Tubal Assessment in Female Infertility Treatment: What the Test Shows and How It Guides Care

The appointment letter says one word she has never seen before: hysterosalpingogram. She reads it twice, then searches it, then closes the tab because the forum threads are louder than they are useful. Fourteen months of trying, two normal blood panels, one partner with a normal semen analysis, and now a test that will, apparently, tell her whether the road between her ovaries and her uterus is open at all.

That is what tubal assessment infertility testing does, and it is one of the few investigations in the fertility workup that can change the plan overnight. An open pair of tubes points toward one set of options. A blocked or swollen tube points toward a different set, and sometimes toward skipping steps that would otherwise cost months.

This explainer walks through what the fallopian tubes do, how each test works, what the pictures actually mean, why the test day feels the way it does, and how the result shapes what happens next. Every decision stays with the treating team; the aim here is to make the conversation easier.

How the fallopian tubes actually work, and why a blockage matters

Picture two slender corridors, each about the length of a pen, running from the top corners of the uterus outward toward the ovaries. They do not attach to the ovaries. Instead each ends in a fringe of finger-like projections, the fimbriae, which sweep over the ovary at ovulation and catch the released egg.

Fertilization does not happen in the uterus. It happens inside the tube, usually in its widest section, the ampulla. Sperm travel up from the cervix, through the uterine cavity and into the tube; the egg waits there for roughly a day. If they meet, the fertilized egg then spends several days drifting back toward the uterus, nudged along by tiny hair-like cilia lining the tube and by gentle muscular contractions, before it implants in the uterine lining.

Three things can go wrong with this corridor. It can be closed near the uterus (a proximal block), closed near the fimbriae (a distal block), or open but damaged, with scarred cilia or a fluid-filled swelling called a hydrosalpinx. A hydrosalpinx is a tube whose far end has sealed shut, so fluid collects inside and stretches it. That fluid can leak backward into the uterus and interfere with implantation, which is why fertility specialists treat it as a separate problem rather than simply as a blockage.

Mayo Clinic lists damaged or blocked tubes among the main identifiable causes of female infertility, alongside ovulation disorders, endometriosis and uterine problems. The point of tubal assessment is not just to ask whether the tubes are open. It is to ask whether they are open, healthy and in the right place to do their job.

Who is tubal assessment usually for, and who is usually asked to wait?

Most couples do not need any test at all in the first year. The NHS notes that most couples, about 84 in 100, conceive within a year of regular unprotected sex, so guidelines generally reserve investigations for those who have tried for a year without success, or for six months when the woman is 35 or older, according to Mayo Clinic.

Within that group, tubal assessment usually comes after, or alongside, two simpler checks: a semen analysis for the male partner and blood tests or cycle tracking to confirm ovulation. If a woman is not ovulating, treating that comes first, and some teams will still check the tubes before starting ovulation medicines so that months of induced cycles are not wasted on a closed corridor.

Certain histories move tubal testing forward in the queue. Past pelvic inflammatory disease, a previous sexually transmitted infection, a ruptured appendix, abdominal or pelvic surgery, endometriosis, or a previous ectopic pregnancy (a pregnancy that implanted in the tube rather than the uterus) all raise the chance of tubal damage. So does a history of tubal ligation, if the goal is to consider reversal.

Who is usually asked to wait? Anyone who might already be pregnant, since dye and X-rays are avoided in pregnancy. Anyone with an active pelvic infection or unexplained pelvic pain, because pushing fluid through an infected tube can spread infection. Anyone with heavy vaginal bleeding at the scheduled time, since the test is timed for the quiet part of the cycle. And in some pathways, couples already headed straight to IVF for another reason, such as a severe male factor, because IVF bypasses the tubes anyway and the test would not change the plan.

What is the most common cause of tubal factor infertility?

Infection. Specifically, pelvic inflammatory disease, or PID, which is an infection that has climbed from the cervix into the uterus, tubes and surrounding tissue. Mayo Clinic and Cleveland Clinic both identify PID, most often triggered by the sexually transmitted infections chlamydia and gonorrhea, as the leading cause of damaged or blocked fallopian tubes.

