Ultrasound Hysterosalpingography (HyCoSy / HyFoSy) Ultrasound Hysterosalpingography (HyCoSy / HyFoSy)

What Is Ultrasound Hysterosalpingography (HyCoSy / HyFoSy)?

HyCoSy (Hysterosalpingo-Contrast Sonography) or HyFoSy (Hysterosalpingo-Foam Sonography) is a modern, painless, and minimally invasive examination primarily used to assess fallopian tube patency through ultrasound imaging with the use of a special contrast foam agent (ExEm Foam®). It is considered one of the most important examinations in fertility assessment, as blockage or dysfunction of the fallopian tubes is one of the leading causes of infertility and accounts for a significant percentage of conception difficulties.

During the examination, the physician evaluates whether the fallopian tubes are patent, meaning whether they allow the normal passage of the egg and the transport of sperm toward it, enabling fertilization to occur. If blockage or reduced tubal patency is detected, the chances of natural conception may be directly affected. At the same time, the examination provides a general assessment of the uterine cavity and uterine anatomy, although this is not considered the primary purpose of the procedure. HyCoSy / HyFoSy is performed without radiation exposure, without the use of iodine, and without the discomfort associated with older methods such as Hysterosalpingography (HSG), offering a safe and reliable solution for modern fertility evaluation.

How Does HyCoSy Differ from Hysterosalpingography (HSG)?

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Traditionally, the diagnosis of fallopian tube blockage was performed using Hysterosalpingography (HSG), an examination based on fluoroscopy and the use of iodine-based contrast dye. This method is often associated with discomfort or pain, involves exposure to radiation, and does not provide a comprehensive evaluation of all reproductive organs.

In contrast, HyCoSy / HyFoSy is a modern fallopian tube examination performed under ultrasound guidance, without radiation exposure and without the use of iodine. It is painless or causes only minimal discomfort, while allowing real-time assessment of fallopian tube patency. At the same time, it provides a comprehensive evaluation of the reproductive anatomy, including the myometrium, the external contour of the uterus, and the ovaries, with high diagnostic accuracy.

The ability to obtain immediate and reliable information makes HyCoSy / HyFoSy a particularly valuable tool in fertility assessment, facilitating fast and targeted decision-making regarding the next steps of the treatment approach.

  
        Feature
        HyCoSy / HyFoSy
        Hysterosalpingography (HSG)
      
        Examination Duration
        15–20 minutes
        30–45 minutes
      
        Pain Level
        Mild or minimal discomfort
        Moderate to severe discomfort
      
        Contrast Medium
        Contrast foam agent (ExEm Foam®)
        Iodine-based contrast dye
      
        Imaging Method
        High-resolution ultrasound
        Fluoroscopy
      
        Radiation Exposure
        None
        Present
      
        Allergic Reactions
        Extremely rare
        Possible (due to iodine)
      
        Recovery Time
        Immediate return to daily activities
        Recovery time may be required
      
        Fallopian Tube Assessment
        Yes, in real time
        Yes
      
        Uterine Evaluation
        Secondary, basic assessment
        Limited (mainly endometrial evaluation)

Feature	HyCoSy / HyFoSy	Hysterosalpingography (HSG)
Examination Duration	15–20 minutes	30–45 minutes
Pain Level	Mild or minimal discomfort	Moderate to severe discomfort
Contrast Medium	Contrast foam agent (ExEm Foam®)	Iodine-based contrast dye
Imaging Method	High-resolution ultrasound	Fluoroscopy
Radiation Exposure	None	Present
Allergic Reactions	Extremely rare	Possible (due to iodine)
Recovery Time	Immediate return to daily activities	Recovery time may be required
Fallopian Tube Assessment	Yes, in real time	Yes
Uterine Evaluation	Secondary, basic assessment	Limited (mainly endometrial evaluation)

When Is HyCoSy Recommended?

HyCoSy / HyFoSy is an essential diagnostic tool in fertility evaluation and is recommended when reliable assessment of fallopian tube patency is required. It is particularly indicated for women experiencing difficulty conceiving, whether due to primary or secondary infertility, as well as in cases where tubal dysfunction is suspected.

