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HyCoSy Tubal patency testing

What is a HyCoSy?

HyCoSy is a short name for hystero-salpingo contrast sonography. It is a technique we use to check if your Fallopian tubes are blocked or not. Some people call it a "tubal patency test." 


About 30% of cases of infertility are due to the woman's tubes being blocked. This can occur from previous pelvic infections, previous ectopic pregnancy or previous surgery. Tubal blockage prevents the egg from meeting the sperm, so conception cannot take place. If your 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. We use sterile saline to highlight the uterine cavity, and bubbled up normal saline to highlight the Fallopian tubes. If the anatomy is very difficult, or there are imaging problems, we sometimes use a commercial contrast agent like ExEm foam as well.


Aerated saline contrast flowing out through the Fallopian tubes.


When should a HyCoSy be done?

It must not be done when you are or could be pregnant, so it is best planned for the first half of your cycle, before day 12-14 when ovulation usually takes place. We count the days from the first day of your last menstrual period. Between day 5 and 10 is best but we can do it later in the cycle if you are certain you cannot be pregnant. 

For example if you have abstained from intercourse with your partner or if you are in a same sex relationship. Most women ring on day 1 of their cycle, when their period first starts, to make an appointment. 

You are asked to empty your bladder and to put on a gown in the bathroom. Then you can lie down while the sonographer covers you.


             Diagram of a HyCoSy procedure

Our doctors are all highly qualified gynaecologists. 

The doctor introduces a speculum into the vagina. It feels like a Pap smear. 

Then she will slip a thin tube into the cervical canal and inflate a tiny balloon on the end to hold it in place. 


The speculum is removed and replaced by the trans-vaginal ultrasound transducer. A solution of saline is instilled to outline the endometrial cavity and then the special bubbly saline is injected. 


The bubbly saline shows up as bright white sparkly fluid on ultrasound examination. Its path is 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 spilling out over the ovaries on each side. If one or both tubes are not patent then this becomes obvious during the examination.

Why is HyCoSy more expensive than sonohysterography alone?

This is an image of a hydrosalpinx  or blocked tube. Colour Doppler Imaging is used to show the blood vessels.

The tubal patency studies are more detailed and require more time and skill. We use special catheters which stop the fluid running back down the cervical canal and everything has to be done with sterile technique. 


The other options available to test tubal patency are laparoscopy and dye, done under general anaesthetic, or hystero-salpingo-graphy done with x-ray visualisation. These other tests are more uncomfortable and more expensive. You may wish to discuss these options with your doctor.


Seeing the fluid flow out of the uterus and along the Fallopian tube and around the ovary proves tubal patency.

Will it be painful?

Sonohysterography does not required hospitalisation, anaesthetic or analgesia. Some women have some period-like pain during or shortly after the procedure. Tubal patency studies can cause a bit more cramping. We recommend you take a couple of Panadol or Naprogesic beforehand.

Are there any risks?

A normal Fallopian tube with contrast and three dimensional reconstruction.

Some women feel a bit faint after the procedure, but after a rest, they recover. There is a risk of introducing infection, though this is extremely rare. If there is a chance that you already have a pelvic 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 doctor about your history before the procedure.

After the procedure?

We recommend that you sit and rest for 10 minutes or so after the test. We will explain the results to you. The report will be forwarded to your doctor. Your doctor will plan whether or not you need further treatment.