Patient guide · Fertility ultrasound
Hysterosalpingo-contrast sonography (HyCoSy), outpatient ultrasound-based tubal patency test with no radiation.
HyCoSy uses transvaginal ultrasound with a foam or saline contrast (ExEm Foam) to assess uterine cavity and tubal patency. Radiation-free alternative to hysterosalpingogram (HSG) — well tolerated, outpatient, and part of the modern fertility workup.
Reviewed by Pulse Atlas Editorial Board, · Published 2026-07-30 · Next review 2027-07-30 · 6 min read
Key facts
What HyCoSy is, in six lines.
The essentials — what the test does, how it feels, and where it sits in a modern fertility work-up.
- 01
Definition
Transvaginal ultrasound combined with a contrast agent to assess the uterine cavity and fallopian-tube patency.
- 02
No radiation
Ultrasound-based, so no X-rays and no iodinated contrast — safe to repeat if needed.
- 03
Outpatient
No admission, no sedation. Home the same visit, with typical mild cramping only.
- 04
ExEm Foam contrast
A stable air-and-gel foam infused through the cervix, echogenic on ultrasound.
- 05
Alternative to HSG
A modern alternative to hysterosalpingogram — no radiation, no iodine.
- 06
Bundled fertility work-up
Combined with pelvic ultrasound and antral follicle count in a single appointment.
Preparation and procedure
From consultation to report — what happens, in order.
Seven steps, most of them straightforward. The scan itself is typically 20–30 minutes.
Phase 1 · Before your scan
Consultation and timing
Phase 2 · On the day
~20–30 minutes at the clinic
Phase 3 · After
Report and plan
- 01
Before
Fertility specialist consultation
A specialist reviews your history, prior scans and blood work before booking the procedure.
- 02
Before
Timed to days 5–12 of your cycle
Booked after menstruation and before ovulation for optimal imaging conditions.
- 03
Before
NSAID before procedure
A simple oral pain reliever (e.g. ibuprofen) taken ~1 hour before the appointment.
- 04
On the day
Speculum and cervical catheter
A speculum is inserted, the cervix cleaned, and a thin catheter placed in the uterine cavity.
- 05
On the day
ExEm Foam infusion under ultrasound
The foam is infused slowly while the sonographer watches in real time on transvaginal ultrasound.
- 06
On the day
Tubal patency assessed
Foam passage through each fallopian tube is directly visualised and recorded.
- 07
After
Written report and plan
A formal report is issued and reviewed with your fertility specialist to shape the next step.
What it shows
The findings HyCoSy is designed to answer.
Tubal patency, cavity anatomy and adnexal structures — the answers that shape a fertility plan.
-
Bilateral tubal patency
Both fallopian tubes freely allow contrast passage — reassuring for natural conception.
-
Unilateral tubal blockage
One tube patent, one blocked — informs IUI, IVF or laparoscopic decisions.
-
Bilateral tubal blockage
Neither tube patent — usually a direct indication to consider IVF.
-
Uterine cavity anomalies (polyp, fibroid, septum)
Endometrial polyps, submucosal fibroids or a uterine septum distorting the cavity.
-
Adenomyosis signs
Junctional-zone thickening and other markers suggestive of adenomyosis.
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Adhesions
Intrauterine adhesions (Asherman’s) or pelvic adhesive disease.
-
Hydrosalpinx
Fluid-filled, dilated tube — a known negative influence on IVF success.
-
Red flag: complex adnexal mass or acute severe pelvic pain — same-day gynae review
A suspicious mass or severe pain during the procedure warrants immediate gynaecology assessment.
Next steps
What HyCoSy findings typically lead to.
The onward pathway depends on the specific finding — from natural conception advice to fertility surgery and IVF.
-
Fertility treatment planning (IUI, IVF)
Results guide whether ovulation induction with IUI, or IVF, is the right route.
-
Hysteroscopic polypectomy
Day-case hysteroscopic removal of endometrial polyps distorting the cavity.
-
Myomectomy for fibroids
Surgical removal of submucosal fibroids affecting the endometrium.