The mechanism is quiet and slow. Chlamydia in particular often produces no symptoms, so the infection can smolder for months. The body responds with inflammation, and inflammation heals with scar tissue. Inside a tube barely wider than a strand of spaghetti, even a thin band of scar can seal the lumen or glue the fimbriae together. Many women learn about a past infection only when a tubal test shows its footprint years later.

Infection is not the only route. Other recognized causes include:

• Endometriosis, where tissue similar to the uterine lining grows outside the uterus and can distort or scar the tubes.
• Previous pelvic or abdominal surgery, including surgery for a ruptured appendix, which can leave adhesions (bands of scar that bind organs together).
• A previous ectopic pregnancy, or surgery to treat one.
• Tubal ligation performed for contraception.
• Tuberculosis affecting the genital tract, which is uncommon in the United States but important in some regions.
• Rarely, congenital differences in how the tubes formed.

Two honest caveats. First, finding a blocked tube does not prove a past infection, and clinicians should not imply that it does. Second, the reverse also holds: a history of chlamydia does not mean the tubes are damaged. That is exactly why the test exists. The history raises suspicion; only imaging or direct inspection answers the question.

What actually happens during an HSG test for blocked tubes

A hysterosalpingogram, or HSG, is an X-ray of the uterus and tubes taken while a contrast dye flows through them. It is usually performed in a radiology department by a radiologist or gynecologist, and MedlinePlus describes it as an outpatient test done after a period has ended but before ovulation.

Here is the sequence most people experience. You lie on an X-ray table with your knees bent, much like a pelvic exam. A speculum is placed, the cervix is cleaned, and a thin catheter or a small cannula with a soft balloon or cup is passed through the cervical opening. The speculum often comes out at this point. Contrast dye, a liquid that shows up white on X-ray, is then slowly injected through the catheter.

The dye fills the uterine cavity first, outlining its shape. Then, if the tubes are open, it travels along each tube and spills out of the fimbrial end into the pelvis, where the body simply absorbs it over the following hours. The radiologist watches this on a live screen (fluoroscopy) and takes a handful of still images. A tube that does not fill, or that fills but shows no spill, is flagged.

Cleveland Clinic puts the whole visit, including positioning and images, at under an hour, with the dye portion itself lasting only a few minutes. You are awake throughout and can usually go home right away, though many people prefer to have someone drive them.

The catheter placement and the moment the dye stretches the uterus are the two points most often described as uncomfortable. Both are brief. A small amount of dye may leak out afterward, and you will be offered a pad. That is the entire procedure; there are no incisions and no anesthesia.

HyCoSy tubal patency test, saline ultrasound and laparoscopy: how the options compare

HSG is the workhorse, but it is not the only way to check tubal patency, which simply means whether a tube is open along its full length. The NHS diagnosis pathway describes three approaches, and each answers the question slightly differently.

A HyCoSy (hysterosalpingo-contrast sonography) uses transvaginal ultrasound instead of X-rays. A catheter is placed exactly as in HSG, but the fluid pushed through is a saline or foam-based ultrasound contrast that appears bright on the screen. The sonographer follows it along each tube in real time. There is no radiation, the ovaries and uterine wall are seen at the same time, and it can be done in a fertility clinic ultrasound room. Its main limit is that tubes are harder to trace end to end on ultrasound, so an uncertain result is sometimes followed by HSG or laparoscopy.

Laparoscopy with dye is a surgical test done under general anesthesia. A thin camera enters the abdomen through a small cut near the navel, and blue dye is pushed through the cervix while the surgeon watches it emerge from the tubes. It is the only method that shows the outside of the tubes, adhesions and endometriosis, and it allows treatment in the same sitting. The NHS notes it is generally reserved for women with a known or suspected problem, because it carries surgical risks.

Feature	HSG	HyCoSy	Laparoscopy with dye
Imaging	X-ray with contrast dye	Ultrasound with saline or foam	Direct camera view
Anesthesia	None	None	General
Radiation	Low dose	None	None
Shows uterine cavity	Yes, outline	Yes, plus wall and ovaries	No (unless combined with hysteroscopy)
Shows outside of tubes, adhesions, endometriosis	No	No	Yes
Can treat at the same time	No	No	Yes
Typical setting	Radiology department	Clinic ultrasound room	Operating room, day surgery

Which test a team chooses depends on history, local expertise and what else they need to know. None is universally best; each trades detail against invasiveness.

