Hysterosalpingo contrast sonography (HyCoSy)

What is HyCoSy?

HyCoSy stands for hysterosalpingo contrast sonography. It's an ultrasound test that checks whether your fallopian tubes are open, and can also help assess the inside of your womb (uterus).

Why might I need HyCoSy?

You might be offered a HyCoSy if you're having difficulty getting pregnant, since your doctor needs to know whether your fallopian tubes are open. This matters because an egg needs to travel through an open tube to meet sperm for natural conception.

The test can also detect some other problems, such as:

• polyps, fibroids or adhesions inside your womb
• a build-up of fluid in a fallopian tube, known as a hydrosalpinx.

It's important to know that HyCoSy can't detect everything: it won't show whether you have endometriosis or scar tissue around the outside of your tubes, which can only be diagnosed by a laparoscopy.

What are the benefits of HyCoSy?

HyCoSy avoids the risks of a general anaesthetic and doesn't expose you to radiation, unlike some of the alternative tests. It also lets your doctor see your womb cavity as well as your fallopian tubes in a single test.

Are there alternatives to HyCoSy?

• Hysterosalpingogram (HSG): Similar to a HyCoSy, but uses X-rays instead of ultrasound to track the dye, which means some exposure to radiation.
• Laparoscopy and dye test: A surgical procedure done under general anaesthetic, where a camera is inserted through a small cut near your belly button while dye is injected through your cervix. This carries the risks of general anaesthetic and surgery, but can also check for other problems, such as endometriosis or scar tissue around your tubes, that a HyCoSy can't detect.

Your doctor may recommend a laparoscopy instead of, or after, a HyCoSy if there's a reason to think you might benefit from it, or if your HyCoSy results are unclear.

How do I prepare for HyCoSy?

• The test is usually timed for the first half of your menstrual cycle, often around days 6 to 12, after your period has finished and before you ovulate
• You may be asked to have a chlamydia test beforehand, and your procedure may need to be rescheduled if the result isn't back in time, since an existing infection needs to be treated first
• You'll usually be asked to use contraception, such as condoms, or avoid sex, from the start of your period in the month of the test, to make sure you're not pregnant when the test is carried out
• You may be asked to do a pregnancy test before the procedure, as HyCoSy shouldn't be carried out if there's any chance you're pregnant
• Taking a painkiller, such as paracetamol or ibuprofen, around 1 to 2 hours beforehand can help with any discomfort; check with the clinic if you're not sure this is suitable for you
• It's a good idea to arrange for someone to accompany you home afterwards, in case you feel uncomfortable or faint.

What happens during HyCoSy?

The procedure itself usually takes around 20 to 40 minutes. A female chaperone will present throughout the procedure to assist you and the clinician if required.

1. You have a routine internal (transvaginal) ultrasound scan just before the main procedure
2. You lie on your back, and a speculum is placed into your vagina, similar to having a cervical screening test
3. A thin catheter (tube) is passed through your cervix and into your womb; a small balloon on the tip may be inflated to hold it in place
4. A dye or contrast fluid is injected through the catheter while another internal ultrasound scan is carried out at the same time
5. Your doctor or sonographer watches the fluid flow through your womb and fallopian tubes on the ultrasound screen, checking whether it passes through freely
6. The catheter and speculum are removed once the test is complete.

What happens after HyCoSy?

Your doctor or sonographer can usually tell you what they've found straight away, before you go home.

You may have some light vaginal bleeding or spotting for a few hours afterwards, so it can help to bring a sanitary pad – don't use tampons during this time. Period-like cramping is common but usually settles quickly once the test is finished.

You can normally go back to your normal activities, including driving and returning to work, straight away, though some people prefer to take the rest of the day off. It's safe to have unprotected sex again from the day of the test onwards if you are trying to conceive.

A full written report is usually sent to the specialist who referred you, and you may have a follow-up appointment to discuss your results and next steps in more detail.

What are the risks of HyCoSy?

• Period-like cramping or discomfort: Common, and usually settles quickly
• Light vaginal bleeding: Common for a few hours afterwards
• Feeling faint: Possible, so it can help to rest for a few minutes afterwards
• Pelvic infection: Uncommon, estimated at around 1 in 100 procedures – you may be given antibiotics as a precaution, or your GP will prescribe them if you develop symptoms such as pain, fever or unusual discharge in the days afterwards
• Allergic reaction to the dye: Rare, less than 1 in 100 procedures
• The catheter cannot be passed: Rarely, the test may need to be abandoned if the catheter can't be passed through your cervix.