Essential Fertility Tests: Should You Consider Hysterosalpingography?

Infertility examination items?

Hello Dr.
Tsao, I would like to inquire about preparing for pregnancy.
I have already had blood tests for ovarian function, progesterone, and other relevant tests, all of which are normal.
I have also been taking ovulation medication for two months and have been tracking my basal body temperature for four months, but I have not yet conceived.
Should I undergo a hysterosalpingography (HSG), or are there other infertility tests that I should consider?

A Dian, 20~29 year old female. Ask Date: 2015/09/13

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, if your hormone levels are normal and ovulation is regular but you have not become pregnant, it is recommended to undergo a hysterosalpingogram (HSG) and semen analysis if you have not conceived after one year.
This will help identify any potential issues.
Wishing you good health.

Reply Date: 2015/09/13

More Info

When considering fertility evaluations, especially after several months of trying to conceive without success, it is essential to explore various diagnostic options to identify any underlying issues. Hysterosalpingography (HSG) is one such test that can provide valuable insights into the health of the reproductive system.

HSG is a radiologic procedure that involves injecting a contrast dye into the uterine cavity and fallopian tubes. This allows for the visualization of the uterine structure and the patency (openness) of the fallopian tubes via X-ray imaging. The test can help identify abnormalities such as blockages, which could prevent sperm from reaching the egg or hinder implantation of a fertilized egg. Additionally, HSG can reveal uterine abnormalities like fibroids or polyps that may affect fertility.

Given your situation, where you have already undergone blood tests to assess ovarian function and have been taking ovulation medications without success, an HSG could be a logical next step. It is particularly recommended if there is any suspicion of tubal factor infertility, which accounts for a significant percentage of infertility cases. If the fallopian tubes are blocked, it could explain the difficulty in achieving pregnancy despite normal ovarian function.

In addition to HSG, there are other fertility assessments you might consider. These include:
1. Transvaginal Ultrasound: This imaging test can help evaluate the ovaries and uterus for any structural abnormalities, such as cysts, fibroids, or polyps.

2. Semen Analysis: If not already done, a comprehensive semen analysis for your partner is crucial. This test assesses sperm count, motility, morphology, and overall semen quality, which are vital for conception.

3. Hormonal Testing: While you have already had some hormonal evaluations, it may be beneficial to ensure that all relevant hormones are assessed, including progesterone, estrogen, and thyroid hormones, as imbalances can affect fertility.

4. Laparoscopy: In some cases, a minimally invasive surgical procedure may be recommended to directly visualize the reproductive organs and diagnose conditions like endometriosis or pelvic adhesions that could impact fertility.

5. Ovulation Monitoring: If you haven't already, tracking ovulation through methods such as ovulation predictor kits or basal body temperature charting can provide additional insights into your fertility cycle.

In summary, considering an HSG is a reasonable step in your fertility evaluation process, especially after several months of unsuccessful attempts to conceive. It can help identify any anatomical issues that may be contributing to infertility. Additionally, collaborating with a fertility specialist to explore other diagnostic tests will provide a comprehensive understanding of your reproductive health and guide you toward the most effective treatment options. Remember, fertility assessments can be complex, and it is essential to have open discussions with your healthcare provider to tailor the approach to your specific situation.

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