24 years of policy statements, guidelines, and policy and practice articles in Human Fertility

In the first issue of this anniversary volume, we published an historical overview of the first 24 years of Human Fertility (Pacey & Leese, 2022). In this issue (issue 2), with the help of Mark Hamilton (former Chair of the British Fertility Society (BFS), and current Chair of the BFS Board of Trustees) we turn our attention to the many Policy Statements, Guidelines, and Policy and Practice papers that have been published over the last 24 years by the various societies associated with the journal. This provides a rich insight into the history of reproductive medicine in the UK and allows us to pay tribute to the authors involved.

To collect these data, we first examined the titles, authors, and abstracts of all the papers published in the twenty-four years since Human Fertility was launched in 1998. We examined the way each of the papers was classified in the Table of Contents for each issue and, where possible, we also consulted the minutes of the BFS Executive Committee, the Editorial Board of the journal, and any other related correspondence. This led to the identification of 49 unique articles which we considered to have been published on behalf of one or more of the societies associated with the journal. These articles are summarised in Table 1.

Table 1. Policy and practice documents published in human fertility (1997–2022).

			Authorship									Impact
Year	Topic	Article Label	ABA	ACE	ARCS	BAS	BFS	BICA	RCN	Other	Reference	Views	Citations	Altmetrics
1998	Surrogacy	Original Article					✓				Balen & Hayden (1998)	90	2	0
1999	Welfare of the Child	Miscellaneous Article					✓				British Fertility Society (1999)	10	2	0
2000	Storage of Ovarian and Prepubertal Testicular Tissue	Original Article					✓				Nugent et al. (2000)	13	9	0
	NHS Fertility Services	Commentary Article					✓				British Fertility Society (2000)	18	0	0
	Screening of egg and embryo donors	Original Article					✓				Aird et al. (2000)	43	8	3
2001	In vitro maturation of oocytes consultation	Original Article					✓				Policy and Practice Sub-Committee, & Executive Committee of British Fertility Society (2001).	8	0	0
	Assisted Hatching	Original Article					✓				British Fertility Society Policy and Practice Sub-Committee (2001)	8	2	0
2002	Donor Information	Commentary Article					✓				Hunt & Fleming (2002)	35	1	0
	NHS Service Provision	Original Article					✓			✓	Shaw et al. (2002)	31	3	0
2003	Sex selection	Original Article					✓				Afnan & Hunt (2003).	20	2	0
	Sex selection	Original Article					✓				Hunt, & Afnan (2003).	30	1	0
	Safe Sedation	Original Article					✓				Elkington et al. (2003)	34	4	6
	Childhood Cancer and Fertility	Review Article					✓			✓	Multidisciplinary Working Group convened by the British Fertility Society (2003)	84	48	0
2004	Professional Conduct	Research Article		✓							The Association of Clinical Embryologists (2004)	27	1	0
2006	Sperm and embryo cryopreservation	Original					✓				Lewis et al. (2006)	20	3	0
	NICE Guidelines	Original					✓				Kennedy et al. (2006)	350	32	3
2007	Multiple Births	Original		✓			✓	✓	✓	✓	Hamilton (2007)	54	5	0
	Female obesity	Obesity and reproductive health					✓				Balen et al. (2007)	1,045	97	7
2008	Preimplantation genetic screening	Preimplantation genetic screening					✓				Anderson & Pickering (2008)	206	48	9
	Elective single embryo transfer	BFS Policy and Practice Issues		✓			✓				Cutting et al, (2008)	969	133	3
	Sperm donor recruitment	BFS Policy and Practice Issues					✓			✓	Hamilton et al. (2008)	70	12	0
	Embryo cryopreservation	BFS Policy and Practice Issues					✓				Granne et al. (2008)	84	7	0
	Sperm, egg, and embryo donor screening	Screening of Gamete and Embryo Donors: UK Guidelines	✓	✓		✓	✓			✓	Association of Biomedical Andrologists et al. (2008)	744	27	8
2009	Medical adjuncts in IVF	Medical adjuncts in IVF					✓				Nardo et al. (2009)	468	12	0
	Oocyte cryopreservation	Oocyte		✓			✓				Cutting et al. (2009)	280	25	8
2010	Bariatric Surgery	Bariatric Surgery					✓			✓	Scholtz et al. (2010)	245	9	0
	Chlamydia screening in IVF	Chlamydia and reproduction					✓				Akande et al. (2010)	419	48	0
	Androgens and Sexuality	Invited Reviews					✓			✓	Wylie et al. (2010)	290	12	0
2011	Quality Manual	Quality Manual Abstracts		✓			✓			✓	McTavish et al. (2011)	115	0	0
	Multiple births	Multiple births		✓			✓	✓	✓	✓	Association of Clinical Embryologists et al. (2011)	188	7	3
2012	Perinatal risks of IVF	Opinion Paper – Risks of IVF					✓			✓	Vulliemoz et al. (2012)	468	14	1
	Andrology Laboratory	Guidelines	✓								Tomlinson et al. (2012)	5,517	8	2
	Embryology Laboratory	Guidelines		✓							Hughes (2012)	12,926	13	0
2013	Infertility Counselling	Research Article						✓			Crawshaw et al. (2013)	277	9	0
	Data collection in assisted reproduction	Data for ART in the UK		✓			✓				Stewart et al. (2013)	191	2	3
	Controlled ovarian hyperstimulation	Ovarian Hyperstimulation Syndrome					✓				Nardo et al. (2013)	1,045	17	1
	Ovarian hyperstimulation syndrome	Research Article					✓				Tan et al. (2013a)	420	15	0
	Ovarian hyperstimulation syndrome	Research Article					✓				Tan et al. (2013b)	428	2	2
	Sperm quality and assisted conception	Sperm Quality					✓				Tomlinson et al. (2013)	872	44	2
	'Ovulation induction in WHO Type 1 anovulation	Ovulation Induction					✓				Yasmin et al. (2013)	785	17	0
2014	Family building with donated gametes and embryos	Gamete and Embryo Donation		✓			✓	✓	✓		Wilde et al. (2014)	743	7	1
	Prevention of ovarian hyperstimulation syndrome	Policy and Practice					✓				Mathur & Tan (2014)	609	18	6
2015	Adjuvants in IVF	Adjuvants in IVF					✓				Nardo et al. (2015)	1,856	29	10
	Choosing the 'best' embryo	Commentary		✓			✓				Bolton et al. (2015)	1,290	22	2
	Elective single embryo transfer	Policy and Practice		✓			✓				Harbottle et al. (2015)	7,266	40	11
2018	Female fertility preservation	Policy and Practice					✓				Yasmin et al. (2018)	3,424	6	47
2020	Sedation in assisted conception	Policy and Practice					✓				Acharya et al. (2020)	243	3	0
2021	Screening of sperm, egg, and embryo donors	Policy and Practice	✓	✓		✓	✓				Clarke et al. (2021)	2,386	5	19
2022	Varicocele treatment and fertility outcomes	Policy and Practice					✓			✓	Maheshwari et al. (2020)	191	0	10

