New Correspondence in The Lancet Obstetrics, Gynaecology, & Women’s Health
Some ideas start in a seminar room. This one started on weekend walks around East Rock in New Haven, in long conversations about how reproductive medicine could capture value that reaches beyond a single short-term trial result.
I am glad to share our new Correspondence in The Lancet Obstetrics, Gynaecology, & Women’s Health, “Measuring what trials miss: decision modelling for value-based reproductive health” (read the article · PDF).
The argument
Randomised trials remain essential, and nothing here changes that. Our point is that many reproductive health decisions have consequences that play out over years or decades, while trials tend to follow patients for a short time and stop at a proximate endpoint such as live birth per cycle. Decision-analytic modelling can connect that short-term outcome to what patients actually live with later: longer-term maternal health, quality of life, costs, and value.
We work through cases where this matters. Frozen embryo transfer, where programmed cycles carry a higher risk of pre-eclampsia and, through it, later cardiovascular risk. Fertility preservation, where the choice between methods shapes the timing of premature menopause. Endometrioma surgery versus an IVF-first path, where focusing only on pregnancy can hide trade-offs that unfold across a lifetime. A short panel lays out four modelling approaches, from a simple decision tree to individual-based microsimulation, and where each one fits.
The hope is a shift in the question the field asks, from “which intervention improves one endpoint?” to “which strategy best improves a patient’s life course?”
Thanks
I am especially grateful to Murat Erden for including me in this work and for the many conversations that shaped it, and to Rosanne Kho and Kutluk Oktay for their insight and expertise. Looking forward to seeing more decision modelling help reproductive medicine measure what really matters to patients.
Erden M, Demiray A, Kho RM, Oktay KH. Measuring what trials miss: decision modelling for value-based reproductive health. The Lancet Obstetrics, Gynaecology, & Women's Health. 2026;2:e581–e582. https://doi.org/10.1016/S3050-5038(26)00176-7.