Fertulity IVF
Fertulity IVF

Aqua Scan (Saline Infusion Sonography – SIS): Accurate Uterine Cavity Evaluation with Ultrasound

What Is Aqua Scan (Saline Infusion Sonography – SIS)

Aqua Scan, also known as Saline Infusion Sonography (SIS), is a specialized diagnostic ultrasound examination used for the detailed evaluation of the uterine cavity. It is a modern and minimally invasive procedure during which a small amount of sterile saline solution is infused into the uterus through a thin catheter in order to improve the visibility of the internal uterine structures.

The presence of the fluid gently expands the uterine cavity, allowing the doctor to identify possible abnormalities or structural changes with greater accuracy, including findings that may not always be visible during a standard transvaginal ultrasound. In this way, Aqua Scan provides high-resolution imaging of the endometrium and contributes significantly to accurate diagnosis.

This examination is widely used in fertility investigations, as the normal structure of the uterine cavity is essential for successful embryo implantation. At the same time, it is a valuable diagnostic tool for evaluating gynecological symptoms such as abnormal uterine bleeding, providing reliable information about the anatomy and condition of the uterus.

How Does HyCoSy Differ from Hysterosalpingography (HSG)

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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

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:
Painless and non-invasive test, with no need for anesthesia or medications
No radiation exposure
Zero risk of allergic reaction due to the absence of iodine
High diagnostic accuracy in assessing tubal patency
Immediate return to daily activities
Can be combined with evaluation of the ovaries and endometrium
Real-time imaging with instant explanation from the doctor

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

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Dr. Chrysostomos Papadopoulos - Specialist in Infertility, Endocrinology & Menopause in Athens

Dr. Maria Oikonomou Obstetrician – Gynecologist

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