October 28, 2017

expert reaction to conference abstract (unpublished work) on red wine and ovarian reserve

An abstract presented at the American Society for Reproductive Medicine investigates whether alcohol intake impacts ovarian reserve.

Prof David Spiegelhalter, Winton Professor for the Public Understanding of Risk, University of Cambridge, said:

“This is absurd – a weak conference abstract based on 135 women with a ‘trend towards significance’.”

Dr Channa Jayasena, member of the Society for Endocrinology, Clinical Senior Lecturer at Imperial College London & Consultant in Reproductive Endocrinology at Hammersmith Hospital, said:

“There is a lot of interest in whether anti-oxidants could improve fertility in men and women.  It is tempting to tell women to rush out and drink red wine, which contains anti-oxidants, but this study does not support that.  The authors found that women who drink red wine are not statistically more likely to have a better ovarian function.  Instead, the only factor found to do this was, unsurprisingly, age of the women who took part in the study.”

Prof. Simon Fishel, Founder and President, CARE Fertility, said:

“There is not enough information presented here to be at all sure that the reported findings are conclusive.  We can’t tell whether this research is of a high quality or not, or whether the data is solid.  From the very limited data presented, it doesn’t look like confounding factors were taken into account at all adequately.  What we need is a full study in the form of a peer-reviewed, published paper – this is not that.  This abstract does not allow us to draw any conclusions about alcohol and ovarian reserves.”

Dr Ali Abbara, Senior Clinical Lecturer in Endocrinology at Imperial College London, and member of the Society for Endocrinology, said:

“Although this is an interesting abstract, it is difficult to ascertain whether red wine causes any change in ovarian reserve based on the study design.  It would be difficult to reach any conclusions until a study is carried out to assess whether measures of ovarian reserve change over time, following either drinking red wine or a similar drink that looks and tastes like wine, but without the resveratrol that the authors propose could be responsible for this observation.”

Dr Raj Mathur, member of the British Fertility Society, Consultant Gynaecologist at St Mary’s Hospital, Manchester, and Honorary Senior Lecturer at the University of Manchester, said:

“This is a study on a small number of patients and it is difficult to know how strong the conclusions are.  The subjects were asked about their alcohol intake retrospectively, and we know that recall is not perfect when it comes to alcohol.  It is interesting that red wine intake was associated with a higher antral follicle count, but the effect was small and it should be kept in mind that even the women with the highest alcohol intake were drinking a maximum of 15 drinks a month, or less than 4 a week.  Hence, I do not think that we can take away a message that women should increase their alcohol intake to protect their fertility.  In such studies, there is always scope for confounding factors – for example, it could be that women who drank mainly red wine were healthier overall than those who drank other types of alcohol.  Very importantly, there is no information about smoking habits and we know that smoking is detrimental to fertility.”

Prof. Adam Balen, Chair, British Fertility Society, said:

“This is an interesting study, albeit with a small sample size which means that it doesn’t reach statistical significance.  It is an interesting idea that a small amount of red wine might be positively associated with ovarian reserve, however we have to remember that the exposure of the developing foetus to alcohol may cause irreversible developmental damage and so alcohol consumption should be less than 6 units per week for women wishing to conceive.”

Prof. Joyce Harper, Head of Research Department of Reproductive Health, and Professor in Human Genetics and Embryology, Institute for Women’s Health, UCL, said:

“This is a very preliminary study that will be presented at the American Society for Reproductive Medicine (ASRM) conference in San Antonio, USA.  It is not a published paper and in its current form it is unlikely that it would be accepted for publication.  Personally I am wary about the robustness and conclusions of this research as there are several major flaws.  The first is that it is a very small study of just 135 women, which is not a large enough sample group to reach any meaningful conclusions, and is too small to take into account confounders such as ethnicity, diet, lifestyle and fertility.  The authors only took into account age and BMI.  But the biggest flaw is that there is no evidence that measuring the antral follicle count has any clinical value.  IVF clinics routinely measure antral follicle count, follicle stimulating hormone (FSH) and anti-Mullerian hormone (AMH) to check ovarian reserve so they can decide which dose of fertility drugs they should give a patient.  But there is no scientific evidence that this ovarian reserve test, the so-called ‘Fertility MOT’, can be used as a predictor of fertility potential even though there are many variations of the test being marketed to women.  This was confirmed in a study published two weeks ago by Anne Steiner and colleagues of the University of North Carolina (http://www.globalwomenconnected.com/2017/10/new-study-confirms-test-of-fertility-predictor/).  Therefore simply measuring the antral follicle count has even less clinical value.  The study that will be presented at the ASRM may lead women to wrongly believe that drinking red wine will improve their fertility.  When such a message hits the media, it can stick for a very long time.”

Prof. Martin Blomberg Jensen, Society for Endocrinology member, Senior Researcher and Group Leader at Righospitalet, Denmark, and Lecturer at Harvard University, said:

“This small study reports a positive association between intake of red wine and antral follicle count.  Unfortunately, only the abstract is available for evaluation, which hampers in depth analysis, but it is fair to say that this finding should be considered as hypothesis generating rather than used for dietary recommendations.  The main limitations are: a small cohort (135 women), the lack of power to achieve statistical significance, no establishment of dose response relationship (5 servings unlikely to be have threshold effect), and a lack of discrimination between binge drinking and moderate intake of alcohol throughout the month.  In conclusion, either red wine itself or women with a high intake of red wine are characterised by other yet unidentified factors responsible for the higher antral follicle count.  Larger studies are warranted to confirm this suggestion, preferably by supporting the finding with endocrine biomarkers such as AMH or FSH.”

* Abstract title: ‘Does alcohol intake impact ovarian reserve?’ by A. Eskew et al.

There is no paper.

Declared interests

None received