Reading a tubal assessment result: patent, blocked, spasm and hydrosalpinx

The report usually comes back with one of a handful of findings, and the words matter.

Bilateral patency means dye passed through and spilled from both tubes. This is the most common result and it rules out complete blockage. It does not guarantee the tubes work perfectly; scarred cilia or subtle damage will not show on an X-ray. But it removes one major barrier and usually keeps less invasive treatments on the table.

Unilateral block means one tube filled and spilled while the other did not. Many women with one open tube conceive naturally, since the fimbriae of the open side can sometimes capture an egg released from either ovary, though the odds depend on why the other tube is closed.

Proximal block is a stop right where the tube meets the uterus. This is the finding most likely to be a false alarm. The muscle at the tubal opening can clamp down in response to the catheter or the cold dye, a phenomenon called tubal spasm, and the tube then looks blocked when it is not. Radiologists sometimes pause, wait, or reposition to test this. A proximal block on HSG is often rechecked by another method before anyone calls it permanent.

Distal block is a stop at the far end, near the fimbriae. Spasm cannot explain this, so it is more reliable as a true finding, and it is usually the result of scarring from infection or endometriosis.

Hydrosalpinx appears as a tube that balloons with dye and never spills. This is the result that most changes the plan, because the trapped fluid can lower the chance of an embryo implanting, and fertility teams often discuss removing or clipping the affected tube before IVF.

The uterine outline is a bonus finding: HSG can reveal polyps, fibroids pressing into the cavity, scar tissue or a septum, any of which may need attention in their own right.

Is HSG painful, and is it more painful than IVF?

Most women describe an HSG as period-like cramping that peaks for a few seconds to a minute when the dye fills the uterus, then fades quickly. MedlinePlus and Cleveland Clinic both note that cramping and mild discomfort are the usual experience, that it is generally short-lived, and that some cramping and light spotting can continue for a few hours to a day or so afterward. A minority find it more intense, particularly if a tube is blocked, because pressure builds behind the obstruction before the operator stops injecting.

Several practical things influence how it feels. Anxiety tightens the pelvic floor and makes speculum placement harder. A skilled operator who injects slowly and warms the dye tends to provoke less spasm. Many radiology departments suggest taking an over-the-counter pain reliever beforehand; if yours does, follow their instructions rather than a forum’s, and tell them about any medicine allergies or kidney problems.

The comparison people search for, HSG versus IVF, is a comparison of unlike things. HSG is one awake procedure lasting minutes with no anesthesia. IVF is a multi-week process of daily hormone injections, several transvaginal ultrasounds, and an egg retrieval performed under sedation or anesthesia, so the retrieval itself is not felt in the moment, though bloating and soreness afterward are common. Most women who have done both say HSG is a sharper but far shorter discomfort, while IVF is a longer, lower-grade physical and emotional load. Neither should be described as unbearable, and neither should be minimized. If you have had a difficult pelvic exam in the past, or a history of trauma, say so when booking; teams can slow down, explain each step, and in some settings offer a HyCoSy or sedation as alternatives.

What is the 10 days rule in HSG?

The so-called 10 days rule is shorthand for timing. HSG is scheduled in the first half of the menstrual cycle, after bleeding has stopped and before ovulation, which in a typical 28-day cycle means roughly cycle days 6 to 10, with day 1 being the first day of full flow. MedlinePlus describes this window as after your period but before you ovulate. The exact days vary by department; some book up to day 12, and women with longer cycles may be given a slightly later window.

Three reasons sit behind the rule. The first is pregnancy safety. Before ovulation there is no possibility of a fertilized egg in the tube or uterus, so X-rays and dye cannot affect a pregnancy that has not begun. Many departments still ask for a urine pregnancy test on arrival, and you will usually be asked to use barrier contraception or avoid intercourse from the start of that period until the test.

The second is image quality. In the days right after a period the uterine lining is at its thinnest, so the cavity outline is clean and small polyps or scar tissue are easier to see. Later in the cycle the thickened lining can mimic abnormalities.

The third is infection risk. Performing the test during active bleeding could carry blood back through the tubes into the pelvis, and the open cervix during a period is thought to offer less of a barrier to bacteria.

If your cycles are irregular, or you are not having periods, the team may induce a bleed first or use ultrasound to confirm you have not ovulated. Missing the window is common and not a failure; it usually just means rebooking for the next cycle. The rule is a scheduling guide, not a medical deadline.

