HyCoSY

Hysterosalpingo-Contrast-Sonography [HyCoSy]

HyCoSy has already replaced X-ray hysterosalpingography [HSG] for fallopian tubes studies in many centres avoiding the need for pelvic organs radiation. It is an office procedure associated with minimal discomfort. Nevertheless patients are advised to take two nurofen tablets one hour before the procedure. It is done during the follicular phase of the cycle between days 5 and 10 depending on the duration of the patients menstruation..

Following aseptic insertion of a ballooned catheter into the uterine cavity the interstitial parts of both fallopian tubes are identified in the transverse pelvic plane. The contrast medium (Echovist) which is a sugar [galactose] solution is then injected slowly and each tube is identified by scanning out of the fundus and forward (anteriorly). The flow of the media for 10 seconds confirms tubal patency.

The top 2 pictures show the balloon in the uterine cavity and the left tube radiating out of the fundus and up. On the other hand the lower 2 pictures show the left and right tubes after switching on the colour Doppler.

HyCoSy with colour Doppler is as accurate as hysterosalpingography in assessing tubal patency without subjecting a patient to any x-ray radiation. Though not needed in most cases the importance of colour Doppler is well demonstrated in difficult cases with increased bowel shadows

Another advantage of HyCoSy over HSG is the ability to examine the course of the tube relative to the corresponding ovary. Any tubal displacement following pelvic adhesions might be identified.

Furthermore it could be combined with baseline ultrasound scan examination to detect any pelvic abnormality in those who have not been scanned before.

HyCoSy and 3-D Technology

Using 3D technology would allow storage of the volume for future examinations in different angles and planes. The 2 photographs shown above illustrate the multiplaner set of pictures used to create a 3D coronal cast view of the uterus and tubes. The ability to rotate the images in different planes could reveal any abnormal displacement of one or both tubes.

Contraindications

As for saline infusion sonohysterography HyCoSy is contraindicated during pregnancy and in cases of suspected pelvic infection.

Methylene blue dye test

Other than HSG and HyCoSy the tubes could be tested using methylene blue dye during laparoscopy. It is a reliable procedure and other parts of the pelvis could be examined and any adhesions or endometriosis could be dealt with at the same time. However it is an invasive procedure usually done under general anaesthesia. Occasionally spasm of one or both healthy looking tubes could give a false impression of obstruction. In these cases another method of testing the tubes would be needed to verify the results. Laparoscopy is usually indicated as a primary procedure in patients with symptomatic infertility [dysmenorrhoea and deep dyspareunia], previous pelvic surgery, long history of unexplained infertility or when clinical or ultrasound examinations showed some pelvic abnormality.