ESHRE 2018: Past, present and future

The European Society of Human Reproduction and Embryology (ESHRE) was created by Robert Edwards and Jean Cohen in 1984. The focus, complexity and growth of ESHRE have shifted dramatically over its 34 years of work, growing to provide leadership in reproductive medicine a global setting. Here is a short history of how the society evolved and a map of where it is heading next. 

History

ESHRE was founded six years after the birth of Louise Brown in 1978 but only in the latter two of those years had IVF made any visible recorded progress. Ethical objections and biological challenges had thwarted groups in Europe and the USA who were keen to follow the precedent of Edwards and Steptoe. Some - such as Howard and Georgeanna Jones in the USA - pursued the false scent of oocyte retrieval from a natural cycle. It was the lack of state support in Britain that had forced Edwards and Steptoe into private practice at Bourn Hall near Cambridge.

France had welcomed its first IVF baby in 1982, by which time IVF in the country was in the hands of two state-supported groups, those of the biologist Jacques Testart and the gynaecologist Jean Cohen, based in Paris. By 1984, despite several live births, IVF was still faltering in France, with low implantation and high ectopic rates. Edwards, whom Cohen had met at IVF workshops at Bourn Hall, rang Cohen to ask if he might help his young biologists.

So Edwards visited Paris to take a look. During this stay in early 1984 he and Cohen recognised the need for a European society along the lines of the American Fertility Society, with its own agenda, annual meeting and - most importantly - its own journal. Reproductive medicine and science had so far been dominated by the American journals but now, Edwards would say, 'when so many of the advances in IVF were made in Europe, it occurred to me that we needed a European journal to serve as a forum for this work'.

The result of these discussions was an informal exploratory meeting at the 3rd World Congress of IVF in Helsinki and a more formal meeting in London where the Society was formally founded and the name ESHRE first recorded. Implicit in the name is the recognition and integration of both science and clinical medicine in reproduction.

As in the origins of IVF, the origins of ESHRE are essentially a story of Robert Edwards, and today one cannot exaggerate the energy he put into the society. His papers in ESHRE's archives in Belgium are testimony to his boundless energy and gentle persuasion, evident in a deluge of correspondence which one day in 1984 ran to 37 letters on ESHRE business. Thus, by the time of that September meeting in London Edwards himself had drafted by-laws which, with amendments at the time, are largely the constitutional arrangements of ESHRE today. Edwards himself wrote up the minutes and noted: 'It was felt that the scope should be restricted in general to the study of gametogenesis, conception, the first trimester of pregnancy, but with the inclusion of associated topics of relevance.'

Early days

There is much else besides the name, the core of the constitution and the scientific scope that endures from those earliest days. Of obvious lasting impact are the annual meetings and the ESHRE journals. But it was also clear from the outset that an open position on the ethical questions likely to face assisted reproduction were high on Edwards's agenda. Indeed, many of ESHRE's original members cited consensus on the ethics of IVF as their principal reason for joining. And today ESHRE's position papers on matters of ethics and law were among the most cited references. Many of the future developments after this point demonstrate a clear inheritance of what justifies the raison d'etre of ESHRE. 

Present day

The society now has over 7,000 members from 119 countries and the Annual Meeting in 2017, held over four days in Geneva, attracted over 10,000 participants. In 2017, of 1725 submitted scientific abstracts to the ESHRE meeting, 52 percent originated from outside Europe.

Training support and education, including position papers, guidelines, training events and certification programmes make up much of the everyday activities of ESHRE today. The overall aim is to set good practice standards and making improvement accessible to all. To this end, ESHRE's registries in European ART (assisted reproductive technology) and global PGD  have painstakingly documented cycles and outcomes on an annual basis. Furthermore, the registries set a benchmark of safety, access and performance against which national activity can be measured. The decline in multiple pregnancy rate in IVF seen over the past decade must surely owe much to the findings of ESHRE's data-monitoring in a sector which in Europe still represents more than half of global ART performance. Vigilance and moral alertness remain strong elements of continued ESHRE activity and have led to greater collaboration with major European authorities.

Journals

In 2017 ESHRE added a fourth title to its stable of journals, HROpen, an open-access journal designed for unrestricted readership. The Society's three other titles were each devised by Edwards, with the flagship Human Reproduction launched in January 1986. This, more than anyone could imagine, would fulfil those first pioneer ambitions of founding a journal in which European scientists and clinicians would find a welcome home for their work. Human Reproduction's sister review journal Human Reproduction Update would go on achieve record-breaking impact factors in the categories of obstetrics and gynaecology, and reproductive biology.

Political role

It's also clear from the society's history, and the 40-year history of IVF, that ESHRE has never been afraid to face political or scientific challenges, however uncomfortable that may be. ESHRE opposed introduction of the infamous Law 40 in Italy in 2004 (banning embryo freezing and embryo selection). More recently it supported open ART legislation in Poland. ESHRE has also been consistent - even if controversially so - in its position on new introductions and adjuvant treatments in ART, repeatedly calling for a strong evidence base before everyday application. This has most prominently been seen in a cautious approach to aneuploidy testing in embryos, where ESHRE has repeatedly doubted the strength of the evidence for any improvement in live birth rates. 

The challenges facing ESHRE today are reflected in the diversity of ART and its social, political and personal implications. Political representation remains an ESHRE priority, to make sure that the directives and positions of a political Europe recognise ESHRE's members and the professional sector they represent.   

Future challenges

The aim and philosophy of ESHRE is based on the underlying recognition that reproductive medicine is equally dependent on scientific and clinical knowledge that ultimately improves global reproductive health, identifies and addresses barriers to access to infertility care and provides an incremental uplift in public health benefits. ESHRE is a growing, open and inclusive community where any member or delegate can meet the world's leaders in human reproduction. It is particularly receptive to the ideas and activities of young researchers and clinicians. 

ESHRE has achieved a global profile and is the reference point in reproductive science and medicine with over 7 million babies born by IVF. We see international collaboration as the gateway to the future. Research, practice and education remain the solid foundations on which ESHRE has supported its past, present and more importantly, its future. In practical terms, ESHRE subsidises many courses, activities and workshops, several at a financial loss, to encourage educational improvement among its members and non-European delegates thereby improving the global healthcare of countries.

The ESHRE community reflects the diverse specialty interests of its members by the support provided by 14 Special Interest Groups (SIGs). These all have something in common: their passion for reproductive health and the understanding of human reproduction. In joint collaboration with our partner patient organisation, Fertility Europe, we undertook an audit that was launched in the European Parliament in March 2017, which addressed differing profiles of nine member states in relation to provision and funding of reproductive healthcare. Clear anomalies were highlighted and further collaboration with Fertility Europe is ongoing in support of European Fertility Week, which launched on 6 November 2017.

The ESHRE Executive Committee will have a more complex and growing agenda to deal with in the next two years. A comprehensive root-and-branch strategy meeting held over two days in May clearly identified areas for development and reconfiguration. As a result, a one-day meeting in September consolidated objectives and drew the roadmap for future direction of travel. Ongoing collaboration with our international partners will build on the shared areas of interest that will benefit from multiagency working.