Hysterosalpingography by ultrasound (HyFoSy)
Hysterosalpingography is one of the essential work up tests for sub- fertility as it can provide us with valuable information about a woman’s fertility. It allows for an evaluation of the fallopian tubes’ patency. Patent fallopian tubes (aka salpinges, or oviducts) is an absolute prerequisite of fertilization.
Until recently, only the “classic” hysterosalpingography (HSG or salpingography), a test performed in an X-ray facility, was available. A special contrast substance was administered through the cervix (the neck of the womb). Then, a series of X-rays is obtained, capturing the passing of the substance through the internal gynecological organs. Salpingography can give us important information because it may reveal womb structural abnormalities, provide hints about the presence of endometrial polyps or fibromas and also can inform us about whether the tubes are open (“patent”) or not. However, this test exposes the body to a small amount of radiation, and there is also a small risk for an allergic reaction to the contrast substance. Some women describe their experience as “uncomfortable” while for several it can be painful.
We now offer, in our Practice, a new method to investigate fertility, pain and radiation free. Ultrasound Hysterosalpingography (HyFoSy)! We are the first Practice in the area of Western Thessaly and one of the few in Greece, to provide this service.
This test is known by several names, such as HyFoSy (from Hystero-Foam-Salpingography, using foam as a contrast medium), HyCoSy (from Hystero-Contrast-Salpinography), painless salpingography, ultrasound salpingography.
Ultrasound Hysterosalpingography is a modern, state of the art, ultrasound test which is recommended as a first line investigation test to evaluate sub- fertility.
Advantages:
· The test is completely radiation free (in contrast with the classic method, where radiation equals that of 8- 10 chest X- rays).
·It is essentially painless, with minimal to little discomfort during the examination (pain-free salpingography).
·Carries zero chance of allergic reaction. The new generation contrast we use (ExEm Foam), made of cellulose and glycerole, is hypo allergic.
·It can be combined with a transvaginal (internal) scan of the womb and the ovaries. Therefore, with one test, we can obtain information about the condition of the womb and the ovaries, which are useful for the overall evaluation of fertility.
·The examination is performed in our Office, therefore you are in an already familiar environment and, additionally, you do not have to seek any long distance specialised facility.
·It takes only a short period of time to complete, usually 15- 20 min.
How is the salpingography by ultrasound done?
First, we use antiseptic to cleanse the vagina. Then, a catheter is inserted through the cervix (the neck of the womb). The the examination is performed with the instillation of the foamy contrast substance in the womb cavity. At the same time, using high resolution ultrasound, we follow the flow of the contrast substance through the tubes, in order to directly visualise if there are any blockages or they are open (“patent”). Pictures (both 2D and 3D) and videos are obtained.
What information do we get from salpingography by ultrasound?
HyFoSy initially tests the womb cavity for any structural problems and subsequently the fallopian tubes for their patency, which permits conception.
Do I need any preparation in advance?
Hysterosalpingography is recommended to be performed before ovulation, in order to exclude the chance of an early pregnancy. However, ultrasound salpingography can be done anytime during your cycle (as it does not expose the body to any radiation), apart from during periods. Previously, we need to check for any vaginal infections and, if needed, treat them accordingly. This way, we minimise the chance of any germs disseminating from the vagina to the womb and the tubes, through the contrast substance instillation in the womb.
Are there any side effects?
There have been more than 60,000 recorded cases of HyFoSy examinations, until today, and no side effects or allergies have been reported, which is quite reassuring. Rarely, mild abdominal discomfort has been reported during the examination.
What are the limitations of the test?
Ultrasound Hysterosalpingography cannot distinguish whether there is a problem with the function of the tubes, only if they are patent or not. In rare occasions, the tubes might constrict and close when the contrast substance is instilled and therefore cannot be visualised, while in fact, they are patent and normal. In case of increased body weight, there might be some difficulty in properly visualising the foamy contrast medium. In such cases, further testing might be required (classic hysterosalpingography, hysteroscopy or, very rarely, laparoscopy).
What are the benefits of the test?
It has been observed that the first months following ultrasound hysterosalpingography, the chance of natural conception for couples trying to conceive, is increased. This might be due to better tube function following the contrast substance instillation.
Frequently Asked Questions (FAQ)
Yes. If the examination is performed before ovulation and your gynecologist does not identify any problem or complication, you may continue trying to conceive naturally during the same cycle. There is no need to wait until the following month.
Can I try to conceive in the same cycle after HyFoSy?
Yes. If the examination is performed before ovulation and your gynecologist does not identify any problem or complication, you may continue trying to conceive naturally during the same cycle. There is no need to wait until the following month.
HyFoSy is not a treatment for infertility. However, several studies have shown that in some women there is an increased chance of natural conception during the first months after the examination. The most likely explanation is the tubal flushing effect, meaning that the passage of the foam contrast medium through the fallopian tubes may improve their function when they are already patent.
There is no specific timeframe. Pregnancies have been reported even in the same cycle, while most spontaneous conceptions are recorded within the first 3–6 months after the examination.
Most women describe HyFoSy as an examination that causes mild discomfort or cramps similar to menstrual pain, lasting only a few minutes. The intensity of discomfort varies from woman to woman, but the examination is generally very well tolerated.
The examination is usually performed after the end of menstruation and before ovulation, in order to exclude the possibility of pregnancy and to achieve the best possible visualization of the fallopian tubes.
Not necessarily. Normal tubal patency is a very reassuring finding, but the decision regarding fertility treatment also depends on several other factors, including the woman’s age, ovarian reserve, sperm quality, duration of infertility, and any underlying gynecological conditions. HyFoSy is an essential part of the fertility assessment, but it is only one piece of the overall evaluation.
Do you have questions about HyFoSy?
If you are planning to investigate your fertility or would like to know whether HyFoSy is the right examination for you, please contact our clinic. We will discuss your medical history in detail and recommend the most appropriate diagnostic and treatment plan tailored to your individual needs.
