1. Understand the five basic causative factors in the approach to infertility.
2. Know that a prior chlamydial infection predisposes to tubal factor infertility.
3. Understand that the HSG is a method for diagnosing tubal disease. Considerations
This 22-year-old woman has experienced difficulty getting pregnant for I year. She had a pregnancy previously, so she has secondary infertility. Her menses are every 28 days, which speaks against an ovulation disorder: regular monthly menses almost always indicates regular ovulation. She denies dysmenorrhea or dyspareunia. which makes endometriosis less likely, but the absence of symptoms does not rule out endometriosis. The semen analysis is normal, so a male factor is unlikely. The history of chlamydial infection in the past definitely points toward tubal factor disease. Chlamydia trachomatis is particularly associated with tubal problems, leading to infertility or ectopic pregnancy. One method of evaluating tubal patency is the HSG, assessing whether the radiopaque dye will spill through the fallopian tubes and out into the peritoneal cavity.
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