Hossam Elzeiny: The Need for Clinically Relevant Studies in Fertility
Hossam Elzeiny, Fertility Specialist and Gynecologist at City Fertility, shared a post on LinkedIn:
“We are publishing more papers than ever – and learning less from them.
Meta-analyses built on weak studies and surrogate outcomes are failing our patients.
It is time to pause – and seriously rethink – how we conduct and publish research in reproductive medicine.
Meta-analyses were originally designed to increase statistical power and clarify uncertainty. Increasingly, however, they are being applied to bodies of evidence that are fundamentally flawed.
When low-quality, heterogeneous studies are pooled together, the outcome is predictable: rubbish in, rubbish out. The conclusion is almost always the same cliché – ‘due to low quality of evidence, no firm conclusions can be drawn and further studies are needed’ – and the cycle simply repeats.
Many of these analyses are performed by statisticians or epidemiologists who have never managed a patient, counselled a couple, or made real-world clinical decisions based on these data. Methodological elegance cannot compensate for clinical irrelevance.
The problem extends beyond meta-analyses:
- Male infertility intervention studies continue to be published using semen parameters as surrogate outcomes, with no reporting of the only endpoint that truly matters to patients—live birth.
- PGT-A studies frequently report live birth per embryo transfer rather than per started cycle, creating a distorted narrative that ignores attrition, cost, emotional burden, and clinical reality.
- Studies that confuse clinicians, mislead patients, and fail to inform practice are still celebrated as ‘high-quality research’.
This represents a substantial waste of time, money, effort – and, most importantly, patients’ trust.
The uncomfortable truth is that much of what we now read in top journals consists of opinion pieces, invited commentaries, and expert consensus – not because these are superior forms of evidence, but because truly robust, clinically meaningful studies are increasingly rare in our field.
Reproductive medicine does not need more statistically sophisticated noise.
It needs a research revolution – grounded in clinically relevant questions, meaningful endpoints, rigorous study design, and outcomes that matter to patients.
Until then, we should be honest about the limitations of what we publish—and courageous enough to demand better.”
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