What are the options if tubes are found blocked in HSG?
You still can consider SSG (Sonosalpingography) or SIS (Saline Infusion Sonography) as a second test to check tubal patency. SSG is an option before you take the final decision. If tubes are open on SSG, you can avoid both Laparoscopy and IVF. If the SSG shows tubes are open, depending on the reports of you and your husband, we can advise medicines (Ovulation Induction) or IUI. At the same time, during SSG, we can evaluate the condition of your uterus and the ovaries. Finally, it's very cheap (even cheaper than HSG).

However, if SSG also shows the “block�, then there are simply two options. You can consider laparoscopy or go for IVF straightforward. It depends on your age, other fertility factors (condition of the sperms and ovaries), duration of infertility and your wish.

When and how Laparoscopy is done?
If HSG or SSG show both the tubes are blocked, then the only way to confirm the blockage is by laparoscopy. This is, because, sometimes, the spasm of the muscles of the tube during HSG or SSG can lead to“false positive� result; that means if tubes are found to be blocked by those tests, the tubes may actually be found open actually during laparoscopy.

Laparoscopy is also advised to check the tubal patency, if there are other reasons (like removal of cyst or severe pain) or when HSG or SSG could not be done for technical difficulties.

Laparoscopy is done under general anaesthesia with two or three small opening (key-hole surgery) in the abdomen and a coloured material (“dye�) is introduced through the uterus.

What are the merits and demerits of laparoscopy?
If you are at younger age, other fertility factors normal and the infertility is of shorter duration, laparoscopy may be the suitable approach for you. If laparoscopy confirms the potency of the tube(s), you can try for pregnancy naturally, by ovulation induction or by IUI (Intrauterine Insemination), depending on your circumstances. Sometimes, attempt can be made to remove the block by laparoscopy ("Hysteroscopic tubal Cannulation"). At the same time, the condition of your ovaries, uterus and the surrounding areas can be assessed in better way and treated, if necessary.

However, if laparoscopy confirms the blockage of both the tubes, you will require IVF. Moreover, although it’s a safe procedure in most cases, there some anaesthesia and surgery-related risks.

When should one go for IVF?
If the conditions of your ovaries or partner’s sperms are not satisfactory, your age is on the higher side, or infertility is of long duration, directly going for IVF would be the better option for you. In that case, you can avoid the risks and costs related to laparoscopy.

Of course, if laparoscopy confirms tubal block, the only fertility-treatment option remaining for you is IVF.

Again, if you fail to conceive within 6-12 months’ time after laparoscopy, even when the tubes were found open, you may need to consider IVF.

Conclusion
If tubes are found blocked, the options are IVF directly or confirming the block by laparoscopy. Many factors are to be taken into account before final decision.