197 General discussion and future perspectives 9 reference population of infertile women (13). The patients from our study additionally reported an increase in stress due to the delay in treatment. Only a third of the infertile patients (30.3%) declared to be able to cope with the change in availability of healthcare during the pandemic, whereas over half (51.9%) of the patients with endometriosis were able to cope. The endometriosis patients showed less detrimental effects and signs of the COVID-19 pandemic to their endometriosis-related health. ‘Only’ 35.9% of the endometriosis patients reported to experience an increase in emotional stress due to treatment delay, compared to 76.6% of the infertility patients that experienced an increase in stress. Of the 33.1% of endometriosis patients that noticed a change in their endometriosis related complaints, 81.7% reported an increase of symptoms. In terms of quality of care for endometriosis patients, the same aspects were imported to them as in a pre-pandemic cohort (14). Patients reported that they preferred the telephone appointments that were used during the lockdown as an addition to regular care, but they did not consider them as a good replacement of physical visits to the outpatient clinic. Figure 2 summarizes the impact of COVID-19. Figure 2. Effects of COVID-19 IMPACT OF COVID-19 Infertility: Quality of life Psychological stress Endometriosis: Quality of life Psychological stress = = The most important outcomes of the study on the effects of COVID-19 for infertility and endometriosis patients are inserted in the image from chapter 1. Comparison to current literature & future perspectives A. HSG: a diagnostic procedure with therapeutic effect A replication of the H2Oil study (2) was recently performed in China (1). At 6 months follow-up the ongoing pregnancy rate was 29.1% in the group that had received oil-based contrast versus 20.1% in the water-based contrast group (RR 1.44, 95% CI 1.15 to 1.81, p=0.001), confirming the results previously found regarding ongoing pregnancy rates in the H2Oil study (2).
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