SALINE INFUSION HYSTEROSONOGRAPHY (SIS) and HYSTERO SALPINGO CONTRAST SONOGRAPHY (HyCoSy)

 

What is an SIS/HyCoSy?

It is an ultrasound performed to:

(a) assess the direction of the neck of the womb (endocervical canal) placing a small catheter through the cervix,

(b) confirm that the uterine cavity is normal (ensure there are no polyps or fibroids) injecting sterile saline fluid to permit dilation of cavity,

(c) to assess tubal patency injection of a special fluid (exem foam) through the same catheter to

confirm the passage of this fluid through the fallopian tubes into the pelvis (pouch of Douglas).

 

It is an outpatient procedure, which takes less than half an hour to perform. It is usually done after menstruation has ended but before ovulation (to prevent interference with early pregnancy) usually between day 6 – 12 of your cycle. It can be performed at any time of the cycle if the patient is on oral contraceptive pill.

 

How is it done?

The patient lies on a table and the Gynaecologist places a speculum in the vagina and cleans the cervix. Then a small catheter is placed into the opening of the cervix. This gives information necessary for correct placement of embryos at transfer time. The doctor then fills the womb with sterile saline fluid through the cannula in the womb. This profiles the cavity to confirm normality. Then special fluid which is used for the HyCoSy is injected in. This appears very white at the ultrasound and the doctor can follow the filling, the profile and dilation of the tubes and finally the spillage in the pouch of Douglas. Spillage confirms the patency of the fallopian tubes, visualization of the tubal position, shape and size and diagnosis of other tubal abmormality as adhesions and/or hydrosalpinx. HyCoSy is done under ultrasound and does not use radioactive contrast or x rays which is used for an HSG, and it is a dynamic test permitting acquisition of more information at the same time. The ovaries are also imaged. This test in not designed to diagnosis endometriosis unless there is an endometriotic cyst present (endometrioma) that can be visualized when assessing the ovaries. After the procedure, the patient can immediately resume normal activities although some doctors ask that the patient refrain from intercourse for few days. Instructions are given to the patient before discharge.

 

Is it uncomfortable?

It may cause mild or moderate cramping for about five minutes and some patients may experience cramps for several hours. Pain medication can be taken for these including Advil, Ibuprofen or Paracetamol.

 

What are the risks and complications of SIS/HyCoSy?

It is considered a very safe procedure; however they’re some rare but serious complications which occur less than 1% of the time:

 

 

Infection: This is the most common serious although rare problem with SIS. It may occur in the presence of previous tubal disease. In rare cases it can damage or necessitate the removal of the fallopian tubes. A patient should call the doctor if she experiences pain or a fever within one to two days of SIS. Antibiotics are given to minimize this chance.

Fainting: Rarely the patient gets light-headed during or shortly after the procedure.

Spotting: Spotting commonly occurs for one or two days after the SIS. The patient should notify the doctor if she does experience heavy bleeding after this investigation.

 

Are there any special precautions I should take before SIS/HyCoSy?

Yes. Eat before the procedure. Also you will need an empty bladder. Finally, we recommend you take two painkillers approximately 1 hour before the procedure.