9 General introduction 1 Figure 1. The journey from wish to conceive to a live born child for infertile couples from left to right. IMPACT OF COVID-19 Diagnostic qualities Wish to conceive Fertility work-up Treatment Live birth Therapeutic qualities Safety Comfort Couples with a wish to conceive are labelled as ‘infertile’ after 12 months of unsuccesful trying. They can be referred for infertility work-up to diagnose the type of infertility. Depending on the infertility diagnosis, a treatment plan is proposed. The orange words depict the clinical aspects this thesis will adress. TUBAL PATENCY TESTING Tubal patency can be assessed by infusing contrast into the uterine cavity and confirming whether this contrast reaches the intra-abdominal cavity through the Fallopian tubes. Nowadays, there are many factors to take into consideration when determining the most appropriate tubal patency test for women facing infertility. This is represented in the smaller circle of figure 1. The diagnostic quality of a test, the sensitivity and specificity for diagnosing a condition with the given test, is the first factor to take into consideration. Therapeutic qualities refer to any beneficial effect or side-effect of the given test. As with any medical intervention, safety should be considered and lastly, the patient experience should be factored in as well. Different tests for the assessment of tubal patency were developed at the start of the 20th century. An early method of tubal patency test was developed by Rubin in 1919 (14). He initially inflated the uterus with oxygen, and later carbon dioxide (which reduced the risk of a gas embolus considerably due to the ability of haemoglobin to
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