Q: We have been married for 4 years. A year after marriage I got pregnant for the first time, which ended up as a missed abortion 2 years back. I again conceived and had a premature delivery due to membrane breach on completion of the 28th week. No particular reason was assigned by doctors to this. The baby (1.16 kg) did well initially in the NICU and reached up to 1.56 kg by the 35th day. But on the 35th day he developed some infection. The infection could not be contained by medicines and he died on the 42nd day. It took us a while to recover from the loss and as the doctors suggested, we began trying to conceive again. We did follicular monitoring, which showed a size of 2.1 cm on the 15th day (with Siphene 50). Thinking everything to be in order we discontinued follicular monitoring and found out that though the follicles were forming, they were not reaching the required size. Later this year, I took no medicines but had Letro for 5 days from the 2nd day of the cycle. I was again given Letroz and the follicles matured to 2.2 cm and 2.5 cm respectively. We opted for IUI both times but to no avail. An HSG has now been advised. We have also been advised to skip IUI this cycle as the dye used in HSG and the X-rays may interfere with the process. We'll be doing it on the 11th day of the cycle as I was too pressed with work on the 9th day, which was the suggestion of the doctor. Will that be OK? What are the chances that my tubes are blocked considering I've already conceived twice without any assistance? What can be done if there is some blockage of the tubes? Is the HSG procedure painful and does it require local anaesthesia?

A:HSG is a must before taking any medicines for ovulation. Sometimes the tubes can get blocked due to subclinical infection following an abortion or delivery. HSG should ideally be done as early in the cycle as possible. Please abstain from vaginal sex till your HSG is done and for at least 5 days following it. Some pain occurs when dye enters the tubes and abdomen, but not much, and it is bearable. Usually no LA is required.