Thank you for the review article on GP involvement in fertility treatment (GP, 20 January). While I agree with most of what he said, I would like to add a few words about pre-conception folic acid.
Although Dr Scott Wilkes writes that women should take 400mu g folic acid from before conception to 12 weeks gestation, he does not state the length of time before conception supplement should start.
Experts agree that folic acid should be started at least six weeks before conception and that three months might be better. A survey that I carried out on 130 women in Surrey (42 undergoing assisted conception) showed that 27 per cent of women with planned natural pregnancies had not taken pre-conception folic acid. Of the remainder, only 31 per cent had taken their folic acid supplement for more than six weeks.
One participant felt she had been let down in a previous pregnancy when she was told 'Start taking folic acid when you start trying for a baby'.
She became pregnant almost immediately. The result was a spina bifida foetus and subsequent termination.
If and when we have folic acid fortification of bread and flour, there is a danger this will give patients and doctors a false sense of security.
My survey shows that even with the expected 200 mu g a day uplift in average intake of folic acid from fortification, 10-30 per cent of women with planned pregnancies will still not have an adequate folic acid intake to significantly reduce the risk of spina bifida and other neural tube defects (NTDs).
Renewed efforts by GPs to encourage pre-conception supplementation after fortification could reduce the number of NTD conceptions by as much as 50 per cent.
Dr John Nichols, Guildford, Surrey.