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Is laparoscopy required to know the cause of secondary infertility?

Q: I am a 36 years old female. I have a nine years old daughter and have been trying for another child for the last two years. Two sessions of intrauterine insemination (IUI) have failed to produce any result. Last month, we decided to go for Hysterosalpingogram (HSG) and got to know that both my fallopian tubes are blocked. My doctor has asked me to take 20 injections of Placentrex (2 ml), one injection every alternate day and then to go for HSG again. Is this going to help me? Do I need to undergo laparoscopy to know the exact problem? Please help me as we are very keen on having another child.

A:Yes, if the semen is normal, then you will need to have a laparoscopy, and a transvaginal ultrasound to find the cause of blocked tubes. Sometimes, the block gets opened when the dye is instilled through the tubes, either at HSG or at laparoscopy. HSG has the advantage that it is cheaper, quicker and does not need hospitalisation, but has the disadvantage that you may still need the lap. The lap gives more information of all possible causes, and also offers the chance of a repair of the tubes / ovarian problems or adhesions which maybe causing the block. If there is a problem like endometriosis it can also be treated at the same sitting. The next line for treatment can be better determined after that - whether medications are needed or tubal surgery or test tube baby, depending on the cause of infertility and the extent of damage.

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