Radiation-free tubal assessment: Hysterosalpingo-foam-sonography (3D/4D HyFoSy)


  • In order to achieve natural pregnancy, the Fallopian tubes must be patent (or at least one of them), as the egg and the sperm meet each other inside the tube.
  • About 30% of infertility cases are due to blocked tubes.
  • Therefore, it is very important to check for tubal patency.
  • Normal Fallopian tubes are not visualized with conventional ultrasonography.
  • The traditional method for tubal assessment has been Hysterosalpingography (HSG). However, HSG is painful, may cause allergic reactions due to the iodine contrast utilized, and uses high doses of radiation (equivalent to 22 chest X-rays).
  • Another method is Laparoscopy. However, this is a surgical procedure that requires general anesthesia, increasing the chances of complications.



  • The latest years different methods of tubal assessment have been developed aiming to overcome the limitations of HSG, mainly radiation exposure. Many contrast agents have been tried in combination with ultrasonography, of which one of most utilized has been a saline solution. The problem with this and other similar solutions is their quick disaggregation, which results in poor visualization of the tubes.
  • Recently, a new contrast agent in the form of a foam has been developed, which has greatly improved the quality of the exam: this test is called Hysterosalpingo-Foam-Sonography (HyFoSy).
  • HyFoSy is a simple, well-tolerated outpatient ultrasound procedure which assesses the patency of the fallopian tubes, and may detect uterine abnormalities as well. No radiation or iodinated contrast material is used for a HyFoSy test.
  • To further improve its reliability, we combine this innovative technique with three-dimensional (3D) and four-dimensional (4D) scanning: 3D/4D HyFoSy, which provides an excellent visualization of the Fallopian tubes.
  • HyFoSy has become standard of care in many countries, replacing in most cases the traditional HSG.



  • Performed at the doctor’s office.
  • As efficient as HSG to visualize the tubes.
  • No radiation exposure.
  • No allergic reactions.
  • Less painful than HSG.
  • 22% increase of fertility for at least 6 months.



When is the best time to perform HyFoSy?

HyFoSy is usually done during the follicular phase of the cycle; that is, after your menstruation has ceased.


How is HyFoSy done?

  • First, a detailed vaginal ultrasound is performed, in order to assess the uterus, the ovaries, and any possible tubal problems which may impair your fertility.
  • Then, a speculum is inserted in the vagina; the cervix is thoroughly cleansed with an antiseptic solution.
  • A very thin catheter is inserted into the uterine cervix.
  • Under ultrasound vision, the contrast (foam solution) is slowly injected. The bright echoes produced by the foam can be used to visualize the uterine cavity and the tubes.


How long does HyFoSy last?

The procedure itself usually takes 10-15 minutes. Nevertheless, since HyFoSy will be preceded by a detailed ultrasound assessment, the whole examination will require about 30 minutes.


Is the HyCoSy procedure painful?

Usually, HyCoSy is a well-tolerated and produces none or slight discomfort. However, some women may experience some mild tenderness. In order to prevent you from having pain, we may prescribe you a painkiller before the procedure. Please contact us for more information.


Is HyFoSy safe?

Yes. Since its launch in 2010, over 16000 tubal patency tests (as December 2014) have been carried out with no reported adverse or allergic reactions. Thus, the combination of glycerol, hydroxyethyl cellulose and purified water (the foam components) is considered to be safe for intrauterine application and tubal patency testing.


Are there any contraindications? 

HyFoSy should not be performed:

  • During pregnancy or if you may be pregnant.
  • In the presence of active pelvic infection, sexually transmitted diseases and profuse vaginal bleeding.
  • In case you have certain severe diseases. Please contact us for more info.


What are possible complications/ problems of HyFoSy?

The most common complication of HyFoSy is mild abdominal pain. Complications similar to HSG may occur, but are extremely rare:

  • Infection of the uterus/pelvis following this procedure is extremely unusual, but it has been reported. You should contact us immediately if you have the following symptoms:
    • Persistent or foul-smelling vaginal discharge,
    • Increasing lower abdominal pain,
    • Unexplained fever,
    • You don’t feel well.
  • Sometimes the tubes (either one or both) are not seen during the HyFoSy procedure. This may be due to:
    • Spasm of the uterus at the opening of the fallopian tubes, which may temporarily prevent the flow of contrast from the uterus into the tube,
    • Permanent tubal occlusion related to an underlying problem (e.g., pelvic adhesions),
    • Technical factors, which may hinder visibility during the ultrasound (such as uterine fibroids, overweight women, or bowel hiding the tubes).

It is important to remember that HyCoSy (like HSG) may not provide definitive answers in all women. In this situation, we will discuss with you whether you need to have further investigations, such as laparoscopy.


Is there any other information I need to know about the procedure?

  • You can eat and drink normally after the procedure.
  • While most women tolerate the procedure well, some may have some cramping. Bear this in mind if you have programmed any activities after the procedure.
  • You can expect a discharge from the vagina for about 24 hours, which is absolutely normal.
  • Antibiotics are not routinely prescribed during this test. Nevertheless, they may be sometimes recommended in order to prevent an infection.


Please Contact Us for any other information you may require.