Tuboplasty: If the hysterogram reveals a blockage in the fallopian tubes, a doctor can do a surgical procedure to cut out the blocked portions and reattach the tubes.

  • Risks: Post-surgical abdominal soreness. If you are older than 35, your doctor might suggest you skip this step and move right on to in vitro fertilization (rather than wasting time on surgery, recovery, and then trying to conceive naturally).

Laparoscopy: If endometriosis is an issue, a laparoscopic surgery can be done to remove endometrial or scar tissue from the around the fallopian tubes and outside the uterus.

  • Risks: The procedure normally takes an hour or so and can be performed with local anesthesia and light sedation. You will probably feel some soreness for a few days afterward.

Artificial insemination: This procedure can be done using your partner’s sperm or donor sperm. You will go to the doctor’s office when you are ovulating and the sperm will be placed directly into the cervical opening. This procedure can be helpful when your partner’s sperm count is low or has low motility; donor sperm could be used if your partner’s sperm is not viable.

  • Risks: You will probably feel some mild cramping for a day or so afterward.

In vitro fertilization: If less invasive treatment options have not resulted in pregnancy, your doctor may suggest that you consider IVF. It is an expensive, invasive, and not always successful procedure (especially for women in their 40s). You will need to take fertility drugs in order to produce several eggs during one cycle and the eggs are then harvested from your ovaries using a needle guided by ultrasound. The eggs are then mixed with sperm (from your partner or a donor) in a petri dish. Ideally, fertilization will take place in one or more eggs, which are then placed directly into the uterus.

  • Risks: All of the same risk factors of fertility drugs apply, plus an increased risk of conceiving multiples.

Donor eggs: Donor eggs are most often used by older women whose reproductive tract is in working order, but whose eggs are no longer viable. The eggs are usually harvested from anonymous donors who are in their 20s. The eggs are then mixed with the male partner’s sperm and IVF is performed to implant the resulting embryos.

  • Risks: You will need to have hormone injections to prepare the uterus to receive the embryos. And like regular IVF, more than one embryo is normally implanted, so there is a risk of conceiving multiples.

Sally Wadyka is a Boulder, Colo.-based freelance writer who writes regularly for Shape, Runner’s World, Real Simple and The New York Times.

Daniel McNeive, MD, is board certified in obstetrics/gynecology and in private practice at St. John’s Mercy Medical Center in St. Louis, Missouri.