Will I get pregnant after an HSG?

This is the question behind many searches, and the honest answer has two parts.

First, HSG is a diagnostic test, not a treatment, and no one should be told to expect pregnancy because of it. Second, there is a real and long-observed pattern: some women conceive in the months right after tubal testing, at a somewhat higher rate than would be expected by chance. Researchers call this the tubal flushing effect, and systematic reviews of randomized trials have found a modest increase in pregnancy rates after flushing the tubes with contrast, particularly with oil-based rather than water-based dye. The size of that effect varies between studies, it does not apply to tubes that are truly blocked, and guidelines do not recommend HSG as a fertility treatment in itself.

Why might flushing help at all? The leading explanations are mechanical and biological. The pressure of the dye may dislodge fine mucus plugs or gentle adhesions that were narrowing, but not sealing, the tube. Oil-based contrast may also dampen local immune activity in the lining, though this is not fully understood. Some of the apparent effect may simply reflect the fact that women having tests are, by definition, still trying and are often being investigated at a point where natural conception remained possible.

What this means in practice: if both tubes are open and you are not starting another treatment right away, many teams suggest continuing to try naturally over the next few cycles, since that is when any flushing benefit would be seen. If your team is choosing between oil-based and water-based contrast, that is a reasonable question to raise. What it does not mean is that repeating the test to chase a benefit is worthwhile; repeat HSG is generally done only when a result was unclear.

HSG pain and recovery: what the days and weeks afterward usually look like

The same day, expect to feel somewhat crampy and to see a little clear or blood-tinged discharge as dye and cervical mucus drain. Cleveland Clinic advises that light spotting for a day or two is normal and that most people return to ordinary activities the same day. A pad is more practical than a tampon while there is any discharge, and many departments ask you to avoid intercourse for a day or two to lower infection risk, though instructions vary and yours take priority.

Within a few days, the cramping should be gone. If it is worsening rather than fading, or you develop fever, that is not part of normal recovery and is covered in the red-flag section below.

The result itself often arrives faster than other fertility tests. Because the radiologist watches the dye live, many women are told the headline finding before they leave the room, with a formal written report following within days. The fertility team then usually reviews it alongside the semen analysis, ovulation tests and ovarian reserve results at a follow-up appointment, commonly a few weeks later.

If a proximal block or spasm was suspected, the next weeks may include a second look by HyCoSy, or a plan for laparoscopy. If a hydrosalpinx was found, a surgical consultation is typically arranged before any IVF cycle. If both tubes were open and everything else is normal, the discussion turns to how long to keep trying naturally versus moving to ovulation induction or insemination, decisions shaped by age, duration of trying and personal preference.

Emotionally, the waiting period between test and plan is often harder than the test. It can help to write down the exact wording of the result and bring it to the follow-up, so the conversation starts from the report rather than from memory.

How tubal assessment infertility results guide treatment choices

The whole reason to do the test is that the answer branches the pathway. Here is how each finding tends to steer decisions, described neutrally; your team will weigh it against everything else in your picture.

Both tubes open. Less invasive options stay available. Depending on age and other results, teams may suggest a further period of trying naturally, medicines that stimulate ovulation, or intrauterine insemination (placing prepared sperm directly in the uterus), all of which rely on functioning tubes. If these do not succeed within an agreed number of cycles, IVF is considered.

One tube open, one closed. Many teams treat this similarly to two open tubes, with the caveat that the closed side may reduce monthly chances. If the closed tube is a hydrosalpinx, it is often addressed even though the other tube is open.

Both tubes blocked. Two routes exist. Tubal surgery, sometimes by laparoscopy, can open some distal blocks or divide adhesions; results depend heavily on how much of the tube is healthy and carry a higher risk of later ectopic pregnancy. IVF bypasses the tubes altogether by fertilizing eggs in the laboratory and placing an embryo in the uterus. Mayo Clinic notes that IVF is often recommended when tubes are severely damaged. Which route makes sense depends on age, ovarian reserve, the male partner’s results and personal values.

Hydrosalpinx present. Because trapped fluid can lower implantation, removing or sealing the affected tube before IVF is commonly discussed. This is a permanent step on that side and deserves a full conversation about trade-offs.

