Fertility investigations can feel overwhelming, particularly when a test is new or unfamiliar. HyFoSy is a straightforward ultrasound procedure, and it’s common for patients to have questions about comfort, what will happen on the day, and how the results may guide next steps in care.
This fact sheet explains what a HyFoSy examination is, why it is performed, and what you can expect before, during, and after your appointment. In this article, Jacqui, Lead Gynaecological Sonographer at QUFW, talks you through the HyFoSy procedure and how it fits into a fertility assessment.
Medical disclaimer: The information provided here is general in nature and intended for educational purposes only. It does not replace medical advice, diagnosis, or treatment. Please speak with your GP or specialist for personalised guidance.
Table of contents
- What is a HyFoSy examination?
- Why does fallopian tube patency matter?
- When is a HyFoSy performed?
- How do I prepare for a HyFoSy?
- What happens during a HyFoSy?
- What will I feel during a HyFoSy?
- How long does a HyFoSy appointment take?
- When and how do I receive HyFoSy results?
- Is HyFoSy safe and accurate?
- After the procedure: recovery and care
- Book your gynaecology scan at QUFW
- References
- Video transcript
What is a HyFoSy examination?
HyFoSy (Hysterosalpingo-Foam Sonography) is a specialised gynaecology ultrasound used as part of a fertility assessment. It evaluates the internal cavity of the uterus and the openness of the fallopian tubes.
“HyFoSy is a specialised gynaecology ultrasound procedure used as part of a fertility assessment,” Jacqui explains in the above video.
The procedure uses a contrast agent called ExEm foam, which is made from a gel and purified water. When mixed, it forms a foam that can be seen clearly on ultrasound.
“It’s used to detect any blockages in the fallopian tubes.”
Unlike X-ray–based tests, HyFoSy is performed entirely under ultrasound guidance and does not involve radiation.
Why does fallopian tube patency matter?
The fallopian tubes play a central role in natural conception.
“The fallopian tubes are an essential part of a woman’s reproductive system, connecting the ovaries to the uterus,” says Jacqui.
For pregnancy to occur:
- The ovary must release an egg
- The egg must travel through an open fallopian tube
- Sperm must meet the egg within the tube
“If both tubes are blocked, the sperm and egg cannot meet, making conception impossible.”
Because fallopian tubes cannot be visualised on a standard pelvic ultrasound, a HyFoSy is used to assess whether they are open (patent).
When is a HyFoSy performed?
Timing is important for safety and accuracy.
“The procedure should be performed between four to ten days after the first day of your last menstrual period,” Jacqui explains.
This timing:
- Reduces the chance of early pregnancy
- Provides optimal visualisation
Our doctors perform the procedure after a thorough transvaginal assessment of the pelvic organs has been performed by our sonographers.
Patients are advised to contact QUFW on day one of their period to arrange an appointment. If cycles are irregular or infrequent, individual advice is provided.
How do I prepare for a HyFoSy?
Preparation is straightforward and designed to support comfort.
“You do not need a full bladder for the examination,” Jacqui notes.
You may be advised to:
- Avoid sexual intercourse before the procedure
- Have a pregnancy blood test if required
- Take your usual pain relief one hour before the appointment
You are welcome to bring a support person if that feels helpful.
What happens during a HyFoSy?
On arrival, you will complete a urine pregnancy test to confirm you are not pregnant.
A transvaginal ultrasound is performed first to assess the uterus and ovaries. Once this is complete, the doctor will:
- Insert a speculum
- Place a thin, flexible catheter through the cervix into the uterus
“As the catheter passes through, you may feel some discomfort or cramping,” Jacqui explains.
A small balloon at the end of the catheter is inflated to keep it in place, which may cause brief pressure.
The speculum is then removed, and the transvaginal probe is reinserted. Saline is passed through the catheter to assess the uterine cavity for scarring, fibroids, or polyps.
Then, the ExEm foam is introduced.
“The goal is to see the contrast flow through open tubes and spill into the area surrounding the ovaries.”
Once complete, the catheter and probe are removed.
What will I feel during a HyFoSy?
Experiences vary between patients.
“Some patients may feel light-headed, hot, or dizzy during the procedure,” says Jacqui.
Common sensations include:
- Mild to moderate cramping
- Period-like discomfort
- Temporary pressure
“These symptoms usually settle quickly,” Jacqui reassures.
Patients are encouraged to communicate during the procedure so comfort can be supported.
How long does a HyFoSy appointment take?
“We allow 45 to 60 minutes for the appointment,” Jacqui explains.
The actual HyFoSy procedure typically takes around 10 minutes, with the remainder of the time used for preparation, explanation, and ultrasound assessment.
When and how do I receive HyFoSy results?
As the procedure is performed, findings are usually discussed in real time.
“The doctor will explain the findings and whether the tubes appear open.”
Occasionally, results may be inconclusive due to temporary tubal spasm rather than true blockage.
Your results are:
- Sent to your referring doctor
- Shared with you via a secure Tricefy link on your mobile
Report timing depends on examination complexity and additional findings.
Is HyFoSy safe and accurate?
HyFoSy is considered a safe and well-tolerated procedure. It does not involve ionising radiation or general anaesthetic.
