Hysterosalpingo-Contrast Sonography (Aqua Scan or HyCoSy)

Modern & Painless Imaging of Fallopian Tube and Uterine Anatomy

What is Hysterosalpingo-Contrast Sonography (also known as Aqua Scan or HyCoSy)

HyCoSy (Hysterosalpingo-Contrast Sonography), also known as Aqua Scan, is a modern, painless, and non-invasive examination that provides detailed imaging of the uterus and the patency of the fallopian tubes using ultrasound and a foamy contrast medium (ExEm Foam®). This method is a worthy replacement for the older hysterosalpingography (HSG), offering a more comfortable and patient-friendly experience. At the same time, it is one of the most essential tests in fertility evaluation, since blocked or non-functional fallopian tubes account for over 30% of infertility cases.

The role of the fallopian tubes in conception is crucial, as this is where fertilization of the egg by the sperm takes place. If the tubes are blocked or non-functional, natural conception becomes impossible. The HyCoSy test evaluates tubal patency — whether the tubes are open and allow passage of the egg — and detects potential intrauterine abnormalities such as polyps, fibroids, or adhesions. It is a test for women with fertility issues that involves no radiation, no iodine, and avoids the discomfort associated with traditional hysterosalpingography (HSG).

How Does HyCoSy Differ from Hysterosalpingography (HSG)

Book A Consultation

Traditionally, fallopian tube obstruction was diagnosed using hysterosalpingography, an X-ray-based test with iodinated contrast dye. However, HSG is often painful, involves radiation exposure, and does not provide clear images of the uterus and ovaries. In contrast, HyCoSy is painless or causes minimal discomfort, does not involve radiation, uses no iodine, and enables full ultrasound assessment of the entire reproductive tract. Furthermore, it provides valuable real-time information, aiding in immediate decision-making regarding the next steps.

  
        Characteristic
        Hysterosalpingo-Contrast Sonography (HyCoSy)
        Hysterosalpingography (HSG)
      
        Test Duration
        15–20 minutes
        30–45 minutes
      
        Pain Level
        Mild
        Moderate to severe
      
        Contrast Medium
        ExEm Foam®
        Iodinated contrast agent
      
        Imaging
        High-definition ultrasound
        X-ray
      
        Radiation Exposure
        None
        High dose of radiation
      
        Possible Allergic Reactions
        None
        Yes (due to iodine)
      
        Recovery Time
        None, immediate return to daily life
        Recovery period needed
      
        Full Uterine Evaluation
        Yes, simultaneous endometrial assessment
        Limited

Characteristic	Hysterosalpingo-Contrast Sonography (HyCoSy)	Hysterosalpingography (HSG)
Test Duration	15–20 minutes	30–45 minutes
Pain Level	Mild	Moderate to severe
Contrast Medium	ExEm Foam®	Iodinated contrast agent
Imaging	High-definition ultrasound	X-ray
Radiation Exposure	None	High dose of radiation
Possible Allergic Reactions	None	Yes (due to iodine)
Recovery Time	None, immediate return to daily life	Recovery period needed
Full Uterine Evaluation	Yes, simultaneous endometrial assessment	Limited

When Is HyCoSy Recommended

Diagnostic Hysterosalpingo-Contrast Sonography (HyCoSy) is a routine test in the context of evaluating female infertility and is especially recommended in cases such as:

Difficulty conceiving naturally (primary or secondary infertility)

History of infections, salpingitis, or endometriosis

Recurrent miscarriages or failed IVF attempts

Prior to initiating an IVF or IUI cycle

To confirm normal tubal anatomy after surgery or treatment

Accurate and timely evaluation of the fallopian tubes helps doctors choose the most appropriate therapeutic approach, whether it involves natural conception or in vitro fertilization.

What Is the Procedure of the Examination

The HyCoSy test is very brief, lasting 15–20 minutes, and is ideally performed between the 6th and 10th day of the patient’s cycle. The steps of the test are:

The woman is positioned in the gynecological chair, just like a standard ultrasound.

After a routine gynecological exam, a thin catheter is inserted through the cervix.

The foamy contrast ExEm Foam® is gently injected into the uterine cavity.

Transvaginal ultrasound is used to track the path of the fluid through the fallopian tubes and detect any blockages or dysfunction.

If the contrast flows freely into the peritoneal cavity, the tubes are considered patent. If flow is obstructed, blockage or adhesions may be present. Additionally, the structure of the uterus and endometrium is assessed by the specialist conducting the exam.

What Are the Advantages of HyCoSy

The HyCoSy test has several advantages and presents virtually no disadvantages.

Specifically:

HyCoSy and Increased Pregnancy Chances

Scientific evidence suggests that HyCoSy not only diagnoses problems but may also offer therapeutic benefits. The passage of the foamy contrast agent through the fallopian tubes may help dislodge minor adhesions or blockages, temporarily increasing the chances of natural conception in the following months. A 2022 study published in Ultrasound in Obstetrics and Gynecology showed a 29% increase in pregnancy rates within three months after HyCoSy, especially in women without major pathology.

(Source: Johnson et al., Ultrasound in Obstetrics and Gynecology, 2022)

Frequently asked questions about HyCoSy or Aqua Scan

Is HyCoSy painful?

No. Most women report mild discomfort, similar to period cramps. Unlike HSG, there is no need for anesthesia during the procedure or painkillers afterward.

How long does the test take?

The test lasts approximately 15–20 minutes in total. It is performed in the office and does not require hospitalization.

Are there any side effects?

Rarely, there may be light bleeding or mild discomfort after the test, which subsides quickly. Preventive antibiotics may be needed in some cases.

What should I be aware of before the test?

The test is performed after the menstrual period and after presenting a negative pregnancy test.

When is HyCoSy not recommended?

HyCoSy is not recommended in cases of active infection, possible pregnancy, or insufficient information about the menstrual cycle.

Our Doctors

In an era where fertility requires knowledge, care, and substantial guidance, FertUlity is not an impersonal clinic. It is two people who look you in the eye and accompany you step by step on the journey you dream of.

Dr. Maria Oikonomou Obstetrician – Gynecologist

See Full CV

Dr. Chrysostomos (Makis) Papadopoulos Obstetrician – Gynecologist, MD, PhDc, MIC I

See Full CV

The First Step Starts Now

You don’t need to have all the answers to begin.
All it takes is one first step, and a team that truly listens.

Book Your Consultation

FertulityThrough the Words of Parents

100% genuine, public Google reviews.
Because every fertility journey begins with honesty and trust.

Why choose FertUlity?

Because every fertility journey deserves the right support.

At FertUlity, we provide science-based fertility care with a human approach.
We support every path, from fertility assessment and preservation to modern assisted reproduction.