What is HYCOSY?

HYCOSY stands for hystero salpingo contrast sonography.

It is a simple and well-tolerated outpatient ultrasound procedure used to assess the patency of the fallopian tubes, as well as detect abnormalities of the uterus and endometrium.

The procedure uses a contrast solution or an agitated saline / air mixture to make the tubes and uterine cavity stand out on ultrasound examination.

It is best performed in the first half of the menstrual cycle between the end of menstrual bleeding and ovulation.

Why do I need a HYCOSY?

It is one of the first non-invasive investigations used to assess the patency of the fallopian tubes as part of an assessment for infertility.

Up to 10% of couples experience difficulty conceiving a pregnancy.  Blockage of the fallopian tubes may be responsible for up to 30% of the inability to conceive for these couples.

How is the procedure performed? 

The initial part of the procedure involves insertion of a vaginal ultrasound probe to image the uterus and ovaries. After this is completed a vaginal speculum is inserted to see the cervix.

The cervix is cleaned with an antiseptic solution. A sterile plastic catheter with a balloon at the end is inserted in the uterus. The balloon is then inflated gently to form a seal so that the contrast solution does not come out of the uterus.

Contrast solution using the EXEm foam kit is then instilled into the cavity while the vaginal probe is used to scan the pelvis at the same time. The solution makes bright bubbles and makes the tubes and the uterine cavity stand out on ultrasound.


Are there any other procedures that also assess the Fallopian Tubes?

Before HYCOSY became available, there were other procedures like hysterosalpingogram (HSG) that use x – rays to assess the uterus. There is also laparoscopy combined with tubal dye test.

These procedures are expensive when compared to HYCOSY. They are also invasive, involving

surgery, anaesthesia and hospitalisation. In addition, they may expose you to radiation.

Advantages of HYCOSY

It is less expensive, has no radiation risk and relatively non-invasive compared to these procedures.

Other advantages include less pain than HSG and an ability to assess small lesions in the endometrial cavity and evaluate for any congenital uterine abnormalities that may affect ability to have a successful pregnancy.

Is it painful?

The procedure is usually not painful. However some women describe it as being uncomfortable and some may have mild cramps after/during the procedure. Simple analgesics can be taken an hour before the procedure to help with decreasing the pain discomfort.


Are there any risks or complications?

The most serious complication is the risk of infection that occurs in less than 1% of women. Some women may feel faint after the procedure. This is a side effect of having a catheter dilate the cervix. This feeling usually settles with 10 – 20 minutes of rest. There may be some PV spotting after the procedure resulting from the insertion of the catheter into the uterine cavity.

Sometimes the fallopian tubes (either one or both tubes) are not seen during the procedure due to spasm of the uterus at the opening of the fallopian tubes or due to technical factors such as uterine fibroids, size of the patients’ abdomen and bowel in the pelvis. This may hinder visibility during the ultrasound and may result in your doctor requesting additional investigations.


Can I drive after the procedure?

Most women are able to drive after the procedure. However it is best if you come with a support person who can drive you home after the procedure.


Where can I have the procedure performed?

 The procedure is available at the JUNIC SPECIALIST IMAGING AND WOMEN CENTER and is performed by Dr Uche Menakaya who is an advanced gynaecology imaging specialist.