More specifically, the examination is recommended in cases such as:

Difficulty conceiving naturally (primary or secondary infertility)
History of pelvic inflammatory disease (PID), salpingitis, or endometriosis
Before starting assisted reproduction treatments such as Intrauterine Insemination (IUI)

The examination may also be used to confirm fallopian tube patency after surgical procedures or therapeutic interventions. In cases of unexplained infertility, it plays an important role in ruling out tubal factor infertility as a possible cause. Accurate and timely evaluation of fallopian tube patency allows targeted clinical decision-making, increasing the chances of successful conception, either naturally or through assisted reproductive treatments. Η ακριβής και έγκαιρη αξιολόγηση της βατότητας των σαλπίγγων επιτρέπει τη λήψη στοχευμένων αποφάσεων, αυξάνοντας τις πιθανότητες επιτυχούς σύλληψης, είτε με φυσικό τρόπο είτε μέσω υποβοηθούμενης αναπαραγωγής.

What Is the Procedure of the Examination

The HyCoSy examination is very short, lasting approximately 15–20 minutes, and is preferably performed between the 6th and 12th day of the patient’s menstrual cycle.

More specifically, the examination is recommended in cases such as:

The woman is positioned in a gynecological examination position, similar to a standard ultrasound examination.
After a routine gynecological examination, a thin catheter is inserted through the cervix.
The ExEm Foam® contrast agent is gently infused into the uterine cavity.
Using transvaginal ultrasound imaging, the physician monitors the flow of the contrast medium through the fallopian tubes and identifies possible dysfunctions or blockages.

If the contrast medium flows freely into the peritoneal cavity, the fallopian tubes are considered patent. If the flow is obstructed, blockage or adhesions may be present. In addition, the structure of the uterus and the endometrium is evaluated by the fertility specialist performing the examination.

What Are the Advantages of HyCoSy

The HyCoSy examination offers numerous advantages and presents virtually no significant disadvantages.

Specifically:

HyCoSy and Increased Chances of Pregnancy

Scientific evidence suggests that HyCoSy / HyFoSy may not only serve as a diagnostic examination but may also help improve the chances of natural conception. The passage of the contrast foam through the fallopian tubes may create a mechanical “tubal flushing” effect, helping remove minor blockages or adhesions that may not be visible on imaging examinations. A study by Engels et al. (2023), which evaluated pregnancy rates after hysterosalpingo-foam sonography (HyFoSy), showed that a significant percentage of women achieved spontaneous pregnancy during the first months following the examination, particularly in cases of unexplained infertility and shorter duration of conception attempts. This potential positive effect makes HyCoSy / HyFoSy not only a valuable tool for diagnosing fallopian tube patency, but also an examination that may practically contribute to improving fertility in selected cases.

Frequently asked questions about HyCoSy / HyFoSy

Is HyCoSy / HyFoSy painful?

No. Most women describe only mild discomfort, similar to light menstrual cramps. Unlike Hysterosalpingography (HSG), HyCoSy / HyFoSy does not require anesthesia during the examination or pain medication afterward.

How long does the examination take?

The examination lasts approximately 15–20 minutes in total. The procedure is performed in the doctor’s office and does not require hospitalization.

Are there any side effects?

In rare cases, mild spotting or slight discomfort may occur after the examination, but these symptoms usually resolve quickly. In certain cases, preventive antibiotics or mild pain relievers may be recommended.

What should I know before the examination?

The examination is performed after menstruation and once a negative pregnancy test has been confirmed.

When is HyCoSy not recommended?

HyCoSy is not recommended in cases of active infection, possible pregnancy, or insufficient information regarding 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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FertulityThrough the Words of our Parents

100% genuine, public Google reviews.
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      EXCELLENT  
   Based on 12 reviews 
    
 
 
 
   
 
 
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   Μαρια 
 26 days ago
 
 
  The word "thank you" to Dr. Makis Papadopoulos is too small to describe the gratitude we feel for this man. I am pregnant after IVF, having succeeded on the first attempt, and we owe this exclusively to our doctor. First Contact & Communication: From the very first contact, he won us over with his kindness, enthusiasm and willingness to dedicate as much time as we needed. Willing to explain everything in every detail, he solved every question we had in depth — not even a professor to students would analyze them with such patience and contagiousness! Scientific Training: He is an excellent scientist, with deep knowledge of the subject, a perfectionist and focused professional who leaves absolutely nothing to chance. He designed the right treatment for us, solving every problem down to the last detail, making us feel that whatever problem arises, it is certain that it will be solved. HUMANITY & SUPPORT: The most important thing, however, is his humanity. Communication with him was Immediate and he always had as much time as you needed on the phone to solve every question. He showed a deep, real interest, embracing us not just as a doctor, but as if he were our brother. We highly recommend him to every couple starting this journey. He deserves blind trust! We thank you from the bottom of our hearts for the greatest miracle of our lives!

