40w LaterGuide

If the fallopian tubes—the pathway where the egg and sperm usually meet—are blocked, it can be more difficult to become pregnant. Two commonly used tests to check whether the fallopian tubes are open are hysterosalpingography (HSG) and hysterosalpingo-contrast sonography (HyCoSy).

HSG: A widely used X-ray test

HSG is an X-ray examination used to assess the inside of the uterus and whether the fallopian tubes are open.

During the procedure, a contrast medium is introduced through the cervix into the uterus. X-ray images are then taken as the contrast fills the uterine cavity and passes through the fallopian tubes.

If the contrast flows through a tube and spills into the pelvic cavity, the tube is considered likely to be open. If the contrast does not pass through, a blockage may be suspected.

HSG can also provide information about the shape of the uterine cavity. However, if a uterine abnormality is suspected, additional tests such as ultrasound, sonohysterography, hysteroscopy, or MRI may sometimes be needed.

A finding of blockage, especially near the uterus, does not always mean that the tube is permanently blocked. Temporary tubal spasm or technical factors can sometimes produce an abnormal result, so additional evaluation may be needed.

HyCoSy: Checking the tubes with ultrasound

HyCoSy evaluates tubal patency using ultrasound rather than X-rays.

A contrast solution, foam, or fluid containing microbubbles is introduced through the cervix. The clinician then uses transvaginal ultrasound to observe whether the contrast passes through the fallopian tubes.

Because HyCoSy uses ultrasound, it does not involve ionizing radiation.

When are these tests performed?

Both tests are usually scheduled after menstrual bleeding has ended and before ovulation, when pregnancy is unlikely.

The exact timing and preparation can vary depending on the clinic, menstrual cycle, and type of contrast used. Follow the instructions provided by the medical facility.

How long do they take?

The actual examination is usually relatively brief, although the total time spent at the clinic may be longer because of preparation and observation.

Cramping or discomfort can occur with either test, and the intensity varies from person to person.

Which test is more accurate?

Both HSG and HyCoSy are considered valid methods for assessing whether the fallopian tubes are open, and their overall diagnostic performance is broadly comparable. HyCoSy results may be more dependent on the experience of the person performing the ultrasound.

What are the advantages of HyCoSy?

The main advantage is that it does not use X-rays. It can also allow simultaneous ultrasound assessment of the uterus and ovaries.

What are the advantages of HSG?

HSG is widely available and provides clear images of the uterine cavity and the course of the fallopian tubes. It may also provide useful information about the location and pattern of a suspected tubal blockage.

Which test is best depends on your medical history, available testing options, and your healthcare provider’s recommendation.