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endocrinology or metabolism, genetics or immunology, and some of the best cited papers were to be found in such general titles as The Lancet, New England Journal of Medicine and JAMA. Let's not forget that the landmark paper from Fauser’s own group on mild IVF turned up in The Lancet, and the much cited PGS trial of Mastenbroek et al in the NEJM. Even Devroey and Van Steirteghem sent their first announcement of an ICSI live birth to The Lancet, before reporting their subsequent studies in Human Reproduction. Can it be that the leading groups in reproductive medicine continue to save their best papers for those journals without affiliation but with high impact factors?
The evolution of keywords
The study also measured progress in the field with an analysis of keywords, and this marked a real shift of research interest in just a few years. The most important keywords with an upward trajectory - reflecting how the field in research continues to grow - involve areas such as ART (mainly IVF), pregnancy outcomes, and the future health of IVF children and mothers. ‘It is laudable,’ say the authors, ‘that interest is shifting from merely developing novel infertility interventions toward more detailed analyses of the health implications for women and their offspring.’
Indeed, just a few years before, the recurring keywords had included infertility, pregnancy, and follicle stimulating hormone, yet those FSH battles seem now consigned to history, along with their big number trials in search of marginal gains. No wonder a press release from Merck issued just before the latest Annual Meeting of ESHRE said the company was ‘going beyond drugs’ to support improvements in ART! Joining FSH (and LH) on a downward keyword spiral was ICSI, no doubt, the authors propose, explained by its upgrade to ‘accepted treatment’. PGD, they add, which might have been expected among the high rankers, has ‘suffered from insufficient randomized studies, which has diminished interest’.
Judged on keywords, the most studied illness in reproduction is PCOS, a heterogeneous condition said to affect up to 10% of all women. No doubt it is the very heterogeneity of PCOS which explains its high citation scores and reflects an increasing awareness of its associations with many other health risks beyond
reproduction. The 2003 consensus report derived from the Rotterdam ESHRE/ASRM‐sponsored PCOS workshop (the ‘Rotterdam criteria’) remains to this day the most cited article ever in Human Reproduction.
Who’s been doing it?
The most cited groups working in reproductive medicine are to be found in the Netherlands (where IVF is universally available as a fully reimbursed treatment), Belgium (also largely reimbursed), Spain, USA and UK. However, a marked and emerging trend is an increase in collaborations, both nationally and internationally, which surely reflects the difficulty of staging single-centre trials today. The number one cited country (the Netherlands) mainly featured just four major centres with strong collaborations among them; in other countries, such as Belgium and Spain, one or two centres were mainly responsible for overall national performance. Elsewhere, as in the USA or UK, many different medium-sized centres were jointly responsible for their collective impact. The number of articles published as international collaborations doubled from 2003 to 2007, while domestic collaboration grew to a lesser extent - and thus decreased the articles signed without collaboration.
The most cited institutions in reproductive medicine were found to be Erasmus University Medical Center in Rotterdam (9006 citations), followed by the University Medical Center Utrecht (7108) and the Vrije Universiteit Brussels (6846). Other centres with highly cited collaborations were the Cleveland Clinic in Ohio, the Rigshospitalet in Copenhagen, and the Saint-Luc University clinic in Brussels.
The theme of this paper is the maturity of reproductive medicine and its elevated status as reflected in the medical journals. The authors acknowledge that the roots of this scientific maturity lay in the introductions of ICSI, PGD and cryopreservation, but that such landmark developments require ‘high quality research and key publications’. The one, they suggest, cannot progress without the other. Now, in a catalogue of journals dedicated to reproductive science and medicine and dominating the fields of O&G and reproductive biology, those requirements seem at last to be fulfilled. Indeed, even the number of journals seems to be increasing, as surely is the number of studies performed and articles submitted. Fauser himself told Focus on Reproduction: ‘We no longer have to be shy.’ Moreover, with an impact factor passing for the first time into double-digits, the reproductive medicine journals can no longer be judged as merely sub- specialty journals. For they, like the discipline itself, seem now to have reached a new level of stature and of self-confidence.
Simon Brown Focus on Reproduction
1. Aleixandre-Benavent R, Simon C, Fauser BCJM. Trends in clinical reproductive medicine research: 10 years of growth. Fertil Steril 2015; 104: 131-137.
BART FAUSER: ‘WE NO LONGER HAVE TO BE SHY.’
SEPTEMBER 2015 // Focus on Reproduction 23