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03 Feb

What should I do next?
Hi doc, About three years ago my husband and I went to a fertility clinic and after an initial scan, we were put on Clomid 50mg for three months (unmonitored). My husband also had a semen analysis done and they said the figures were fine. We were not successful but has a pregnancy the month after my last course of Clomid which ended in a miscarriage before we even knew we were pregnant (confirmed in the ER). Last year March we went to another clinic and after initial consult and blood tests, said my AMH levels were low and my husband's sperm count was low. We spent a few months on meds (Glucophage, Prelox for my husband and Insu-Max Q for both but stopped due to the costs (salaries affected by COVID). We went back to the clinic last week and we did a post coital scan on CD13 and the sperm was all dead. Not a single wiggle, nothing. So now my husband has to do another semen analysis (third one) which is fine, but I don't understand the next step for me. They want me to do a Laparoscopy and a Hysteroscopy, the doctor said just to make sure we've covered our bases but I don't understand how this will link to a clearly hostile environment? From what I've read up (and I know Google is not the best but not the worst), hostile cervical mucus can destroy sperm like mine does but not where do they mention doing the above procedures to determine cause. Is this the normal next step? Thank you for your time.
Fertility expert
Fertility expert

22 Feb

Dear Anon,

There seems to be a lot of factors involved in your case, both male and female factors. It definitely does seem like a good idea for your husband to repeat the semen analysis. Regarding your question however, I believe you are wanting to know whether a laparoscopy and hysteroscopy is indicated or not. It seems as though your doctor would like to do it for diagnostic purposes and the findings may in fact be completely normal. However endoscopy is often used in the field of infertility and can sometimes provide very useful information which may not be identified on ultrasound and general examination such as the presence of mild/ minimal endometriosis which may have an impact on fertility.

Answered by Dr T Mohamed
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