Hysterosalpingo-foam sonography (HyFoSy)
1. What is sonohysterography?
Sonohysterography is a minimally invasive imaging investigation that combines the use of 3D/4D ultrasound with the instillation of sterile saline solution or contrast into the uterine cavity , aiming to evaluate the uterine cavity and the patency of the uterine tubes. The informative value of the method is 80-91% .
2. What types are there?
There are 2 types of sonohysterographies:
• Saline sonohysterography involves the intrauterine infusion of saline solution to highlight pathological processes in the uterine cavity by providing contrast.
• Contrast sonohysterography (HyCoSy) and foam sonohysterography (HyFoSy) for diagnosing intrauterine pathology and assessing the patency of the fallopian tubes.
3. When is sonohysterography indicated?
Sonohysterography is indicated in:
✓ Irregularities in the menstrual cycle (painful periods, heavy or irregular menstruation, intermenstrual bleeding, etc.)
✓ Infertility
✓ Before the IVF procedure
✓ Recurrent miscarriages
This method allows for the visualization of uterine issues such as:
✓ Endometrial polyps
✓ Submucosal leiomyomas
✓ Endometrial hyperplasia
✓ Uterine congenital defects
✓ Isthmo-cervical insufficiency
✓ Endometrial adhesions/ synechiae
Additionally, contrast sonohysterography (HyCoSy and HyFoSy) can assess the permeability of the uterine tubes, determine the level of their obstruction, and highlight the presence of hydrosalpinx
4. How is it performed?
The patient is placed in a gynecological position, a vaginal speculum is applied, and the cervix and vagina are wiped with an antiseptic solution. Subsequently, a catheter is passed through the cervix into the uterine cavity through which the saline solution will be introduced. After positioning the catheter, the speculum is removed, and the endovaginal ultrasound examination begins concurrently with the instillation of the saline solution.
5. Is the procedure painful?
It's not a painful procedure, but the patient may experience abdominal discomfort/cramps when the saline solution is introduced into the uterus.
6. What can be expected after sonohysterography?
After this procedure, the patient may experience mild abdominal cramps, light genital bleeding, and watery discharge due to the elimination of the solution introduced into the uterus.
7. What are the side effects?
There may be transient pain, post-procedure bleeding, and vasovagal reactions, which manifest as dizziness, nausea, vomiting, a sensation of warmth, and cold sweats. All these manifestations are temporary.
8. What are the contraindications?
The patient must not be pregnant, which is why sonohysterography is performed in the first two weeks of the menstrual cycle, more precisely, from day 6 to day 11 of the menstrual cycle.
Before the procedure, the patient should not have pelvic inflammatory disease. This means that cervical culture tests must be negative or no older than 3 months.
9. Which tests need to be performed before sonohysterography?
It is recommended:
• Pap smear test in the last 12 months
• Vaginal secretion culture, Mycoplasma, and Chlamydia swabs taken from the cervix in the last 3 months
