What's Going On?

Question:

We've already had a baby, he's over three now, and we've been trying for more than a year to conceive again. Since we've already had a successful pregnancy, and both of us have been tested and everything is normal, we want to know what to do now.

Secondary Infertility

Secondary infertility is not as uncommon as some may think. It can not only be very perplexing, but has the potential to create high levels of emotions for both you and your partner as you wonder what has happened.

Knowing that you are ovulatory, that is you have regular cycles, your OPK test is positive and your progesterone level is normal, are good signs. The OPK test looks for luteinizing hormone (LH) which surges just prior to ovulation and rises to a higher level. The surge can be pinpointed with an OPK. And, since your husband's semen analysis is normal as well, the cause may be ferreted out through the use of a couple of different tests.

What's an HSG?

There are times when a mucus plug can form in the tubes and this hinders the sperm from reaching the egg. A hysterosalpingogram (HSG) can push the plug out and open the tubes. During a HSG, a dye is put through a thin tube which is inserted into the uterus through the vagina. Since the fallopian tubes are connected to the uterus, the dye will naturally flow into the tubes. While the dye is running, an x-ray is being taken showing the flow of the dye and this will reveal any blockages, damage to the fallopian tubes, perhaps caused by infection, or abnormalities in the tubes. A blockage not only prevents the sperm from getting to the egg, conversely it can prevent the egg from moving through the fallopian tube to the uterus after it is fertilized.

What an HSG Can Accomplish

An HSG is also used to locate and identify uterine problems such as abnormally shaped uterus or tubes, an injury to the reproductive organs, polyps, fibroid cysts or tumors, adhesions or a foreign body in the uterus - perhaps the remnants of an IUD. Any of these things have the potential to cause very painful periods and repeated miscarriages. Finally, an HSG can be used to determine whether a tubal ligation reversal has been successful.

Laparoscopy - Taking a Closer Look

The other test you may need to have is a laparoscopy. A laparoscopy is minimally invasive and is a technique designed for abdominal surgery which is performed through a small incision, usually just below the navel. A laparoscope, a telescopic rod connected to a video camera, is put into the hole and the surgeon is able to view the pelvic cavity. This way, he is able to determine if there are pelvic abnormalities such as endometriosis and scar tissue. If you've had any pelvic surgeries or have had endometriosis, this method can help to discover if it is making you infertile.

The results of these tests can help you determine what you next step in the fertility process will be.