## Clinical Context This patient has primary infertility with a regular menstrual cycle, normal hormonal profile, and a partner with normal semen analysis. The next logical step is to evaluate structural and tubal factors. ## Rationale for HSG **Key Point:** HSG is the first-line imaging modality to assess tubal patency and detect uterine cavity abnormalities in the infertility workup when ovulation is confirmed and semen analysis is normal. **High-Yield:** The standard infertility workup follows a stepwise approach: 1. Confirm ovulation (regular cycles + normal FSH/LH) 2. Assess semen analysis (normal in this case) 3. Evaluate tubal patency and uterine anatomy (HSG) 4. If HSG abnormal or if HSG normal but still infertile after 6–12 months, consider laparoscopy **Clinical Pearl:** HSG is minimally invasive, cost-effective, and can be therapeutic in cases of minor tubal obstruction (oil-soluble contrast may have a therapeutic flushing effect). It should be performed in the follicular phase (days 7–12 of cycle) to avoid disrupting an early pregnancy. ## Why HSG Before Laparoscopy - Laparoscopy is invasive and reserved for cases where HSG is abnormal or after failed conception despite normal HSG and semen analysis - This patient has not yet undergone tubal assessment, so HSG is the appropriate next step [cite:Jeffcoate's Principles of Gynaecology 8e Ch 28]
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