Hysterosalpingo Contrast Sonography (HyCoSy)

What is HyCoSy?

HyCoSy is a test done on an outpatient basis to find out if your fallopian tubes are open. It can also help detect some problems with the womb (uterus) cavity and problems inside the womb cavity (endometrium). A dye is passed through the neck of the womb (cervix) to outline the cavity and the tubes. The dye is visible on internal (transvaginal) ultrasound scans.

What are the benefits of HyCoSy?

HyCoSy is one of the tests available to assess your fallopian tubes and uterine cavity. It is an alternative to hysterosalpingography (HSG) which involves radiation (X-ray) exposure or a laparoscopy which is a surgical operation that requires a general anaesthetic.

A liquid dye which is visible on an ultrasound scan is gently pushed into the womb.

What are the risks of HyCoSy?

If there is infection (chlamydia or gonorrhoea) in the cervix it may be pushed inside the womb and up into the tubes. You should not have a HyCoSy until you have had vaginal swabs to rule out any infection that you may not be aware of. If an infection is identified it must be fully treated and confirmed to be gone before a HyCoSy can be done.

When is the best time to have the HyCoSy?

• It is important that you are not pregnant at the time HyCoSy is done.
• If you have regular periods, please ensure that either you or your partner use contraception (such as condoms) from the start of your period in the Hycosy test month, until the Hycosy is done. You may decide not to have sex instead. It is safe to have unprotected intercourse from the test day onwards.
• If you have irregular periods (for example with polycystic ovary syndrome) please use contraception for four weeks before the HyCoSy test date. You may be advised to have a blood pregnancy test two days before your HyCoSy test to confirm that you are not pregnant.
• A urine pregnancy test will be done at the clinic on the day of your test. Please bring an early morning urine sample with you so that you can arrive with a partly full bladder.
• If you are on your period (bleeding) on the day of the test, it will not be possible to do it. An alternative date will be offered.
• You should not take Clomifene citrate (Clomid), Letrozole or any other fertility drugs during the month (or the menstrual cycle) in which you are having the HyCoSy.

How should I prepare myself for the procedure?

• Please attend with a partly full bladder ready for the test.
• Please bring a small urine sample from the morning of the test day for pregnancy testing in the clinic.
• Simple pain relief is recommended. Please take one of the following, one hour before your test. Do not take any medicine which has given you side effects or allergy in the past.
  – 400 mg of Ibuprofen tablets OR
  – 1g (2 x 500 mg tablets) of Paracetamol OR
  – Two tablets of Co-codamol (8/500)
• Please bring a sanitary towel with you as you may experience some fluid draining from your vagina or spotting after the procedure.
• A low fibre diet is advised for a couple of days before your test.
• If you tend to move your bowels infrequently (2-3 times per week or less), a laxative such as Fybogel or Senna may improve the ultrasound images. These medicines are available over the counter at the chemist or supermarket.

What does the procedure involve?

You may be asked to empty your bladder keeping a sample for the nurse for pregnancy testing. HyCoSy is done in a procedure room on an outpatient basis. You may bring your partner with you. You are advised not to bring any children under the age of 18 years with you on the day. The procedure lasts about 20 minutes. Your legs are placed into supports and a screening transvaginal ultrasound is done first. A speculum is placed in the vagina (like having a smear test). A thin plastic catheter is then passed through the neck of the womb and a small balloon attached to the catheter is inflated to keep the catheter in place and reduce the dye from leaking out during the procedure. The dye is injected through the catheter. The flow of the dye is observed into the uterus and fallopian tubes with internal ultrasound.

You are likely to experience cramps or period-like discomfort in the lower part of the tummy during the HyCoSy and for a short while afterwards. You do not need to have any specific time for rest afterwards.

You do not need to use contraception or abstain from sexual intercourse after the procedure.

Risks and Complications

HyCoSy is relatively safe, but as with any procedure it is associated with some complications:

• The test can not be completed. There is a small chance that the test may not be completed if the catheter does not fit properly into the neck of the womb, or if the fluid injection is very uncomfortable and the technician needs to stop. The tubes may be hidden by the bowel if it is full and active.
• Pelvic infection after this procedure (rare).
• Increased abdominal and pelvic pain for which a few hours of hospital admission and stronger pain relief may be needed (rare).
• Perforation of the womb. It is very rare for a medical instrument (the catheter or a guide probe) to make a hole in the womb during this procedure. Further observation in hospital or investigation may be necessary.
• Allergic reaction to the contrast (dye fluid). This is very rare.

How and when do I find out the result of my HyCoSy test?

The practitioner doing your test will tell you the result when it is complete. A plan will be made for the next steps according to your individual circumstances. It is helpful if your partner is with you.

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