Fewer randomized controlled trials in fertility and gynecology field: why is this happening?

Article type
Authors
Glujovsky D1, Ciapponi A1
1IECS - Instituto de Efectividad ClĂ­nica y Sanitaria, Argentina
Abstract
Background: Although randomized controlled trials (RCTs) are at the top of the pyramid of evidence-based medicine, this type of study does not constitute the majority of publications. In particular, there are some specialties that, due to the type of interventions or the characteristics of the disease, have a lower proportion of RCTs than others. In 2012, our group published a study showing that less than 7% of the studies published in the top fertility journals were RCTs. We wanted to see if we could find any trending in terms of improving or decreasing the proportion of published RCTs.
Objectives: Firstly, to analyze the absolute numbers and proportion of randomized controlled trials (RCTs) and systematic reviews (SRs) published in the last 10 years in the top five journals that published clinical studies about fertility. Secondly, to interview the editors of these journals to evaluate the potential causes of the observed changes.
Methods: We selected the five journals with the highest impact factors that publish clinical trials about infertility. We performed a search in March 2015 on PubMed, identifying the RCTs and SRs published between 2005 and 2014, and analysed whether there was any change in the last decade in the publication of these type of studies. To make a comparison, we also evaluated the number of RCTs and SRs that were published in PubMed in all medical fields. Finally, we wrote an email to the editors of the five journals to ask them about the potential reasons for the observed changes.
Results: We found that in the last ten years there was a clear trend to publish fewer RCTs, with 7.7% in 2005, 7.1% in 2009, 6.2% in 2011 and 4.9% in 2013 (see Figures). However, when we looked at the same type of studies in the whole medical field, the proportion of RCTs had not changed. Regarding the SRs, an increase was seen in the last decade (similar to other fields), from 2.5% in 2005 to 6.1% in 2013. Editors' opinions will be reported at the Colloquium.
Conclusions: A decrease in RCTs but not in SRs has been shown for the last decade. We are going to evaluate the potential reasons for this and suggest potential interventions to improve it.