HyCoSy

Hysterosalpingo Contrast Sonography (HyCoSy)

What is it?

It is an investigation of the Fallopian tubes. This test involves the use of an ultrasound contrast agent specially designed for use with this type of test. The agent is safe and will not affect future fertility. It is used to provide a clearer view of the fallopian tubes on the ultrasound scan.

The HyCoSy test is performed by a sonologist with specialist skills in carrying out this type of procedure. A sonologist is a registered obstetrician and gynaecologist who has undertaken additional sub-specialty training and qualifications in performing and making diagnoses from ultrasound examinations and procedures.

Who should have the procedure?

You will have been referred for this procedure by your doctor if you are having difficulty getting pregnant. The Fallopian tubes carry the egg from the ovaries to the uterus. If the tubes are damaged or blocked it may be difficult to become pregnant. Your doctor will need this information about your Fallopian tubes to understand whether the tubes may be blocked or damaged. This test result can help your doctor to plan any future care you may need.

How is the procedure performed?

On the day of the procedure a transabdominal and/or transvaginal ultrasound will be performed prior to the procedure. Before the procedure commences your bladder will need to be emptied completely.

For the procedure itself a speculum will be placed in the vagina and the cervix cleansed with antiseptic. A fine plastic tube is passed through the cervix into the uterus. A small balloon on the catheter is inflated to keep the catheter in place. The speculum is removed and a vaginal ultrasound scan is then performed as the contrast agent (ExEm foam) is injected.

Is it safe?

The most common ill-effect is the discomfort involved. For most women, the use of a mild pain killer beforehand will usually make the procedure quite acceptable. If you cannot tolerate non-steroidal anti-inflammatories (eg. due to asthma or stomach ulcers) simple analgesics such as Panadeine or Panadol may be substituted. An anaesthetic is not required.

There is a small risk of introducing infection into the uterus and pelvis. If you develop symptoms of fevers, loss of appetite, pelvic pain, unusual discharge in the days following the procedure, please see your referring doctor for further assessment.

Very occasionally, handling of the cervix results in a reflex fall in blood pressure, and a fainting episode (cervical shock). If you are feeling faint or experiencing loss of vision or hearing during the procedure, please alert the doctor performing the procedure.

There is a small chance that the contrast fluid passage may not be visible through the Fallopian tubes, even if your tubes are open. This may be the result of a muscular spasm.

When a HyCoSy result suggests tubal blockage, this may be followed by advice from your referring doctor to have the diagnosis confirmed with a laparoscopic dye test, considered the “gold-standard” procedure. However, if the tubes are seen to be open to the flow of the contrast fluid key-hole surgery and its associated risks can be avoided.

How to best prepare for the procedure?

The HyCoSy is performed transvaginally. There is no special preparation required. You will be asked to ideally refrain from intercourse for 5 days prior to the procedure. You will be asked to empty your bladder prior to the examination. Therefore, there is no need to attend with a full bladder.

In general antibiotics may be used prophylactically to reduce the infection risk of the test.

When in my cycle can I have the procedure?

The procedure is performed between days 4 – 10 of the cycle. Typically this is when you will have finished menstruating, but well before the 14th day of your cycle, which is the average time in a women’s cycle that ovulation occurs.

It is important to do this test well before the 14th day. If the HyCoSy scan is carried out after 14 days into your cycle and you have conceived that month, the scan procedure would ‘flush’ the embryo out of the uterus.

You will be asked to complete a consent form on the day of the procedure, please inform the staff if you have had any allergic reaction in the past to medications or other ultrasound contrast agents.

How will I feel after the procedure?

You may have some period-like cramps. Most women are comfortable enough to drive home and continue with usual daily activities, but if you are concerned about the pain it may be worthwhile having someone available to drive you home. Local heat (hot water bottle or wheat bag) applied to the lower abdomen may be helpful to manage pain.

Some discharge from the vagina may be expected, so you may like to bring a panty-liner.

If you develop symptoms of infection in the days after the procedure (eg. fever, loss of appetite, pelvic pain, unusual vaginal discharge) see your referring doctor as early as possible.

How long do the results take?

The doctor performing the procedure will give you the results immediately after the procedure. A written report will be sent to your referring doctor. You will be able to discuss the results at your next appointment with your referring doctor.