How Do I Know If I’m Infertile?

Dec 7, 2022 10:40:25 AM Posted by Iowa Radiology

Iowa Radiology sonohysterogram hysterosalpingogram


Fertility Changes Over Time

If you’ve been trying to get pregnant, you may be surprised at how long it can take. While women tend to be most fertile in their 20s, many in the U.S. have been waiting longer to start their families. Census data show that the median maternal age at birth rose to 30 in 2019, up from 27 in 1990. Births to women in their 20s fell dramatically during that period, while births to women aged 30–44 rose even more sharply.


How long does it take to get pregnant?

The later in life a woman starts trying to conceive, the longer it is likely to take. A 2012 statistical analysis showed that at age 25, a woman has approximately a 22% chance of conceiving in her next cycle and an 87% chance of conceiving within the next twelve cycles. By age 35, however, the odds of conceiving fall to 16% in the next cycle and 73% in the next twelve. At age 40, these odds are around 9% and 49%, respectively.


Should I patiently keep trying or see a doctor about possible infertility?

Infertility is common, affecting around 10% of women in the U.S. Age is one of the main risk factors for infertility. Others include smoking, excessive alcohol use, stress, poor nutrition, hormonal imbalance, infection, and being over or underweight. Positively influencing any of these factors could enhance your odds of conceiving. Experts recommend that women under age 30 consult a doctor about possible infertility after a year of unsuccessful attempts, and women aged 35 and older wait just six months.


What tests can help diagnose infertility?

When you see your doctor about difficulty conceiving, they could order a variety of tests to try to pinpoint the cause. Some of these include

  • Hormone testing
  • Monitoring basal body temperature
  • Antral follicle count (ultrasound test to assess egg supply)
  • Sonohysterogram
  • Hysterosalpingogram
  • Hysteroscopy or laparoscopy (procedures that use a lighted camera to view reproductive organs)


Common Imaging Tests for Infertility



If your doctor suspects a structural cause for your trouble conceiving, such as fibroids or polyps, they may order a sonohysterogram. This transvaginal (TV) ultrasound procedure uses a saline solution that’s introduced into the uterus via the cervix with a thin, flexible catheter. This sterile solution expands the uterine cavity and allows the technologist to capture clearer images than TV ultrasound alone. Sonohysterography allows the radiologist to visualize structural impediments to pregnancy within the uterus and assess whether a biopsy of any structural anomalies is appropriate.



A hysterosalpingogram can also be useful in determining the cause of infertility. This exam uses fluoroscopy—a moving X-ray image—enhanced with contrast dye to visualize the uterus and the fallopian tubes. While sonohysterography is more sensitive and provides more accurate, specific information about the uterus than hysterosalpingography, it does not provide clear visualization of the fallopian tubes. For this reason, if your doctor suspects a blockage of the fallopian tubes, they will likely order a hysterosalpingogram.


What to Expect During Sonohysterography and Hysterosalpingography

A sonohysterogram is typically scheduled around one week after the beginning of your period. While your instructions may be different, the exam is generally avoided during menstruation. The procedure begins with a standard transvaginal ultrasound exam. If you’ve never experienced a TV ultrasound, it’s important to familiarize yourself with this procedure first. See our article, What’s a Transvaginal Ultrasound Like and Why Do I Need One? for essential information. After the initial TV ultrasound, the technologist inserts a speculum into the vagina, sterilizes the cervix, and then inserts the thin catheter to deliver saline solution into the uterus. The speculum is then removed, and TV ultrasound images are taken again.


A hysterosalpingogram is similar in that the technologist inserts a speculum, sterilizes the cervix, and then inserts a thin, flexible catheter. In this case, the catheter delivers contrast dye to the uterus instead of saline. After removing the speculum, the technologist then takes fluoroscopy images from outside the body, allowing a wider view that encompasses the fallopian tubes.


Following either procedure, you may experience cramping similar to menstrual cramps. Complications are rare following these procedures, but infection is possible and must be treated promptly if suspected. With hysterosalpingography, some patients may have an allergic reaction to the contrast dye; be sure to inform your provider if you’ve ever had a reaction to imaging contrast.


At Iowa Radiology, we pride ourselves on putting our patients first. We understand that medical exams can evoke stress and worry, and we take steps to help our patients be as comfortable as possible during their time with us. To learn more about medical imaging and important health care topics, subscribe to our blog.




American College of Obstetricians and Gynecologists. Evaluating Infertility FAQs. Published January 2020. Accessed August 10, 2022.


Ancholonu UC, Silberzweig J, Stein DE, Keltz M. Hysterosalpingography Versus Sonohysterography for Intrauterine Abnormalities. JSLS. 2011;15(4):471–474.


Sozou PD, Heartshorne GM. Time to Pregnancy: A Computational Method for Using the Duration of Non-Conception for Predicting Conception. PLoS ONE 2012;7(10):e46544.


Morse A. Stable Fertility Rates 1990-2019 Mask Distinct Variations by Age. Published April 6, 2022. Accessed August 10, 2022.


Office of the Assistant Secretary, U.S. Department of Health and Human Services. Infertility. Published February 22, 2021. Accessed August 10, 2022.










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