Studies have shown HyFoSy to have high diagnostic accuracy for tubal patency, comparable to traditional hysterosalpingography (HSG), with better patient comfort and fewer risks.
After the procedure: recovery and care
After a HyFoSy, it is normal to experience:
- Watery discharge
- Light bleeding or spotting
- Mild cramping or bloating
“This is normal and due to the saline and contrast used,” Jacqui explains.
A sanitary pad is provided, and symptoms usually resolve within a day or two. Normal activities, including intercourse, can be resumed.
If you experience:
- Severe pelvic pain
- Fever
- Green or yellow vaginal discharge
you should contact your GP or referring doctor, as these may indicate infection, which is uncommon.
Book your gynaecology scan at QUFW
Fertility investigations can bring up many emotions, including hope, worry, and uncertainty. Having clear information can make the process feel more manageable.
At QUFW, gynaecology scans are performed in a supportive environment using evidence-based techniques and clear communication. Your HyFoSy examination is designed to provide meaningful information to guide your fertility care, while prioritising safety and comfort.
You are supported every step of the way.
References
- Exacoustos, C., Di Giovanni, A., Szabolcs, B. et al. (2015). Automated sonographic tubal patency evaluation using contrast agent (HyFoSy). Ultrasound in Obstetrics & Gynaecology, 46(5), 620–627. https://pubmed.ncbi.nlm.nih.gov/19852043/
- Dreyer, K., Out, R., Hompes, P. G. et al. (2017). Oil-based or water-based contrast for hysterosalpingography in infertile women. New England Journal of Medicine, 376, 2043–2052. https://www.nejm.org/doi/full/10.1056/NEJMoa1612337
Video transcript
Hi, my name’s Jacqui. I’m the lead gynaecological sonographer for QUFW. I’m here to talk you through your HyFoSy examination at QUFW.
HyFoSy is a specialised gynaecology ultrasound procedure used as part of a fertility assessment. It provides information about the internal cavity of the uterus and the fallopian tubes. A contrast agent, ExEm foam, is used to visualise the tubes. It is made from a gel and purified water which, when mixed, create a foam used to detect any blockages in the fallopian tubes.
Why are patent fallopian tubes important?
The fallopian tubes are an essential part of a woman’s reproductive system, connecting the ovaries to the uterus. Open (or patent) fallopian tubes are important for conception. If both tubes are blocked, the sperm and egg cannot meet, making conception impossible. The fallopian tubes cannot be visualised on a standard ultrasound, which is why the HyFoSy procedure is used.
When the procedure is performed
The procedure should be performed between four to ten days after the first day of your last menstrual period. We recommend calling our office on day one of your period to make a booking. If you have irregular or infrequent cycles, please call for individual advice.
Some patients may be asked to avoid sexual intercourse before the procedure and/or have a pregnancy blood test. You do not need a full bladder for the examination. It’s recommended that you take your usual pain relief about one hour before your appointment. You may bring a support person if you wish, although this is not required.
What happens on the day
On arrival, you’ll be asked to perform a urine pregnancy test to confirm you are not pregnant. A transvaginal ultrasound is done first. Once this is complete, the doctor will insert a speculum and place a thin, flexible catheter through your cervix into the uterus. As the catheter passes through, you may feel some discomfort or cramping. Once it’s in position, a small balloon at the end of the catheter is inflated, which may cause mild pressure that should ease quickly.
The speculum is then removed and the transvaginal probe reinserted so we can visualise the procedure. Saline (a sterile saltwater solution) is passed through the catheter to check the uterine cavity for scarring, polyps, or fibroids that may not be visible on regular ultrasound. Then, the contrast agent (ExEm foam) is passed through the catheter. The doctor observes the contrast as it moves through the uterine cavity and fallopian tubes. The goal is to see the contrast flow through open tubes and spill into the area surrounding the ovaries.
When the procedure is finished, the catheter and probe are removed.
What to expect during a HyFoSy
Some patients may feel light-headed, hot, or dizzy during the procedure. Mild cramping, similar to period pain, is also common. These symptoms usually settle quickly, and pain relief can help if needed. Please tell your doctor or sonographer if you feel unwell, and they’ll help you feel more comfortable.
How long it takes
We allow 45 to 60 minutes for the appointment, including preparation and scanning time. The actual procedure usually takes about 10 minutes.
When you’ll receive your results
As the procedure is performed, the doctor will explain the findings and whether the tubes appear open. Occasionally, results may be inconclusive if it’s difficult to distinguish between tubal spasm and blockage.
Your results will be sent directly to your referring doctor, and you’ll also receive a copy via a secure link through Tricefy on your mobile. The time taken for your doctor to receive the written report will depend on the complexity of the examination and whether additional findings were noted.
After the procedure
You may notice some watery or light bloody discharge afterward. This is normal and due to the saline and contrast used. A sanitary pad will be provided. Mild bloating, cramping, or lower abdominal discomfort can occur and is usually relieved with standard pain medication. Light bleeding or spotting may continue for a day or two.
If you experience severe pelvic pain, fever, or an unusual vaginal discharge that is green or yellow, contact your GP or referring doctor promptly, as these may be signs of infection (which is uncommon).
It is safe to resume normal activities, including intercourse, after the procedure. The HyFoSy is a very safe procedure that does not involve ionising radiation or general anaesthetic.
Learn more here or contact us here.
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