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   Alexandra 
 52 days ago
 
 
  I don't often write reviews, but I feel that Mr. Makis truly deserves it. From the very first moment, he made me feel safe and confident. He listened carefully to what was on my mind, answered every question I had, and explained everything in a simple way, always based on scientific data. Many times, he even sent me relevant scientific studies so that I could better understand why he was suggesting a particular approach. But what stood out to me the most was that he didn't stop at the appointment. He followed up, was genuinely interested in my progress, and was available when I needed him. This is something you rarely encounter. Fortunately, he returned to Greece. He is one of the few doctors who, beyond their knowledge, remain above all human beings. He makes you feel like he sees you as a person and not as just another incident.

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   Matina 
 69 days ago
 
 
  A big thank you to Dr. Makis Papadopoulos who supported us from day one, who checked every little detail, who explained to us every move-step, every test, every medication for the reason we were doing it and what we would achieve. With incredible experience, knowledge, a lot of patience (because we had two other failed attempts with another doctor) and trust, within 8 months he adapted the protocols for our case and we achieved the positive result and we hold in our arms a priceless diamond. Above all, a rare person, calm and always available to listen to our concerns and reassure us. I highly recommend him!

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   Eva 
 93 days ago
 
 
  Thanks to Dr Makis Papadopoulos, I am now holding my two beautiful babies in my arms! He is a true expert. Professional with a human centric approach, friendly and empathetic, always available to answer our (many many) questions. I trust Dr Makis blindly and, honestly, I cannot recommend him enough!
  
 
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   Ivy 
 100 days ago
 
 
  My experience with Dr. Makis took me from a clinical stagnation to an incredible breakthrough, highly recommend Dr. Makis! Navigating the exhausting world of IVF, you know how devastating it is to watch your protocol dosages go up while your results go down. After three intense, high-dosage cycles with a previous clinic, I was left feeling incredibly discouraged. Despite escalating medications and growth hormones, my blastocyst yield was dwindling, culminating in a heartbreaking round with zero blastocysts. I knew I needed a doctor who didn't just follow a standard script, but who truly understood the nuances of egg quality and customized protocols. That is when I found Dr. Makis. Dr. Makis completely revolutionized my treatment plan. Instead of just pushing maximum dosages, he took a highly strategic, tailored approach. The result? Quality over pure protocol size. While my previous doctors kept increasing the medication dosages (which yielded fewer or zero blastocysts), Dr. Makis completely changed the strategy. He lowered the heavy stimulation, introduced smart egg-quality support (like melatonin), changed the protocol style entirely, and achieved a 700% increase in blastocysts compared to my best previous rounds. Beyond the incredible results, Dr. Makis brings a level of expertise, precision, and reassuring care that is rare to find. He looks at you as an individual, not a statistic, and knows exactly how to pivot when traditional routes fail. If you are looking for a specialist who can turn a difficult prognosis into an overwhelming success, look no further than Dr. Makis. I am incredibly grateful for his care.
  
 
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   Olga 
 111 days ago
 
 
  Dr. Makis Papadopoulos was excellent, professional, and very reassuring throughout the entire process. Thanks to his expertise and guidance, we were able to identify the issue early and take the appropriate steps from the beginning. He took the time to explain everything clearly, answered all our questions with patience, and made us feel comfortable and confident throughout our journey. We truly appreciated his caring approach, professionalism, and dedication. Highly recommended!
  
