation. Sexual intercourse,therefore, every 2 to 3 days will optimisethe possibility of conception, without theneed to time sexual intercourse.A healthy balanced diet is importantwhen trying for a pregnancy. Womenshould be advised to take Folic Acidsupplements before conception and upto 12 weeks’ gestation to reduce therisk of neural tube defects (spina bifida).Other dietary supplements, such asmultivitamins, are of no benefit.Obesity is associated with loss of fertility and increase in pregnancy complications.Women who are underweight, Body Mass Index (BMI) of less than 19 may alsoexperience difficulty in conceiving. Ideally, women planning a pregnancy should have aBMI that is in the normal range (20-25).Couples trying for a pregnancy should be advised on lifestyle. Excessive alcoholconsumption in men is known to affect sperm quality. The effects on female fertilityare less clear, but excess alcohol consumption is harmful to the fetus and womentrying to conceive are advised to drink in moderation and avoid binge drinking.Drugs, such as marijuana and cocaine, can adversely affect fertility in both men andwomen and should be avoided. Some prescription drugs can also affect fertility orhave adverse effects in pregnancy, and further advice should be sought from theprescribing doctor.There is an association between smoking and reduced fertility in women. Smokingcan have a negative effect on sperm quality, therefore, both males and females shouldbe advised that giving up smoking may help increase the likelihood of achieving apregnancy, as well as improving their general health.Women trying to conceive should ensure that their cervical smears areup-to-date, not because abnormal smears are associated with infertility, but becausethe treatment of abnormal smears is usually delayed if the woman is pregnant.Couples concerned about their fertility should be reassured that the majority will besuccessful by 12 months. However, if they are unsuccessful they should be referred forspecialist investigation.Mr Michael SavvasConsultant Gynaecologist“Couples concerned abouttheir fertility should bereassured that the majoritywill be successful by12 months. However, ifthey are unsuccessful theyshould be referred forspecialist investigation.”Infertility7