Tubal patency test (HyCoSy / HSG) (Tubal patency testing (HyCoSy / hysterosalpingography))

A test to check whether the fallopian tubes are open, using either an ultrasound scan with contrast (HyCoSy) or an X-ray with dye (HSG), as part of investigating difficulty conceiving.

✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review

In short

A tubal patency test checks whether the fallopian tubes are open, using either ultrasound with contrast (HyCoSy) or X-ray with dye (HSG).
It is done as part of investigating difficulty conceiving; it cannot prove the tubes work perfectly or guarantee a pregnancy.
It can cause period-like cramping, so painkillers beforehand are advised, and there is a small risk of pelvic infection.
It must be done when you are not pregnant, usually after a period and before ovulation, and you should avoid unprotected sex in that cycle until after the test.

A plain-English summary. The detail — including risks and recovery — is below.

At a glance

TypeImaging test with contrast or dye (ultrasound or X-ray)

AnaestheticNot usually needed; painkillers beforehand are advised

How long it takesAround 15 to 30 minutes

Hospital stayOutpatient

Time off workUsually none or the rest of the day

When you'll see resultsOften explained at the time, with a full report soon after

On the NHS?Often available on the NHS when fertility is being investigated (local eligibility varies); a self-requested test is often private

A general guide. Your specialist will give you advice for your situation.

Best fit

Shows whether the fallopian tubes appear open, an important part of investigating fertility.

Pause if

When there is any chance you are pregnant, as the test should not be done in pregnancy.

Main recovery point

You may feel period-like cramping as the fluid passes. Tell the team if it is severe; the test can usually be paused.

Good aftercare

Clear advice on cramping, expected light bleeding and when it should settle.

During the test

You may feel period-like cramping as the fluid passes. Tell the team if it is severe; the test can usually be...

First few hours

Cramping usually eases with simple painkillers. There may be light bleeding or fluid leakage, so a sanitary pad is...

Rest of the day

Many people return to normal activities, though some prefer to take it easy. Light bleeding may continue for a day...

Results and after

Findings are often explained at the time, with a full report soon after. A specialist should discuss what the...

Medical line illustration of tubal patency test for Tubal patency test (HyCoSy / HSG). — Illustration only - not a diagnosis, medical advice or a promise of result. Your anatomy and treatment plan may differ. Vuemedics does not publish before-and-after photos.

What is a tubal patency test (HyCoSy / HSG)?

A tubal patency test checks whether your fallopian tubes are open, so that an egg and sperm can meet and a fertilised egg can travel to the womb. Blocked or damaged tubes are a recognised cause of difficulty conceiving, so this test is part of investigating fertility in women not already known to have tubal disease.

There are two common ways to do it. HyCoSy (hysterosalpingo-contrast sonography) uses an ultrasound scan while a contrast fluid is gently passed through the womb and tubes; it avoids X-rays. HSG (hysterosalpingography) uses an X-ray while a dye is passed through. Both show whether the fluid flows through and out of the ends of the tubes. A version of HyCoSy using foam is sometimes called HyFoSy. NICE suggests HyCoSy as an alternative to HSG where the right expertise is available, and laparoscopy with dye (a keyhole operation under general anaesthetic) is used when a closer look at the pelvis is also needed.

The test shows whether the tubes appear open, but it has limits. It cannot prove the tubes work perfectly or that you will conceive, and results can sometimes be unclear, for example if the tube goes into spasm. It is one part of a couple's assessment, alongside ovulation, ovarian reserve and sperm tests.

In the UK, fertility investigations are guided by NICE and treatment is regulated by the HFEA.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

HyCoSy (hysterosalpingo-contrast sonography)

An ultrasound-based test using a contrast fluid passed through the womb and tubes. It avoids X-rays and tends to be better tolerated, and can also show the womb and ovaries.

HyFoSy (foam sonography)

A form of HyCoSy that uses a foam contrast. It works similarly and is widely used; your clinic will use whichever contrast it is set up for.

HSG (hysterosalpingography)

An X-ray test using an iodine-based dye passed through the womb and tubes. It involves a small dose of radiation and a small chance of a dye reaction.

