Essentially a small amount of fluid (contrast material - ExEm foam) is injected into the uterus through a fine tube and observed as it flows through the open Fallopian tubes.
What is the main reason for having this examination?
- Investigation of sub-fertility
You should not have the procedure if you are pregnant or may be pregnant at the time of the examination or you have acute pelvic infection or unexplained pelvic tenderness or other symptoms which may be due to pelvic inflammatory disease.
This technique is used to detect blockage of the Fallopian tubes. It can also be used to assess the uterine cavity shape, though plain 3-D ultrasound or saline-infusion sonography is usually preferred for this purpose. HyCoSy is an alternative to the x-ray procedure called hysterosalpingogram (HSG). Unlike with HSG, HyCoSy uses no radiation or iodinated contrast material.
How is the procedure performed?
On the day of the procedure a transabdominal and/or transvaginal ultrasound may be performed immediately prior to the procedure. Before the procedure commences your bladder will need to be emptied completely. For the procedure itself you will be undressed from the waist down and covered with a sheet. Your legs will be placed in stirrups (the lithotomy position) and the external genitalia cleansed with Betadine (or an alternative) antiseptic solution. A speculum will be placed in the vagina and the cervix also cleansed with antiseptic. A fine (2 mm) plastic tube is passed through the cervix into the uterus. A small balloon on the catheter is inflated to keep the catheter in place. The speculum is removed and a vaginal ultrasound scan is then performed as the contrast fluid (ExEm foam) is injected. You will be advised of the findings as the procedure is performed.
Will I need an anaesthetic?
Whilst you may experience some mild discomfort, this is not usually a painful procedure and therefore no anaesthesia is required. However, we strongly encourage you to take 2 tablets of an anti-inflammatory medication (such as nurofen, naprogesic or advil) an hour before the procedure. This not only helps to minimise crampy discomfort, but also helps the procedure to be performed with greater ease, due to the uterine relaxation produced. If you cannot tolerate anti-inflammatories (eg. due to asthma or stomach ulcers) simple analgesics such as panadeine or panadol may be substituted.
Are there any risks involved?
The most common ill-effect is the discomfort involved. For most women, use of an anti-inflammatory beforehand will make the procedure quite acceptable.
There is a small risk of introducing infection into the uterus and pelvis. If you develop symptoms of fevers, loss of appetite, pelvic pain, unusual discharge in the days following the procedure, please see your referring doctor for further assessment.
Very occasionally, handling of the cervix results in a reflex fall in blood pressure, and a fainting episode (cervical shock). If you are feeling faint or experiencing loss of vision or hearing during the procedure, please alert the staff.
There is a small chance that the foam may not be visible in the Fallopian tubes, even if your tubes are open. This may result in the false conclusion that the tubes are blocked. When a HyCoSy result suggests tubal blockage, this is usually followed by advice from your referring doctor to have the diagnosis confirmed with a laparoscopic dye test, considered the 'gold-standard' procedure. However if the tubes are seen to be open to the flow of dye, key-hole surgery and its associated risks can be avoided.
How will I feel after the procedure?
You may have some period-like cramps. Most women are comfortable enough to drive home and continue with usual daily activities, but if you are concerned about pain it may be worthwhile having someone available to drive you home. Local heat (hot water bottle or wheat bag) applied to the lower abdomen may be helpful to manage pain.
Some dark discharge from the vagina may be expected due to the Betadine antiseptic solution, so you may like to bring a panty-liner with you to the appointment.
If you develop symptoms of infection in the days after the procedure (eg. fever, loss of appetite, pelvic pain, unusual vaginal discharge) see your doctor as early as possible.
What preparation is required?
In general antibiotics are not necessary before the procedure but if you have a history of pelvic or uterine infections, a dose of antibiotics 2-3 hours before the procedure may be appropriate. Discuss this with your referring doctor, who will be the one to provide you with a prescription for if required.
You do not need to drink fluids to fill your bladder before the procedure.
How are bookings made?
The procedure is performed in the interval between the end of menstrual bleeding and ovulation (usually no later than Day 11 in a typical cycle). To help us determine an appropriate time for your procedure you are asked to complete the attached form and forward/fax to us together with your referral. You will then need to contact us on Day 1 of your next menstrual period so that the appointment can be scheduled in the correct window of opportunity, based on the information you have given us. We will contact you if we need to discuss any of the details that you have provided about your menstrual cycle and history.
There may be circumstances where the procedure is not feasible and if this is suspected we may recommend that you be booked for a routine pelvic scan for further evaluation first (if not already done) or discuss the alternative radiology procedure, HSG, with your doctor instead.