Secondary infertility for over 2 years

Patient's question:

29 years old, infertile for over 2 years after miscarriage, had one medication abortion. Had one induced abortion; the last one was in October 2001. In the past 2 years, the couple had normal sexual life without contraception, but remained childless. In January 2004 and October 2005, she underwent two hysterosalpingograms (HSG) at different hospitals, both showing patent tubes. The doctor recommended an iodine oil contrast study. She is allergic to iodine. The cervix has moderate erosion and is retroverted. Ultrasound shows normal adnexa, ovulation is monitored, and infertility antibodies are normal. What should she do now? The doctor suggested laparoscopy to check the fallopian tubes. Is it necessary? Do you have any other good suggestions? Thank you (What is the difference between hysteroscopy and laparoscopy? Thank you). Will these surgeries have any impact on her health? She needs to

Doctor's answer:

Hello: For patients with anovulation due to dysfunction of the hypothalamic-pituitary-ovarian axis, ovulation induction can be achieved using medication:
(1) Clomiphene: Start taking clomiphene orally at 50–150 mg/day from the 5th day of the menstrual cycle, for 5 consecutive days. Ovulation may occur 5–11 days after stopping the medication. If estrogen levels are low, a small dose of estrogen can be used first. Diethylstilbestrol (DES) at 0.125–0.25 mg/day can be taken for 20 consecutive days. Using 1–3 cycles can increase the sensitivity of the hypothalamic-pituitary-ovarian system, and then clomiphene can be used for ovulation induction to enhance efficacy. If cervical mucus is scarce and viscous, DES at 0.125–0.25 mg/day should be added for 7 days after completing clomiphene treatment.
(2) Hormonal artificial cycle with estrogen and progestogen: For patients with menstrual disorders but with a certain level of estrogen, a sequential regimen of estrogen and progestogen can be used for 3 months of artificial cycle therapy, which may lead to ovulation after stopping the medication.
(3) Human Chorionic Gonadotropin (HCG): HCG has the effect of luteinizing hormone, and administration near the time of mature follicle development can induce ovulation. ① Combination of clomiphene and HCG: Clomiphene at 50–150 mg/day for 5 consecutive days is given, and HCG at 5000–10000 IU is administered intramuscularly on days 4–16 of the menstrual cycle or when serum estradiol ≥1000 pmol/L or a follicle diameter of ≥2.0 cm is observed on ultrasound. ② Combination of clomiphene, HMG, and HCG: Each HMG vial contains 75 IU of FSH and LH, which can promote follicular growth and maturation. Clomiphene at 50–150