Review

Get basics right first

INFERTILITY: a sympathetic approach to understanding the causes and options for treatment
Robert Winston
Vermilion, 1996, £8.99

Who better to write a book about the causes and treatments of infertility than the man who has made his name as the media ‘star’ on the subject? He lists all the available treatments and tests, and describes their current status clearly and authoritatively, although some of his definite statements, eg on the benefits of tubal surgery, are possibly statements of personal opinion.

In general, this book delivers what it promises. It is sympathetic, offering understanding advice which repeatedly acknowledges the emotional pain which accompanies infertility. Text and diagrams are comprehensible to the layperson. Winston does not pretend that medical science is going to deliver a solution in all cases, or that the most ‘scientific’ treatments, like IVF, are necessarily the most appropriate. He is refreshingly sceptical on the subject of IVF, urging the importance of ensuring that all appropriate and less emotionally (and financially) demanding treatments have been tried first. It is also encouraging to read someone urging patients to use the NHS where possible and not assume that private treatment will necessarily be better.

A weakness is that the book launches directly into ‘Identifying your problem’ as the first chapter. Although ‘lifestyle’ issues — weight, smoking and alcohol for male fertility; IUCD contraception, smoking and diet for female fertility – are mentioned, these are scattered references in the text. It would have been more encouraging if the book had started with chapters on ‘Promoting fertility’ and ‘What to do before seeking medical advice’.

Sensible advice on all these matters, including sexual practices, might encourage people to avoid getting into the demanding infertility system too early. My own research demonstrated the numbers of people referred for secondary care before anyone had ensured they fully understood the most basic facts of reproductive life and corrected the general failure to appreciate that regular unprotected intercourse does not immediately lead to conception for many women.

Those seeking to start families in their thirties or beyond are especially vulnerable to infertility, as Winston acknowledges honestly.

Winston emphasises the significance of emotional and psychological factors in infertility, but devotes only a fairly skimpy and superficial eight pages to this topic. He virtually ignores the contribution of counselling; not mentioning the statutory requirement for its provision. Sex also merits more detailed attention than it receives.

Like most ‘new editions’, it is not as revised as it should have been. While the medical and scientific data seem to have been brought up to date (as far as this non-medic can tell), other important areas are curiously unrevised. These criticisms aside, however, still the best available book.