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New conceptions on issues of fertility

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VOL: 96, ISSUE: 50, PAGE NO: 40

Evelyn Thomson, RGN, SCM, BSc, is maternity outpatients coordinator at Falkirk Royal Infirmary, Stirlingshire

Research suggests that consuming as little as five units of alcohol a week can reduce female fertility by half (Hakim et al, 1998) and with the recommended daily alcohol intake for women limited to 2-3 units, the influence of alcohol may be significant.

Research suggests that consuming as little as five units of alcohol a week can reduce female fertility by half (Hakim et al, 1998) and with the recommended daily alcohol intake for women limited to 2-3 units, the influence of alcohol may be significant.

However, there is a suggestion that alcohol only has an adverse effect on fertility when combined with other lifestyle factors, such as smoking, drinking coffee and experiencing stress (Meerabeau and Denton, 1995).

Background
From the ancient Greeks to modern times, there have been conflicting views on what impact alcohol has on a woman's gynaecology, fertility and pregnancy.

In 498 BC, the patriarchal society of the ancient Greeks awarded more wine and beer to women breast-feeding their male children because they thought it would produce stronger men.

Celts in the 11th century used strong wine to treat menstrual disorders, such as oligomenorrhoea and dysmenorrhoea.

But in Roman times a different view prevailed. Producing strong healthy children was the most important function of Spartan women, and society forbade the consumption of alcohol among women of child-bearing age.

At the beginning of the 21st century, the reasons for and treatment of infertility continue to be an important issue in developed countries.

Appleton (1999) suggests that in the UK between 5% and 9% of couples of child-bearing age will be unable to conceive within two years of unprotected intercourse.

There may be a physiological reason for this, such as polycystic ovarian syndrome or tubal disease in women and azoospermia in men. But there are still many couples for whom there is no explanation.

Around a quarter of couples who attend for assisted conception in this country will be diagnosed with unexplained infertility. If these couples cannot fund their own treatment, they might be on the NHS waiting list for four years before they are considered for assisted conception.

Alcohol and women
Many studies have been carried out to establish the physiological effects of alcohol in genera l and on women in particular (Grodstein et al, 1994; Jensen et al, 1999; Bradley et al, 1998).

They suggest that women appear to develop many alcohol-related medical problems at much lower levels of consumption than men.

Alcohol is distributed throughout the body water, so most tissues, including the heart, brain and muscle, are exposed to the same concentrations as in blood.

Very little alcohol enters fat because of its poor blood supply and that is why women, who have more subcutaneous fat and a smaller blood volume than men, appear to achieve higher blood and tissue concentrations. Alcohol may exacerbate existing gynaecological problems, such as polycystic ovarian syndrome, because of the high calorie content of alcohol and related high body mass index often seen in the condition.

Hyperinsulinaemia can often be seen in women with polycystic ovaries and these women tend to be overweight.

Drinking alcohol in pregnancy is recognised as having a detrimental effect on the developing foetus. A baby with foetal alcohol syndrome will present with symptoms which may include a low birth weight, below-average intelligence and distinct facial features (McConville, 1995).

Lifestyle influences
The suggestion that alcohol alone is responsible for fertility problems in women is disputed by many researchers (Meerabeau and Denton, 1995; Curtis et al, 1997). They conclude that with many women delaying conception until their mid-30s, lifestyle also has a significant part to play in infertility.

McConville (1995) cites Foresight - an organisation which promotes preconceptual care - which claims social 'poisons', such as tobacco, drugs, poor nutrition, environmental pollutants and alcohol, can make problems worse.

For many women, it is easily possible to consume a couple of units of alcohol a day (two glasses of wine).

This level of consumption does not indicate that they have an alcohol problem but it may, along with other lifestyle factors, have a negative impact on fertility.

Conclusion
Significant evidence is available to support the view that drinking alcohol undermines a woman's fertility. But the suggestion that alcohol on its own has a negative effect is not supported by some studies. Lifestyle influences, such as tobacco, drugs, caffeine and alcohol, can be contributory factors.

Olatunbosun et al (1997) suggest that many couples seeking medical intervention for conceptual problems disregard their lifestyle as having an adverse effect on their fertility. There is clearly a need for health professionals to appreciate the importance of health promotion in managing infertility.

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