My husband’s sub par semen analysis results alone don’t completely explain why I haven’t gotten pregnant. After all, men with abnormal counts, morphology, and motility are still able to naturally impregnate their partners.  So in order to truly understand what is preventing conception, we’d now need to explore my uterus. Fun.

“Because you have a history of painful periods,” Dr. Collins, my regular OBGYN said, “Let’s have you obtain a hysterosalingram to see if there are any tubal blockages.”

Hysterosalpingogram? What the heck was that? I wondered if it was painful. I had had ultrasounds, pap smears, basic physical examinations, but this was nothing I’d heard before. The unknown toyed with my imagination like a cat with its kill.

“Does it hurt?” I asked sheepishly. I pictured a mad-scientist type doctor cackling above me as he prepared some surgical implement in a fire pit, embers glowing like the innards of hell. An active imagination and fear of pain are a horrible combination.

“It can,” she answered honestly. “You’ll typically feel some cramping when they flush your uterus and tubes with the solution.”

Flush my uterus! And tubes! With what solution!? How the heck were they going to do that!? The term “flush” implied a burst of pressure, a cleaning out. I was happy keeping any flushing to the toilet. But like I do in any moment of perplexity, I took to the web in a fury, determined to better understand what I was in for.

What is a hysterosalpingogram?

According to WebMd, a hysterosalpingogram or HSG is:

An X-ray test that looks at the inside of the uterus and fallopian tubes and the area around them. It often is done for women who are having a hard time becoming pregnant (infertile).

During a hysterosalpingogram, a dye (contrast material) is put through a thin tube that is put through the vagina and into the uterus. Because the uterus and the fallopian tubes are hooked together, the dye will flow into the fallopian tubes.

Don’t you just love how they put “infertile” in parenthesis above, as if not popping out children on demand is a baby making death sentence. WebMD needs to get it straight. Just because someone is having a hard time getting pregnant, typically known as subfertility, does not mean that they never will. So there. Infertility refers to an “inability” to conceive, as in it ain’t gonna happen. Subfertility, on the other hand, is the more accurate definition for most. Merriam Webster defines subfertility as: “the condition of being less than normally fertile though still capable of effecting fertilization.”

Despite any challenges we face, I’m not jumping on the “infertile” bandwagon just yet. I’m feeling quite capable thank you very much.

The HSG and Pain

I expected the worst when I arrived at Wilshire Imaging Center on a Wednesday afternoon.

A petite Filipino nurse led me into a room that resembled an alien spaceship’s experimentation laboratory. She instructed me to lay atop the table underneath a gigantic X-Ray device that was fixed to the ceiling. The doctor (or head alien) would be in shortly, she explained.

“Is it that bad?” I asked, as she prepped a menagerie of implements that I assumed were meant for me.

“Nah,” she answered. “Just feels like menstrual cramping.”


To some menstrual cramps are a mild annoyance, but to me they’ve been debilitating in ways that are hard to understand if you haven’t experienced them. I’ve missed work, school, major life events. I’ve writhed around on the bathroom floor twitching from pain. I’ve been rushed to the emergency room. Once, I was even carted away in an ambulance. To say I’ve lived in fear of period cramps is an understatement, so when the nurse said I could expect a similar sensation during this procedure I wasn’t comforted.

Yet, I’m happy to announce that my HSG paled in comparison to any menstrual cramps I’ve ever felt.

A mousey male doctor quietly explained the risks of the procedure before he instructed me to lay flat on my back while he inserted a tube through my cervix. I began taking deep nose to mouse breaths, as if I were relaxing in the last pose of yoga class, savasana. This helped. Moments later, he instructed the nurse to send solution through the tube, while he looked up at a monitor above my head.

Though I did feel a small push of pressure as the liquid filled me, it was in no way similar to the agony of my monthly flow. This was it? I almost wondered if he was doing it wrong. According to, “Some women experience only mild discomfort, while others experience severe pain.”  Lady Luck had rolled the dice in my favor for a change.

“What do you see?” I asked. I knew if I didn’t inquire that I’d have to wait a week to discuss the results with Dr. Collins. I’m a very hands-on-let’s-talk-about-it-now kind of patient.

“Please be advised that this is not my final impression. You’ll have more thorough results in my report.”

“Sure,” I acknowledged. “I won’t hold you too it, just keep me posted ok?”

“Ok,” he answered. I felt another gentle pulse as more fluid spread inside me. “I now see that I’m not able to pass through your left tube.”

I detected a mild, but distinct disappointment when he said this.

“But your right tube,” he said, “is perfectly clear.”

“How can I fix the blocked one?” I asked him.

“You’ll have to discuss that with your OBGYN,” he said professionally.

His vague answer to my question told me everything I needed to know. Fixing, in some capacity, would indeed be required.

The Results

“Combining your husband’s sperm analysis with your blocked tube you are excellent candidates for IVF,” Dr. Collins explained several days later. She made our status sound like we’d just qualified for a home refinance or a free trip to Disney land, rather than a heart breaking expensive medical procedure.

Aside from the expense, there were emotional and ethical implications surrounding IVF as well. I pictured my test tube baby, a grotesque creature growing rapidly and then shattering its glass incubator. The cat was playing his games again. And what of survival of the fittest? You know, super sperm meets super egg and baby genius is born. Perhaps we weren’t meant to have children. Perhaps we were better off broken.

“But why IVF?” I asked, not satisfied. “I have one tube open after all.” There had to be more to the story.

She explained that I may eventually get pregnant on my own, but the various factors made it closer to unlikely. There’s no telling how often the open side produces a mature egg. Also if one tube is no good, it’s common that the other can contain damaged cilia which make it virtually impossible for an egg to reach the ideal position for fertilization. One blocked tube implies overall damage to the entire uterus apparently.

So what caused my blocked tube, I wondered? My research and further discussion with the docs indicate that they can be caused by pelvic inflammatory disease, other infections, and endometriosis. Considering a lifetime of horribly painful periods, I was sure endometriosis was to blame in my situation.

Endometriosis might as well be renamed The Worst Thing Ever. Wikipedia explains that endometriosis affects to 6 to 10% of women and often results infertility. Great. Not only do I have up to 20 more years of pain ahead of me (provided I go through menopause around age 50), but I may also never experience the joy of having a child. It just keeps getting better, people.

Yet Dr. Collins didn’t seem too concerned.

“You’re both very healthy despite these issues,” she said. “You may need a little help, but I have no doubt you’ll have children.” She smiled, gave me a referral for a fertility clinic, and sent me on my way.

Strangely, I left with more relief than I expected. It felt good to know that we both played a part in the problem, that we weren’t alone in our malfunctions. It also became clear that this would be a process, not something that would happen overnight. Being the instant gratification kind of girl that I am, this was half the battle.

Changing our Lives

Though we are two tall, educated, overall healthy adults, who floss regularly, it seemed likely that many lifestyle changes were on the horizon. Would we need to give up caffeine and alcohol? Exercise more or less? Change our diets? What about our spending habits? Would we be able to afford IVF?

Since learning that we’d need to work with a fertility center to pave the wave for baby B, we’ve undergone quite the metamorphosis. I’ve found and continue to find answers to all of the above questions. There’s so much great information out there. In part 3, I’ll discuss how we improved hubby’s sperm quality, the blood test for endometriosis and my pending surgery. There may or may not be a baby at the end of this obstacle course, but it’s still a worthwhile race. A 54.8% chance (the typical IVF success rate of Southern California Reproductive Center) is better than no chance at all, don’t you think?

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