Laparoscopy with dye

A keyhole operation under general anaesthetic that looks directly at the tubes and pelvis while dye is passed through. Used when a fuller look is needed, for example if endometriosis or adhesions are suspected, and it carries the risks of surgery.

HyCoSy vs HSG vs laparoscopy

	HyCoSy	HSG	Laparoscopy
Uses	Ultrasound + contrast	X-ray + dye	Keyhole surgery + dye
Radiation	None	Small dose	None
Anaesthetic	Usually none	Usually none	General anaesthetic
Also sees pelvis?	Womb and ovaries	Limited	Direct view, can treat

HyCoSy and HSG are outpatient tests of whether the tubes are open. Laparoscopy is an operation that gives a direct view and can treat some problems, but carries surgical and anaesthetic risks.

Preparing for your test

The test is timed to your cycle: usually after your period has finished and before you ovulate, so you are not pregnant.
Avoid unprotected sex from the start of that period until after the test, to be sure you are not pregnant.
You will usually be screened for infections such as chlamydia beforehand, as the test can spread an untreated infection.
Take simple painkillers, such as ibuprofen or paracetamol, about an hour before, as advised, to ease cramping.
Tell the team about any allergy, especially to iodine or contrast dye, particularly before an HSG.
Arrange to bring a sanitary pad, as there may be some leakage of fluid or light bleeding afterwards.
Ask whether you can drive home; most people can, but you may prefer company if you are anxious or crampy.

What happens

You lie back as for a smear test, and a speculum is gently placed so the neck of the womb (cervix) can be seen. A fine, soft tube is passed through the cervix into the womb, and a small balloon may be inflated to hold it in place.

Contrast fluid (for HyCoSy) or dye (for HSG) is then passed slowly through the tube. With HyCoSy, an ultrasound probe watches the fluid move through the womb and tubes; with HSG, X-ray pictures are taken. The team can see whether the fluid flows through and spills out of the ends of the tubes, which suggests they are open.

The test usually takes around 15 to 30 minutes. Many people feel period-like cramping as the fluid passes, which usually settles soon afterwards. The findings are often explained to you at the time, with a full report to follow. You can normally go home shortly afterwards and back to normal activities.

Is this test right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

May not be suitable if…

When there is any chance you are pregnant, as the test should not be done in pregnancy.
When you have a current pelvic infection or untreated sexually transmitted infection, until it is treated.
An HSG when you have a known significant allergy to iodine-based contrast, where another approach is safer.
As a standalone answer to fertility, since open tubes do not guarantee conception.

Delay or rearrange if…

You may be pregnant, or have not avoided unprotected sex since your last period this cycle.
You have an active or untreated pelvic or sexually transmitted infection.
You have unexplained pelvic pain or abnormal bleeding that needs assessment first.
You have not been screened for infection, where the clinic's protocol requires it.

Alternatives to discuss

HyCoSy instead of HSG to avoid X-rays, where the expertise is available.
HSG instead of HyCoSy depending on local services and your situation.
Laparoscopy with dye when a direct view of the pelvis is also needed, accepting surgical risk.
Proceeding straight to IVF in some situations, which can bypass the need for open tubes.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

What matters most to me?

Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.

What are all my options?

Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.

What would make me pause?

Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.

What happens if I do nothing today?

For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.

Benefits

Shows whether the fallopian tubes appear open, an important part of investigating fertility.
Can pick up a blockage or damage that may change your treatment options.
HyCoSy can also show the womb lining and ovaries at the same time.
Avoids surgery and anaesthetic in most cases, as it is an outpatient test.
Helps a specialist plan next steps, such as whether IVF may be needed to bypass blocked tubes.

Risks & complications

More common

Period-like cramping during and shortly after the test
Light vaginal bleeding or some leakage of fluid afterwards
Feeling faint or dizzy around the time of the test
An unclear result, for example if a tube goes into spasm and looks blocked when it is not

Less common

Pelvic infection, which is why infection screening beforehand is important
A reaction to the iodine-based dye used in HSG
The test not being completed, for example if the tube cannot be passed through the cervix

Rare but serious

A more serious pelvic infection needing antibiotics or hospital treatment
Injury to the womb from the catheter, which is very uncommon
A significant allergic reaction to contrast or dye

The two risks to weigh most are cramping pain, which is common but usually short-lived, and pelvic infection, which is uncommon but important and is why you should be screened for infection first. HSG also involves a small dose of radiation and a small chance of a dye reaction. Ask the clinic how they reduce pain and infection risk, what happens if the result is unclear, and which test they recommend for you and why.