 
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   Euaggelia 
 122 days ago
 
 
  Dr. Makis Papadopoulos is an excellent scientist and above all a rare person! He is an approachable and smiling doctor, with excellent medical knowledge, who from the first moment I met him made me feel comfortable and trust him completely, answering every question I had with patience and documenting every answer with scientific studies and articles! The most important thing, however, is that Dr. Makis Papadopoulos is always there on the other end of the line to listen to you and reassure you without a trace of haste, a doctor who truly cares and makes you feel like he is your own person! Makis, thank you very much for everything!!! I am very lucky to have met you!

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   Anastasia 
 129 days ago
 
 
  Dr. Makis Papadopoulos is an excellent scientist with a human-centered interest. Our collaboration was excellent from the very beginning and he made me feel confident and secure by explaining every step of the process in great detail. I highly recommend him!

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   Fay 
 131 days ago
 
 
  Dr Makis Papadopoulos is very professional, caring and attentive. Very thorough in explaining the whole process throughout every step. Thank you! Highly recommended!!
  
 
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   Christina 
 134 days ago
 
 
  I would like to share my experience with Dr. Makis Papadopoulos, an outstanding gynecologist and scientist. We first connected in the summer of 2024, while he was based in Germany, through a mutual acquaintance, following a particularly challenging period for us. Prior to meeting him, we had gone through repeated unsuccessful attempts of stimulation and fertilization with other gynecologists. Unfortunately, those approaches relied largely on standardized protocols, without sufficient personalization to address the specific needs of my case. From the very beginning, Dr. Makis stood out for his human-centered approach and his willingness to dedicate time to truly understand our situation in depth. With strong, up-to-date scientific knowledge, he approaches every case holistically, focusing on individualized treatment and adapting protocols to the patient's unique needs. Throughout our collaboration, which now spans approximately two years (with a few breaks on our side), he has consistently been available, supportive, and clear in his guidance. He inspired confidence and helped us stay positive even during difficult phases of the journey. Beyond his scientific expertise, what truly sets him apart is his genuine care for the person behind each case: his empathy, honesty, and continuous effort to achieve the best possible outcome. My husband and I are deeply grateful for his support and guidance, and we now feel ready and optimistic to move forward to the next final stage. We highly recommend him to anyone seeking a gynecologist with true expertise, professionalism, and compassion. I would like to share my experience with Dr. Makis Papadopoulos, an excellent gynecologist and scientist. We met in the summer of 2024, when he was in Germany, through a mutual acquaintance, after a particularly demanding period for us. Before meeting him, we had gone through repeated failed attempts at stimulation and fertilization with other gynecologists. Unfortunately, the approaches that had been followed were mainly based on standardized protocols, without the necessary individualization to the specifics of my case. From the beginning, Dr. Makis stood out for his human approach and his willingness to spend time to understand our case in depth. With modern knowledge and scientific training, he approaches each issue multidimensionally, emphasizing the individualization of treatment and adapting the protocols to the real needs of the patient. During our collaboration, which now spans about two years (with short breaks on our part), he was always available, supportive and clear in his guidance. He inspired confidence in us and helped us remain optimistic even in difficult phases. In addition to his scientific competence, what sets him apart is his genuine interest in the person behind each case: his empathy, his honesty and his constant effort to achieve the best possible outcome. My husband and I thank him warmly for his support and guidance and we now feel ready and optimistic to move on to the next final stage. We highly recommend him to anyone looking for a gynecologist with real knowledge, professionalism and humanity.

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   Faidra 
 135 days ago
 
 
  Dr. Makis Papadopoulos is an excellent gynecologist and above all an excellent person! I truly thank him for his support and care during the egg freezing process. Although my case was particularly demanding, he stood by me with patience, knowledge, great experience and real interest. Our communication was direct and human, while his availability at the many appointments made me feel safe at every step. The protocols were designed specifically for me, aiming for the best possible result, while also taking into account the cost of the medications. I recommend him with all my heart to every woman who wants to trust someone for something so important and sensitive for her.

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   Iliana 
 137 days ago
 
 
  I highly recommend Dr. Makis, he is an incredible specialist. My journey was far from easy, encountering several challenges that  made the process feel overwhelming at times. What sets him apart is his willingness to go beyond standard procedures. He developed a specialized, custom protocol, tailored to my situation, which ultimately made all the difference. Beyond his technical expertise, his calm and clear communication kept me grounded throughout the process. I am so grateful for his persistence and high level of care!

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