Key: ABA = Association of Biomedical Andrologists; ACE = Association of Clinical Embryologists; ARCS = Association of Reproductive and Clinical Scientists; BAS = British Andrology Society; BFS = British Fertility Society; BICA = British Infertility Counselling Association; RCN = Royal College of Nursing Fertility Nursing Forum.

Given that the BFS owns the copyright of the journal, it is not surprising that most of the papers had been published with the BFS as the major contributor. However, over the 24 years it is noticeable that article style and presentation has changed considerably. For example, in the early years (1998–2003) most of the papers were published directly by, or on behalf of, the BFS only. Some were published in the names of the primary authors (e.g. Balen and Hayden, 1998) whereas for others the author was the BFS itself (e.g. British Fertility Society, 1999). For some papers, it was clear from the title that the paper had the approval of the BFS (e.g. ‘BFS recommendations for good practice on the storage of ovarian and prepubertal testicular tissue’ by Nugent et al. (2000)) and in others the title was less helpful (e.g. ‘Department of Health donor information consultation: providing information about gamete or embryo donors’ by Hunt and Fleming (2002)). In examples such as this it was only after reading the article that it became clear that the publication was in fact official BFS policy. We must therefore issue a caveat that the list of papers shown in Table 1 is only as accurate as it was possible to be by reviewing titles, authors, and abstracts. We cannot exclude the possibility that we may have missed some relevant policy papers, though we feel this is unlikely.

After 2003, the authorship of society papers published in the journal shifted and they started to become visibly more collaborative. This began with the publication of ‘A strategy for fertility services for survivors of childhood cancer’ which was published by a Multidisciplinary Working Group convened by the British Fertility Society (2003), although the working party was convened and chaired under the auspices of the BFS. This was followed by a consensus statement on multiple births (Hamilton, 2007) which involved 8 professional organisations and 11 patient organisations, although again these were not listed as formal authors in the journal. By 2008 the paper on elective single embryo transfer signalled a new style of collaboration as both the BFS and the Association of Clinical Embryologists (ACE) were listed as authors, alongside the individuals who pulled the paper together (Cutting et al., 2008). These arrangements, where applicable, have continued ever since, with further collaborative papers including the 2008 guidelines on the screening of sperm, egg and embryo donors being published on behalf of five organisations (Association of Biomedical Andrologists et al., 2008) and the 2019 paper on oocyte cryopreservation (Cutting et al., 2008) which was produced on behalf of ACE and the BFS.

