Medically assisted reproduction in the context of time

In this thesis, we focus on reproduction in the context of time. To do so, we divided time in three time frames: pre-treatment phase, treatment phase and post-treatment phase.
Chapter 2 presents a new prediction model to predict natural conception. A previously conducted cohort study including almost 5000 couples after fertility work-up was used to create a model that can be repeatedly used in the same couples. Chapter 3 provides a review of a systematic collected sample of 223 RCTs on medically assisted reproduction. We assessed whether these trials report on multiple cycles and which factors are associated with this. Chapter 4 presents the results of a retrospective matched cohort study in which we compared treatment with IUI versus no treatment in 72 couples with poor prognosis on natural conception. We report on the three year outcome of these couples. Chapter 5 reports on the three year outcome of a previously published RCT comparing immediate treatment with IUI to six months expectant management in 99 couples with isolated cervical factor subfertility. Chapter 6 reports on the three year outcome of a previously published RCT comparing immediate mobilisation to fifteen minute of immobilisation after IUI in 391 couples who had received up to three cycles. Chapter 7 addresses the problem of multiple pregnancy after ART from a broader point of view. We incorporated population statistics with ART statistics and assessed the contribution of ART multiple pregnancies on all multiple pregnancies in seven countries with differences in utilisation of ART and usage of single embryo transfer. Chapter 8 provides discussion on the findings presented in this thesis, with recommendations for further research.