Other reasons for no coneption

[mahavidhan]

We are TTC since 15 months. First six months without medication, Next six months with medication and Past three months without medication. I am 37 and DH is 40 and we are already blessed with a boy who is 12 now. First pregnancy was C-Section.

During medication, I have done follicular study thrice which was fine with dominant follical rupturing properly. Took HCG injection, took medicines such as Fol123, Clome 50mg, Duphastone 10mg and Progynova 2mg, DH was on Productive-M (Clomifene Citrate Tablets IP & Antioxidants, Multivitamin, Amino Acid & Minerals Tablets), Did semen analysis twice. Both of us are medically fit with normal blood reports for cbc, thyroid etc., we physically appear to be little less than our age and are aesthetically fit with weight in proportion to height with a correct BMI.

The issue is yet to be discovered or diagnosed and we are still thinking what could be the reason of no conception. Lately I was advised to do HSG and SSG which was done. HSG (with contrast dye) and Hystero-Salphingography (with saline) both are normal. Count, Motility, Morphology, everything in semen analysis is good. Can someone suggest list of reasons for no conception even though semen, hsg, ssg all are good?

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Before Salphingography procedure:
No obvious intra / extra-uterine gestational sac is seen.
Uterus is anteverted and anteflexed in position.
Both the ovaries show few follicles within.
Both adnexae are clear. No obvious mass lesion is seen.
No free fluid is seen in the Pouch of Douglas.

During/After Salphingography procedure:
"On USG fluid flow can be noted in the right and left adnexa after the normal saline was pushed on color Doppler, suggestive of bilateral tubal patency" with a conclusion that says "both fallopian tubes are patent and free fluid in the POD"

Semen Analysis:
Color: White Opaque, Transparency: Translucent, pH Alkaline (7.5), Viscosity: Normal, Fructose: Present, Count 80.0 millions/Cu.mm, Total sample count 160 millions
After 30 mins Motility: 75%, Sluggish 5%, Motile: 80%, Non motile: 20%
After 60 mins Motility: 65%, Sluggish 5%, Motile: 70%, Non motile: 30%
After 120 mins Motility: 50%, Sluggish 10%, Motile: 60%, Non motile: 40%
Active Motile sperms at the end of 30 mins 60.0 millions/ Cu.mm
Abnormal head: 4%, Abnormal mid-piece: 2%, Abnormal tail: 4%, Mixed defects: 4%, Total percentage of abnormal sperms: 14%
Pus Cells: 1-2 HPF, Immature Spermatozoa: 1-2 HPF, Alugtination of Sperms: Absent, RBC per H.p.f.: Absent, Epithelial Cells: 0-1/ HPF, Crystals: Absent, Yeast Cells: Absent, richomonas Vaginalis: Absent.

Thanks