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Laparoscopy and dye for suspected adhesions
Diagnostic and therapeutic laparoscopy where adhesive disease is likely.
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Salpingectomy for hydrosalpinx
Removal of a hydrosalpinx before IVF to improve implantation rates.
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Endometrial receptivity work-up
Further tests (e.g. ERA) where implantation failure is suspected.
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Structured fertility MDT
Multidisciplinary review — reproductive medicine, gynaecology and embryology.
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Genetic and immunology add-ons
Karyotyping, thrombophilia and immune screens for recurrent loss or failed IVF.
Red flags
When HyCoSy findings need urgent onward review.
Nine clinical situations where the result carries more weight and needs prompt specialist input.
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Bilateral tubal occlusion
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Uterine septum
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Recurrent pregnancy loss
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Hydrosalpinx impacting IVF
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Chlamydia antibody positive
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Post-infection tubal disease
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Endometriosis with complex adnexal mass
-
Post-surgical adhesions
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Undiagnosed pelvic pain
Sources
Guidelines this guide is built on.
Reviewed by Pulse Atlas Editorial Board, . Last reviewed 2026-07-30. Next review 2027-07-30.
Frequently asked
Everything we get asked about HyCoSy.
Quick answers on comfort, timing, HSG comparison and when a laparoscopy is still the right test.
-
What is a HyCoSy and what does it show?
HyCoSy (hysterosalpingo-contrast sonography) is a transvaginal ultrasound performed with a foam contrast agent (ExEm Foam) infused through the cervix. It shows the shape of the uterine cavity, identifies polyps, fibroids or a septum, and directly assesses whether each fallopian tube is patent.
-
Is HyCoSy better than a hysterosalpingogram (HSG)?
HyCoSy is a radiation-free alternative to HSG. It uses ultrasound rather than X-rays, avoids iodinated contrast, and is generally as well tolerated. HSG is still used in some centres and offers particular views of the tubes; HyCoSy is now widely preferred in modern fertility work-ups.
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When in my cycle is HyCoSy done?
Ideally between days 5 and 12 of your cycle — after menstruation has finished and before ovulation. This timing gives the clearest views of the uterine cavity and reduces the small risk of disturbing an early pregnancy.
-
Is HyCoSy painful?
Most patients describe mild to moderate period-like cramping during and shortly after the infusion. A simple oral pain reliever (e.g. ibuprofen) taken about an hour before the procedure is usually sufficient. Discomfort typically settles within a few hours.
-
How quickly are results available?
The sonographer will usually discuss the main findings with you immediately after the scan. A formal written report is issued to your fertility specialist within a few working days to shape the next step.
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When would I still need a laparoscopy and dye test?
If HyCoSy suggests adhesions, endometriosis or gives an ambiguous result — or if pelvic pain is a significant symptom — a diagnostic laparoscopy and dye test may be recommended for a more definitive assessment.
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In practice, in London
Getting hysterosalpingo contrast sonography hycosy sorted in London, without the guesswork
With hysterosalpingo contrast sonography hycosy, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. The wait for hysterosalpingo contrast sonography hycosy on the NHS depends heavily on where you live and how urgently the referral is graded. Central and West London private clinics can normally book within a week, with imaging or a procedure slot to follow shortly after. It’s worth being honest about the reason for going private: usually it’s time, not a fundamentally different test.
A private hysterosalpingo contrast sonography hycosy pathway in London usually looks like this: an initial consultation, any diagnostics booked at a nearby facility (most within Zone 1 or 2), and a written report sent to you and your GP within a few days. The consultants we work with hold NHS posts alongside their private lists, which keeps the standards consistent across both settings. For hysterosalpingo contrast sonography hycosy specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
Fit matters more than people expect. For hysterosalpingo contrast sonography hycosy, the right consultant depends on what you actually need — a second opinion, a definitive diagnosis, a bridge into treatment, or reassurance that nothing’s being missed. We match on that, not on who has the biggest brochure. If a test isn’t the right next step, we’ll say so before you book anything.
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