HyCoSy (Hysterosalpingo-Contrast Sonography)

What is a HyCoSy?

HyCoSy is a specialised ultrasound scan that checks if your fallopian tubes are open (patent) and examines the shape of your womb (uterus). A small amount of sterile contrast fluid is gently introduced into the uterus via a thin catheter, while an ultrasound probe (usually placed in the vagina) monitors its flow. If the tubes are open, the fluid flows through them and can be seen spilling out on the scan.

Your gynaecologist may recommend HyCoSy to investigate:

• Infertility: To check if blocked fallopian tubes are preventing pregnancy.
• Recurrent Miscarriages: To assess uterine shape (e.g., for fibroids, polyps, congenital abnormalities) and tubal patency.
• After Tubal Surgery: To confirm if surgery to unblock tubes was successful.
• After Difficult Uterine Surgery: To check if fallopian tubes are patent

Before the Procedure

• Scheduling: Usually performed in the first half of your menstrual cycle (days 5-12) when you are not bleeding and not pregnant.
• Pregnancy Test: Mandatory beforehand to exclude pregnancy.
• Infection Screen: May require a recent chlamydia/gonorrhoea test to reduce infection risk.
• Pain Relief: Often advised to take ibuprofen or paracetamol 1 hour before to reduce cramping.
• Preparation: Avoid sex, tampons, or vaginal creams for 24 hours before. Eat and drink normally.

• Positioning: You lie on a couch with legs supported (like a smear test).
• Ultrasound Probe: A clean probe is gently inserted into the vagina.
• Catheter Insertion: A speculum may be used (like a smear test). A thin, soft catheter is passed through the cervix into the womb. This may cause brief discomfort.
• Contrast Fluid: Sterile fluid is slowly introduced via the catheter. The ultrasound monitors the fluid filling the womb and flowing into the tubes.
• Examination: The doctor watches the fluid movement on screen to assess tube openness and uterine shape.
• Duration: Typically, 10-20 minutes.

• Recovery: Most women go home immediately. Rest briefly if needed.
• Common Side Effects:
  • Mild period-like cramps (usually short-lived, minutes to hours).
  • Light vaginal spotting or watery discharge (may contain contrast fluid).
• Self-Care:
  • Use sanitary pads (not tampons) for any discharge/spotting.
• • Avoid sex, swimming, and baths for 48 hours (showering is fine).
  • Take over-the-counter painkillers for cramps if needed.
• Return to Activities: Most women resume normal activities, including work, the same or next day.

• Common (Temporary): Mild cramping, light spotting/discharge.
• Uncommon:
  • Pelvic Infection: Risk is low (<1%). Symptoms: fever, increasing pain, unusual discharge. Prompt antibiotic treatment is needed.
  • Vasovagal Reaction: Brief dizziness/fainting during the procedure.
• Very Rare: Allergic reaction to contrast fluid (if not saline/air).

Follow-Up

• Results: Often discussed immediately after the scan or at a short follow-up appointment.
• Next Steps: Recommendations depend on findings (e.g., further tests, fertility treatments).

• Q: Will it hurt?
  A: Most women experience mild to moderate cramping when the fluid enters, similar to period pain. Taking painkillers beforehand helps. Discomfort usually stops quickly after the test.
• Q: How accurate is it?
  A: Very good for detecting blocked tubes and major uterine abnormalities. Sometimes further tests (e.g., laparoscopy) are needed.
• Q: Are there alternatives?
  A: The main alternatives are Hysterosalpingogram (HSG – uses X-rays) or Laparoscopy with dye test (keyhole surgery). HyCoSy avoids radiation and is less invasive.
• Q: Does it improve fertility?
  A: There’s some evidence that the fluid flushing the tubes might slightly increase pregnancy chances in the following months for some women.

eGynaecologist Advice

• HyCoSy is a valuable, minimally invasive outpatient test for investigating fertility and uterine/tubal health and must be preferred ahead of HSG or laparoscopic dye test.  
• You should contact your gynaecologist immediately if you experience severe pain, fever, heavy bleeding, or unusual discharge after the test.