Uterine cavity abnormality. A polyp, fibroid or septum seen on the same images may prompt hysteroscopy (a camera passed through the cervix) to confirm and, where appropriate, treat it.

In every branch, the tubal result is one input among several. It rarely dictates a single answer, but it reliably rules some answers out.

What people often get wrong about tubal factor infertility causes and tests

“A blocked tube means I had an STI.” Not necessarily. Endometriosis, previous surgery, a past ectopic pregnancy and unexplained scarring all block tubes, and a proximal block is often spasm rather than scar. The test describes plumbing, not personal history.

“If my tubes are open, they work.” Patency and function are different things. Dye can flow through a tube whose cilia were damaged by infection, and an X-ray cannot see cilia. An open tube is good news, but it is not a clean bill of health.

“HSG can unblock tubes, so I should ask for it as treatment.” The flushing effect is real but modest, applies to tubes that were nearly open anyway, and is not a reason to repeat the test. Guidelines do not list HSG as a treatment.

“One blocked tube halves my chances.” Egg capture is more flexible than the diagram suggests; an open tube can sometimes collect an egg from the opposite ovary. Real-world reduction depends on the cause of the block, not simple arithmetic.

“Laparoscopy is the gold standard, so I should skip straight to it.” It gives the most information, but it is surgery under general anesthesia with its own risks. Most pathways start with HSG or HyCoSy and reserve laparoscopy for suspected disease or unclear results.

“Supplements or massage can open scarred tubes.” There is no reliable evidence that any supplement, herbal preparation, or manual therapy reopens a tube sealed by scar tissue. Anyone promising this is selling something.

“The test is dangerous or ruins fertility.” Serious complications are uncommon; the main recognized risks are infection, an allergic reaction to contrast, and brief fainting. The radiation dose is low and confined to a moment before ovulation.

“Normal tubes mean the problem is definitely me or definitely him.” A normal tubal test narrows the search; it does not assign blame, and a meaningful share of infertility remains unexplained after all standard tests.

Questions to ask your care team before and after tubal assessment

A short list, carried into the appointment, changes the quality of the conversation. These are the questions that tend to matter most.

Before the test

• Which test are you recommending for me, HSG, HyCoSy or laparoscopy, and why that one given my history?
• What days of my cycle should this be done, and how do I confirm I have not ovulated if my cycles are irregular?
• Should I take anything for discomfort beforehand, and should I avoid anything?
• Will you use oil-based or water-based contrast, and does that choice matter in my case?
• Do I need to avoid intercourse or use protection before the test, and for how long after?
• What are the risks of infection or allergic reaction for me specifically, and do I need any medicine to prevent infection?
• Who will tell me the result, and when?

After the result

• Were both tubes open, and did the dye spill freely on both sides?
• If a block was seen, where is it, and could it be spasm rather than scar? Do you want to confirm it another way?
• Is there any sign of hydrosalpinx, and if so what are my options for dealing with it before treatment?
• Did the uterine cavity look normal, or is there anything that needs a closer look?
• Given this result, my age and my partner’s results, what are the realistic pathways, and what would you expect the next three to six months to look like under each?
• How many cycles of a less invasive option would you suggest before reconsidering?
• Is there anything in this result that changes urgency?

Write the answers down. Fertility conversations are dense, and the words used about tubes, patent, spasm, distal, hydrosalpinx, are precise enough that a small misremembering can distort the whole picture.

When to call your doctor after a tubal assessment

Mild cramping and light spotting for a day or two are expected after HSG or HyCoSy, and a few days of soreness around small incisions is expected after laparoscopy. The signs below are not expected and should prompt a same-day call to the department that did the test or to your regular doctor.

• A fever, chills, or feeling generally unwell in the days after the test, which can signal pelvic infection.
• Pelvic or abdominal pain that gets worse instead of better after the first day, or severe pain at any point.
• Foul-smelling or discolored vaginal discharge.
• Bleeding heavier than a normal period, or bleeding that continues beyond a few days.
• Fainting, persistent dizziness, or a racing heartbeat.
• Hives, swelling of the face or lips, wheezing or difficulty breathing, which may indicate a reaction to contrast dye and needs emergency care.
• After laparoscopy: redness, spreading warmth or pus at an incision, vomiting that will not settle, or shoulder-tip pain that persists beyond a couple of days.

