196 Chapter 9 The important aspects of tubal patency testing and the answers that this thesis provides are summerized in Figure 1. Figure 1. Aspects of tubal patency testing Diagnostic qualities HSG vs HyFoSy vs THL vs MR-HSG — will follow Up to 2 years after HSG Advanced age, high risk & ovulatory disorders will follow Therapeutic qualities VR does not reduce discomfort Comfort Safety Oil-based contrast is safe on short term Zooming in on the figure from the introduction, visualizing the route that infertile couples take in their wish to conceive, we highlight the most important aspects of tubal patency testing. With the results of the articles presented in this thesis we can conclude that the therapeutic effect of oil-based contrast is present up to two years after HSG, that oil-based contrast during HSG is safe, and that VR is not effective at reducing discomfort during HSG. We have yet to investigate the diagnostic qualities of HSG in comparison to other visual tubal patency tests, and the effect of oil-based contrast during HSG in women with other types of infertility than idiopathic subfertility or subfertility based on mild male factor. D. COVID-19 and infertility Coronavirus Disease 2019 (COVID-19) reached the Netherlands during the course of this project at the end of February 2020 and gave rise to the shutdown of all non-essential health care in March 2020. This led to the temporary closure of all outpatient clinics for infertility and endometriosis in the Netherlands for a period of 3 months. During this time, many clinics tried to set up some form of eHealth for their patients to be able to help at least some of them. This gave rise to the final research question addressed in this thesis: What is the impact of the treatment pause on quality of life and quality of care of patients with infertility or endometriosis in the Netherlands, and how do they rate eHealth? In our prospective questionnaire-based study in Chapter 8 we observed that patients facing infertility scored lower in terms of quality of life when compared to a Dutch
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