Tubal Patency Testing (HyCoSy)
What is a HyCoSy?
HyCoSy is a short name for hystero-salpingo contrast sonography. It is a technique used by the Ultrasound Care team of gynaecologists and sonographers to check if your Fallopian tubes are open or blocked.
HyCoSy is also sometimes referred to as a “tubal patency test.”
Why is HyCoSy important?
About 30% of cases of infertility are due to the woman’s tubes being blocked. There are many different reasons for tubal blockage including previous pelvic infections, endometriosis, previous ectopic pregnancy or previous surgery.
Tubal blockage prevents the egg from meeting the sperm, so conception cannot take place. If your referring doctor wants to test whether or not your tubes are working, there are several different choices of tests available.
HyCoSy refers to the test we perform with transvaginal ultrasound examination and a contrast agent.
When should a HyCoSy be done?
It must not be done when you are pregnant or if you believe you could be pregnant. The Ultrasound Care team will want to plan your HyCoSy procedure for the first half of your cycle, that is before day 12-14 when ovulation usually takes place.
To calculate this, we count the days from the first day of your last menstrual period with between day 5 and 10 being best. Most women who have been referred to Ultrasound Care for an HyCoSy will call us on day 1 of their cycle, when their period first starts to make an appointment.
What happens during a HyCoSy procedure?
Before starting your HyCoSy procedure, our care team will ask you for a small urine sample on the day for a urine pregnancy test. Once we have determined you are not pregnant, we can then undertake the HyCoSy.
As a starting point, our care team will ask you to empty your bladder and to put on a gown or modesty sheet in your en-suite. All Ultrasound Care scan rooms are private with their own en-suite to always ensure our patient’s privacy.
We also have specialist gynaecological procedure beds which allow us to adjust and lower the foot of the bed to make it more comfortable for your hips.The Ultrasound Care doctor
and sonographer will do a pelvic ultrasound to assess your uterus and ovaries.
To do this, your doctor introduces a speculum into the vagina and cleans the cervix with antiseptic. This part of the procedure feels like a Pap smear. She will then slip a thin tube into the cervical canal and inflate a tiny balloon on the end to hold it in place.
The speculum is then removed and replaced by the trans-vaginal ultrasound transducer. A solution of saline is instilled to outline the endometrial cavity and subsequently the bubbly saline is injected. The bubbly saline shows up as bright white sparkly fluid on ultrasound examination, and its path can be followed up into the uterus and then (hopefully) out through the Fallopian tubes on each side.
We can also use colour Doppler imaging to demonstrate the presence of the contrast agent in the Fallopian tubes and it spilling out over the ovaries on each side.
If one or both tubes are not patent, then this becomes obvious to your doctor during the examination.
Why is HyCoSy more expensive than sonohysterography alone?
The tubal patency studies (HyCoSy) are more detailed and require more time and skill to perform. Ultrasound Care also uses special catheters which stop the fluid running back down the cervical canal and everything must be done with sterile technique. It is also important to note that there is no x-ray involved.
The other options available to test tubal patency are laparoscopy and dye, done under general anaesthetic, or Hystero-salpingo-graphy (HSG) done with x-ray visualisation. These other tests are more uncomfortable and more expensive.
If you are unsure about the best option, you should arrange to discuss the different choices with your referring doctor.
Is HyCoSy painful?
Some women have some period-like pain during or shortly after a HyCoSy procedure. Unless you have an allergy, we recommend you take a couple of Panadol or Naprogesic before your procedure.
Are there any risks associated with HyCoSy?
Some women (around 1: 10) feel a bit faint after the procedure, but recover after a rest.
There is a risk of introducing infection, though this is extremely rare. If there is a chance that you already have a pelvic or urinary tract infection the procedure should be avoided because of the risk of it being exacerbated.
We also recommend prophylactic antibiotics if you have a heart valve problem or are on any immunosuppressive medications. Please talk to the Ultrasound Care doctor about your history before the procedure.
What happens after a HyCoSy procedure?
Your Ultrasound Care team will recommend that you sit and rest for 10 minutes or so after the test. We will explain the results to you at the time of the procedure, and the report will be forwarded to your referring doctor. The information from your report will allow your doctor to determine whether or not you need further treatment and plan what treatment is required.
How do I arrange for a HyCoSy?
If your doctor has referred you for a HyCoSy or tubal patency test, please call the Ultrasound Care clinic that is most convenient to you in Sydney and speak to our team to arrange for an appointment.