Sudden, severe one-sided pelvic pain with dizziness or shoulder pain at any time in the weeks and months after tubal testing, especially if a period is late, is treated as a possible ectopic pregnancy until proven otherwise. That is an emergency, not a phone call to wait on.

More broadly, if you have been trying to conceive for a year, or six months if you are 35 or older, or you have a known history of pelvic infection, endometriosis or pelvic surgery, it is reasonable to ask for a fertility evaluation rather than waiting longer. Tubal assessment is one part of that evaluation, and the treating team will decide whether and when it is the right test for you.

Frequently asked questions

What is the most common cause of tubal factor infertility?

Pelvic inflammatory disease is the most common cause. It is an infection that spreads from the cervix into the uterus and tubes, usually triggered by chlamydia or gonorrhea, and it heals with scar tissue that can seal a tube or fuse its fimbriae. Endometriosis, previous pelvic surgery, a past ectopic pregnancy and tubal ligation are the other main causes.

Is HSG more painful than IVF?

They are hard to compare because they are different experiences. HSG is a few minutes of awake cramping, often sharp but brief, with no anesthesia. IVF involves weeks of injections and monitoring, and the egg retrieval is done under sedation, so it is not felt at the time, though soreness afterward is common. Many women describe HSG as sharper and IVF as longer.

Will I get pregnant after an HSG?

Not as a rule, and no one should promise it. HSG is a diagnostic test. That said, systematic reviews have found a modest increase in pregnancy in the months after tubal flushing, especially with oil-based contrast, likely from clearing minor debris in tubes that were nearly open. It does not help tubes that are truly blocked, and repeating the test for this purpose is not recommended.

What is the 10 days rule in HSG?

It refers to scheduling the test in the first half of the cycle, after bleeding has stopped and before ovulation, commonly between about day 6 and day 10, sometimes up to day 12. This timing avoids X-raying an early pregnancy, gives a clear view of the thin uterine lining, and lowers infection risk. Departments vary, so follow your own instructions.

What is a HyCoSy tubal patency test?

HyCoSy stands for hysterosalpingo-contrast sonography. A catheter is placed through the cervix, as in HSG, but saline or a foam contrast is pushed through while a transvaginal ultrasound tracks the fluid along each tube. It uses no radiation and shows the ovaries and uterine wall at the same time. Tubes can be harder to trace fully, so unclear results are sometimes followed by HSG or laparoscopy.

Can a blocked fallopian tube be a false result?

Yes, particularly when the block is at the uterine end. The muscle where the tube joins the uterus can clamp down in response to the catheter or cold dye, a tubal spasm, so the tube appears closed when it is open. Radiologists may pause or reposition to test this, and a proximal block is often confirmed with a second method before it is treated as permanent.

What is a hydrosalpinx and why does it matter for IVF?

A hydrosalpinx is a fallopian tube whose far end has sealed shut, so fluid collects inside and stretches it. On HSG it appears as a tube that balloons with dye but never spills. The trapped fluid can leak back into the uterus and lower the chance of an embryo implanting, so fertility teams often discuss removing or clipping the affected tube before an IVF cycle.

Can I still get pregnant with one blocked tube?

Many women do. The open tube’s fimbriae can sometimes capture an egg released from either ovary, so the reduction in monthly chance is smaller than simple halving suggests. What matters more is why the other tube is blocked; a hydrosalpinx or widespread pelvic scarring changes the picture more than an isolated block does. Your team will weigh this with your age and other results.

How long does HSG pain and recovery last?

The sharpest cramping lasts seconds to a minute while the dye fills the uterus. Milder cramping and light spotting commonly continue for a few hours to a day or two, and most people return to normal activity the same day. Pain that worsens after the first day, fever or unusual discharge is not part of normal recovery and should be reported promptly.

Is there any way to assess fertility before trying to conceive?

Partly. Ovarian reserve blood tests and a pelvic ultrasound can be done before trying, and a history of pelvic infection, endometriosis or pelvic surgery can prompt earlier tubal testing. Routine tubal assessment before trying is not standard, because most couples conceive within a year and the test carries small risks. A clinician can help decide whether your history justifies checking sooner.

References

• MedlinePlus: Hysterosalpingography
• NHS: Infertility overview
• NHS: Infertility diagnosis

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.