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There are several extra tests that doctors can use to find out more about your infertility. It's important to discuss the advantages and disadvantages of any medical procedure with your doctor.

This is an X-ray test that shows the inside of a woman's womb and fallopian tubes (the tubes run from the ovaries to the womb). It can check for blockages or growths.¹

You should not have a hysterosalpingogram if:

• You have abnormal bleeding or your last period was not normal. (This may mean you are pregnant.)
• You have a pelvic infection.
• You are taking a drug called metformin. (You must stop taking it before you have a hysterosalpingogram.)

You need to go to a doctor called a radiologist for this test. It's carried out during the first half of your menstrual cycle. The test can be painful so your doctor may advise you to take painkillers one hour before. Here's what happens:

• The doctor puts a small tube through the neck (cervix) of your womb and injects a small amount of special fluid into your womb
• The fluid will make your womb and possibly your fallopian tubes stretch
• An X-ray machine is passed over your abdomen and takes pictures as the fluid fills your womb
• If your tubes aren't blocked, the fluid will spill out the far ends of your tubes, near your ovaries
• If your tubes are blocked, the X-rays will show that the fluid is stuck inside and can't pass through to the other end
• After the test, the fluid is absorbed or drains out of your vagina.

You may feel a little sick or dizzy or have stomach cramps for a day or two after the test.

Doctors normally use a water-based fluid for this kind of investigation. But recent research has found that if doctors use an oil-based fluid to flush your tubes, it can increase your chance of getting pregnant and having a baby (as well as show up any blockages).² It's worth asking your doctor about this.

This is a relatively new test. The doctor puts an ultrasound probe into your vagina. Sound waves (instead of X-rays) show whether the fallopian tubes are blocked.

As with hysterosalpingography, doctors inject a special fluid into your womb and look at the passage of the fluid through the tubes. This flushing may increase your chance of getting pregnant.² But unlike hysterosalpingography, doctors can't see if there are other problems with the tubes.

This also uses sound waves, this time to get pictures of the ovaries, fallopian tubes and womb.

Doctors put a small probe into your vagina in order to get the pictures and sometimes add a dye to get clearer images. Doctors may use this method to do a HyCoSy (see above) and also to watch the growth of eggs (follicles) in the ovaries. This is called follicle tracking.³

Doctors use this test to diagnose or treat problems in or near the womb.⁴ You can have a local anesthetic or a general anesthetic for this test.

Here's what happens:

• Your doctor puts a thin, telescope-like device (called a hysteroscope) into your womb, through the vagina and cervix
• The doctor can then look through the tube into the womb to check for fibroids or other reasons why an egg that has been fertilized might not be able to grow in the womb
• If necessary, your doctor can also take a small sample of tissue to examine in the laboratory
• Sometimes, doctors take samples from a fibroid or other growths using the hysteroscope.

The doctor may want to get a better look at your ovaries, tubes and womb using a laparoscope. This is a flexible tube with a special camera at one end. You'll probably need to have a general anesthetic for this.

Here's what happens:

• Your doctor makes a small cut at the lower edge of your navel
• The tube goes through this hole
• Looking through the tube, the doctor can check for problems such as endometriosis, blocked or damaged tubes, cysts on your ovaries or fibroids in your womb
• Your doctor can take a sample of tissue and may be able to remove growths or repair some damage.

A laparoscopy can provide more information than hysterosalpingography or hysteroscopy. But it is a more serious procedure with a small risk of bleeding or damage to other parts of your body. It may take you longer to recover from than from other tests.⁵

If your other tests are normal, your doctor and you will need to decide whether or not to do this test. Some couples and doctors may decide to proceed with treatment instead.⁶

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.