The Procedure

HyCoSy (hystero-salpingo contrast sonography) is an ultrasound technique developed to assess whether the fallopian tubes are open or blocked. It is usually requested by your doctor as part of an assessment of infertility or prior to treatment of infertility, even if another cause for infertility is known or suspected.

This is done by putting fluid containing small bubbles into the uterine cavity, and watching with ultrasound to see whether the fluid flows through the fallopian tubes and spills around the ovaries. The fluid/bubble mix we use is either normal saline mixed with air, or a fluid called ExEm foam gel, which is specifically designed to be used for this test.

Why have I been referred?

HyCoSy may be requested by your doctor in the following circumstances:

  1. As part of the assessment of infertility,
  2. Prior to treatment for infertility

When should it be done?

It must not be done when you are or could be pregnant, so it is best planned for the first half of your cycle, before day 12-14 when ovulation usually takes place. The test is ideally done between day 5 and day 10 of the menstrual cycle, counting from the first day of your period. If there is no chance of pregnancy (e.g. you are on the oral contraceptive pill, or have completely abstained from sexual intercourse since the first day of your period), we may be able to do the test later than day 10. If there is any doubt regarding possible pregnancy, the test will be rescheduled. It should not be done if there is any chance of acute pelvic infection. Discuss this with your referring doctor.

What happens on the day?

You do not need to have a full bladder. A scan through the abdomen may be performed initially, and you will then be sent to the bathroom to completely empty your bladder and put on a gown.

You will be positioned on the bed with your feet comfortably resting at a lower level. A transvaginal ultrasound is then performed, where we will assess the shape and appearance of your uterus, the endometrium (lining of the uterus), and the ovaries.

One of our doctors will then discuss the procedure with you in detail. A speculum is inserted into the vagina, similar to a pap smear. The upper vagina is cleansed with antiseptic, and a very thin (2mm) tube, or catheter, is passed through the cervix into the uterus. The speculum is then removed and replaced by the trans-vaginal ultrasound probe. A small balloon on the catheter is inflated to keep the catheter in place. The first part of the test involves injecting normal saline into the catheter, which gives us information about the inside of the uterus. We then inject a solution of tiny bubbles, which shows up intensely white on the ultrasound image. If the fallopian tubes are open, we can see the fluid passing through the tubes and spilling around the ovaries.

What happens afterwards?

We are able to discuss results with you on the day of the test, and a detailed report is sent to the referring doctor.

Most women are able to drive after the procedure. However, as some women may experience faintness or cramping pain, it can be helpful to have someone available to drive you home.

Minor cramping and some watery discharge from the vagina may persist for up to 24 hours. Occasionally there may be light bleeding or spotting. Symptoms of infection include fever, loss of appetite, pelvic pain, or unusual vaginal discharge. If you have any concerns, contact your doctor as soon as possible.

Is there an increased likelihood of pregnancy?

It is safe to try for pregnancy in the days and weeks following the procedure. In fact, it has been found that spontaneous pregnancy rates are higher in the cycle that the procedure is done.

How long does it take?

Allow 45-60 minutes for your appointment.

The preliminary pelvic scan takes approximately 20 minutes and the HyCoSy procedure takes approximately 15 minutes. Our doctor will discuss the results with you on the day and a more detailed report will be sent to your doctor.

How much does it cost?

It does cost more than a normal pelvic examination. It is a consultant led pelvic examination using special contrast and equipment specifically for highlighting the fallopian tubes and uterus. Unfortunately the contrast and the equipment required for this procedure is very expensive and this is reflected in our overall cost. Please contact our reception staff for more information.

Is the test painful?

Most women experience only mild discomfort. Others may experience period-type cramping during the procedure. This can be minimised by taking two tablets of an anti-inflammatory medication such as Nurofen or Brufen 1 hour before the procedure. Women who are unable to take anti-inflammatory medications may substitute by taking Panadol or Panadeine.

Are there any risks involved?

Some women feel faint during or after the procedure. It is important to let us know if you are feeling unwell. Infection as a result of the procedure occurs in less than 1% of women, most commonly if there is a history of pelvic infection. It is important to discuss with your referring doctor whether you may be at risk of infection, and, if so, obtain a prescription for antibiotics to be taken a few hours prior to the procedure.

Things you should know

  • It is done as part of an assessment for infertility
  • The study is best performed in the first 10 days of the menstrual cycle.
  • There will be some bleeding after which should stop after 24 hours.
  • It must not be done if you think you may have a pelvic infection. Please contact your G.P. first.