Why do I need Sonohysterography / Hystero-salpingo-foam sonography (HyFoSy)? Sonohysterography is for checking if there are any uterine polyps or abnormalities of the womb cavity. HyFoSy assesses whether your fallopian tubes are patent (i.e. whether they are blocked or open). These procedures will provide information about the female organs that may aid further management.
What does it involve? This procedure is performed in a room with an ultrasound machine. Usually no analgesia is given and most patients tolerate the procedure well. Occasionally, lower abdominal pain may be experienced during or after the procedure and the doctor will administer medication where necessary. The procedure is best performed between day 6 to 10 of your menstrual cycle (day 1 being the 1st day of your menses). This timing allows visualization of the womb cavity and fallopian tubes with reduced possibility of disrupting a potential pregnancy.
During the procedure, an ultrasound probe is inserted into your vagina to evaluate the womb and ovaries. A speculum is placed in the vagina (like for Pap smear) and the cervix is cleansed. A slender catheter is inserted through the cervix into the uterine cavity and the balloon may be inflated to prevent the catheter from slipping. Occasionally, your doctor may need to grasp the cervix with an instrument and on rare occasions, he/she may need to use a metal device to find the path to the womb. The speculum is then removed and the scan probe is placed in the vagina. Warm saline will be instilled through the catheter to visualise the womb cavity followed by the foam to assess the patency of the fallopian tubes.
The entire procedure usually lasts between 30-45 minutes. After the procedure is completed, the catheter will be removed.
What precautions must I take for the procedure? You must abstain from sexual intercourse from the 1st day of your menses until your test date. Please inform your doctor if you have illnesses, allergies or injuries. Before the procedure, please inform your doctor for further advice if any other of the following are applicable:
What are the risks and complications of the procedure? This is generally a safe procedure. The following are potential procedural risks and complications (note that the list is not meant to be exhaustive).
Severe pain Severe pain may be experienced (<10%) in the lower abdomen shortly after the procedure. You will be given medication where necessary.
Pelvic infection The most serious complication is pelvic infection, which may cause tubal obstruction and infertility (1.4%-3.4%). Your doctor may prescribe you with antibiotics if you are found to have dilated blocked tubes during the procedure or if you are deemed to be at risk of pelvic infection.
Effects of a developing pregnancy If there is a possibility of a potential pregnancy, it is advised that this procedure be postponed. The effects that the procedure may have on a developing pregnancy are uncertain, but there is a possibility of causing a miscarriage or ectopic pregnancy (pregnancy outside the womb).
Inaccuracy of test No tubal assessment is 100% accurate; there may be a possibility that patent tubes are mistakenly shown to be blocked (5%). Sometimes the results can be inconclusive as there may be difficulty visualising the cavity and / or the tubes. For greater accuracy, you may approach your gynaecologist to discuss the merits of alternatives procedures such as hysterosalpingography (HSGH) and Hystero-laparoscopy.
Allergic reaction to saline solution Such reaction, while extremely rare, may manifest by way of common signs and / or symptoms such as rashes.
What can I expect after the procedure? A small amount of vaginal discharge or bleeding and mild to moderate pain may be experienced. Mild pelvic discomfort, which is generally bearable, may be experienced by some patients. Up to 10% of patients may have moderate to severe cramps, vomiting or diarrhoea. Such symptoms usually subside within half an hour to one hour after procedure.
You may leave the hospital on your own once you are deemed to be well by the medical team. A medical certificate may be issued upon request for you to rest for that day.
Sexual intercourse may resume 24-48 hours following the procedure, unless your doctor has instructed you otherwise.
Occasionally, there may be some difficulty in interpretation of the scan; when this happens or when abnormalities are seen, your doctor may advise you on further test(s) and/or procedure(s) that may be necessary.
What are my options? You may choose not to undergo the procedure. The alternatives to assess tubal patency and uterine cavity include:
Hysterosalpingogram This procedure is similar to HyFoSy but utilises low dose x-rays and liquid dye that can be seen on x-ray for evaluation of the cavity of the womb and assess for tubal patency. If the tubes are blocked, the doctor may counsel you on the option to recanalise (open up) the tubes.
Hystero-laparoscopy This is a minimally-invasive surgery to assess tubal patency and to check womb cavity. There are some risks associated with this surgery. Your doctor will be able to discuss with you in detail on the abovementioned options and their associated benefits and risks.
* Do note that Medical Certificate (MC) for this procedure will be given upon request on the day of procedure.
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