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Tubal Patency Test (HyCoSy)

Hysterosalpingo-Contrast Sonography (HyCoSy) is an ultrasound procedure used to assess the patency of the fallopian tubes and detect abnormalities of the uterus and endometrium.

The procedure uses a non-toxic contrast agent for visualization under ultrasound.

The HyCoSy is a safe and reliable alternative to the conventional hytsterosalpingogram (HSG) that uses X-rays.

Who could benefit?

If you are considering trying naturally, timed sexual intercourse, ovulation induction or intra-uterine insemination (IUI), you will require patent fallopian tubes in order to achieve a pregnancy. Occluded (blocked) fallopian tubes are a common cause of infertility. Tubal occlusion can occur as a result of a number of conditions, including previous pelvic infection, previous appendicitis, pelvic adhesions and severe endometriosis. Many women will be unaware that these conditions are present or that tubal occlusion has occurred.

Does the HyCoSy only assess my tubes?

The HyCoSy allows integrated assessment of the fallopian tubes, uterus and endometrial cavity. The initial part of the HyCoSy uses saline to assess the uterine cavity for pathology, such as endometrial polyps, submuccous fibroids and congenital uterine abnormalities.

When can a HyCoSy be performed?

Firstly, it is important that you are not pregnant when you have a HyCoSy, as the procedure can disturb the pregnancy. It is recommended that you avoid intercourse from the first day of your last menstrual period up to the day of the procedure to avoid pregnancy.

The best time to perform the procedure is just after your period has finished but before you ovulate, approximately day 7 to day 12 of a regular 28 day menstrual cycle. If you have shorter cycles, you will need to have the test earlier. If your cycle is longer, but still regular, you may be able to have the test slightly later. If your periods are infrequent or irregular, please discuss the timing of the test with your doctor or nurse.

You will need to be screened for Chlamydia and Gonorrhoea before the procedure to exclude infection. Your consultant may also suggest you have a high vaginal swab for the same reason.

Is it painful?

A HyCoSy is considered a simple procedure lasting approximately 30 minutes and no anaesthetic is required. Most women experience mild to moderate discomfort similar to period cramping.

We advise that you take over the counter pain relief 30 prior to the procedure. We recommend Ibuprofen (400 mg) and Buscopan (10 mg). If you are allergic to Ibuprofen another option isParacetamol (1 gram).

A prophylactic course of antibiotic with be prescribed: 1gm of Azithromycin (250mg x 4) orally and 1gm Flagyl suppository rectally 2 to 4 hours before procedure.

Patients may eat and drink normally before the procedure. Patients are advised to drink 2 glasses of water 30 minutes before the procedure to ensure a half full bladder.

How is a HyCoSy performed?

The first part of the HyCoSy is similar to a smear: a vaginal speculum is inserted into the vagina to visualise the cervix. The cervix is cleansed with antiseptic solution to decrease the risk of infection. A thin flexible balloon catheter is passed through the cervix into the uterus. A small balloon at the tip of the catheter is slowly inflated with saline solution to keep the catheter in place and prevent fluid leaking back through the cervix during the test. The vaginal speculum is then removed, with the catheter remaining inside the uterus.

Initially, a small amount of saline is introduced into the uterine cavity, which allows ultrasound visualization of the contour and shape of the cavity. The doctor will be looking for presence of uterine pathology detailed above. Next, a small amount of contrast dye (ExEm foam) will be introduced through the catheter. The injection of the contrast dye may cause some discomfort similar to the uterine cramps experienced during menstruation. The dye can be clearly visualized under ultrasound. The doctor will be looking to see if the dye freely flows into through both fallopian tubes and spills out at the end of the tube into the area around the ovaries. If this occurs, the tubes are patent.

What are the risks?

The HyCoSy is a safe and well tolerated procedure for the assessment of tubal patency. Infection of the uterus or pelvis is not common but can occur in rare cases. You should contact the clinic immediately if you have the following symptoms:

  • Persistent or foul-smelling vaginal discharge
  • Increasing lower abdominal pain
  • Unexplained fever
  • Extended general malaise

Such symptoms may indicate treatment with antibiotics. Please inform your consultant if you have a history of pelvic infection because they may prescribe you with antibiotics to prevent infection prior to the procedure.

After the procedure

You should wear a sanitary towel after the procedure because there may be persistent vaginal discharge for a few hours as the fluid used in the HyCoSy drains out of the vagina. This discharge is sometimes blood stained so do not become alarmed if this occurs.

You should be able to resume normal daily activities after the procedure. Your consultant will discuss the results of the procedure with you directly after it has been performed.

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