Interestingly, although collaborative papers between the various societies associated with the journal have become more common, we have been unable to identify any examples over the past 24 years involving the Irish Association of Clinical Embryologists (ICE) or the Irish Fertility Society (IFS). There have also been none published by, or in collaboration with, the Association of Reproductive and Clinical Scientists (ARCS), although this is perhaps to be expected given it was only established in 2020 (Kasraie et al., 2020). It is noteworthy that the journal has also published guidelines on behalf of other organisations (e.g. German guidelines for psychosocial counselling in the area of gamete donation by Thorn and Wischmann (2009)), even though there was no formal relationship between the BFS and the professional body which produced them (Infertility Counselling Network Germany).

The data shown in Table 1 also include information on the number of views, citations and the Altmetrics; a measure of the attention a paper receives on social media, on-line news media and other non-traditional bibliometrics, (correct as of 15^th May 2022). We have included this to see if it was possible to identify any markers of success to determine a paper’s popularity or impact. Based wholly on ‘views’, the laboratory guidelines published in 2012 by ACE (Hughes, 2012) and the ABA (Tomlinson et al., 2012) have collectively been the most popular with 12,926 and 5,517 unique views respectively. Similarly, the Policy and Practice paper by Harbottle et al. (2015), which describes UK best practice guidelines on elective single embryo transfer, has 7,266 views. In terms of citations, arguably the best marker of academic impact, it is the paper by Cutting et al. (2008) on guidelines for elective single embryo transfer which, at 133 to date, has had the highest number. Because citations can only increase over time, there may be papers which have been published more recently which will ultimately achieve a greater impact. We have not made any attempt to adjust citation numbers for time since publication, and so this will be for future editors to determine. Finally, in terms of Altmetrics, these show that the paper by Yasmin et al. (2018) on guidelines for female fertility preservation has, to date, yielded the highest altmetrics score at 47. However, we should be careful about over-interpreting this finding since Altmetrics only became established around 2010 and so papers published before this time are unlikely to receive an accurate score, if at all.

Of course, in this editorial, we do not claim that the 49 papers listed in Table 1 represent the totality of the societies’ work in setting policy, guidelines and policy and practice papers over the last 24 years. We are aware that some formal papers produced by various Executive Committees may have been published elsewhere. For example, in the early days of the journal, the BFS itself chose to publish some of its responses to Department of Health and/or Human Fertilisation and Embryology Authority consultations (e.g. British Fertility Society, 1999; Policy and Practice Sub-Committee, & Executive Committee of British Fertility Society, 2001), whereas in recent years these have been published on-line on the society website. Given the pressure of space in Human Fertility this is now wholly appropriate, but an absence of journal placed publication could erroneously give scholars and historians the view that responses of societies and professional bodies to public consultations are now less valuable. This is not the case. Moreover, the change in fashion/approach by the journal to providing subheadings to categorise published contributions has made it harder for us to be confident that we have identified all relevant papers accurately. It is only recently that Human Fertility has consistently used the ‘policy and practice’ label while many papers which would be classified in this way now, were actually published as original articles, commentaries or even under a miscellaneous label.

Finally, in reviewing the list of 49 articles summarised in Table 1, it is useful to consider their breadth and scope within reproductive medicine. An obvious conclusion is that relatively few of the papers over the past 24 years have focussed on male infertility, notwithstanding that some topics such as choosing the best embryo (Bolton et al., 2015), or infertility counselling (Crawshaw et al., 2013) are gender neutral endeavours. Nevertheless, it is sobering to note that only two articles have focussed exclusively on issues of male reproduction: (i) a paper in 2013 on semen quality and its relationship to natural pregnancy and assisted reproduction (Tomlinson et al., 2013); and (ii) a new paper in this volume on varicocele treatment and fertility outcomes (Maheshwari et al., 2020). Disappointingly, this is not unusual in reproductive medicine (see Barratt et al., 2021, for a discussion), but by highlighting the issue here we hope this will provide impetus for the various societies associated with Human Fertility to attempt to address the imbalance when commissioning new pieces of work.

In conclusion, we hope that this editorial will serve as a useful overview of the Policy Statements, Guidelines, and Policy and Practice papers that have been published in Human Fertility since 1998. Much fine work has been carried out, and if nothing else, we hope this editorial will serve as a useful compendium of what has been published and celebrate the major influence on policy and policymakers across a wide range of important topics which the BFS and associated societies have had in the last quarter century.

Disclosure statement

No potential conflict of interest was reported by the author(s).