Published figures to discuss

Tubal patency testing is generally an outpatient test, and serious complications are uncommon, but it is not without risks. Cramping pain is common, pelvic infection is uncommon but important, and HSG adds a small radiation dose and a small chance of a contrast reaction. Published complication rates vary between services and methods and are not consistently reported, so the wording below is deliberately cautious rather than a precise figure; ask your clinic for its own figures.

Figure	Reported range	How to interpret it	Source / confidence
Period-like cramping	Common, especially as the contrast or dye passes; usually short-lived	Simple painkillers taken beforehand reduce it; tell the team if it is severe.	Guide sourcesClinical context
Pelvic infection	Uncommon; reduced by screening and treating infection before the test	Report fever, worsening pain or smelly discharge promptly, as antibiotics may be needed.	HyCoSy vs HSG pain and tolerability — study (PMC)ncbi.nlm.nih.govSource-linked context
Contrast or dye reaction (mainly HSG)	Rare; significant allergic reactions are very rare	Tell the team about any iodine or contrast allergy before the test.	Guide sourcesClinical context

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

Recovery from a tubal patency test is usually quick. Most people have some cramping and light bleeding for a short time and can return to normal activities the same day.

During the test

You may feel period-like cramping as the fluid passes. Tell the team if it is severe; the test can usually be paused.

First few hours

Cramping usually eases with simple painkillers. There may be light bleeding or fluid leakage, so a sanitary pad is useful. Most people go home shortly after.

Rest of the day

Many people return to normal activities, though some prefer to take it easy. Light bleeding may continue for a day or so.

Results and after

Findings are often explained at the time, with a full report soon after. A specialist should discuss what the result means for your fertility plan.

What's normal — and not a worry

Period-like cramping during and shortly after the test
Light vaginal bleeding for a day or so
Some watery fluid leakage afterwards
Feeling a little tired or shaky immediately afterwards, which soon passes

Aftercare

Take simple painkillers as needed for cramping, following the advice you are given.
Use a sanitary pad rather than a tampon for any bleeding or fluid leakage.
Watch for signs of infection, such as fever, worsening pain or smelly discharge, and report them promptly.
Ask when you can try to conceive again, and whether anything changes this cycle.
Make sure you understand the result and what it means for your next steps.
Keep a copy of the report to share with your GP or specialist.

Before your test

Simple painkillers at home for cramping
A sanitary pad for bleeding or fluid leakage
The clinic's contact number in case of fever or worsening pain
A clear explanation of the result and next steps
A copy of the report for your records
A plan for when you can try to conceive again

⚠ Get urgent help if…

Fever or feeling generally unwell in the days after the test (possible infection)
Worsening or severe lower tummy pain rather than easing cramping
Smelly or unusual vaginal discharge
Heavy vaginal bleeding rather than light spotting
A rash, swelling or difficulty breathing after contrast or dye (possible allergic reaction)
Feeling faint and unwell that does not quickly settle after the test

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your specialist gives you.

Results & realistic expectations

The test shows whether contrast or dye flows through the womb and spills out of the ends of the fallopian tubes. Free spill on both sides suggests the tubes are open; if the fluid does not pass, the tube may be blocked or in spasm. The findings are often explained at the time, with a full report to follow.

A tubal patency test cannot prove that the tubes work perfectly, that an egg will travel along them, or that you will conceive. Results can also be uncertain, for example if a tube goes into spasm and looks blocked when it is not, so an unclear result may need a repeat or a different test such as laparoscopy. A specialist should interpret the result as part of your wider fertility assessment.

How long it lasts

A tubal patency test reflects your tubes at the time of the test. Tubes can become blocked later, for example after a pelvic infection, so a normal result is not a permanent guarantee. The test is not usually repeated unless something changes or the first result was unclear, and your clinician should explain whether a repeat or a different test is worthwhile.

Related tests, treatments or support

A tubal patency test is one part of a couple's fertility assessment and is usually considered alongside ovulation and hormone blood tests, ovarian reserve checks (AMH and antral follicle count) and a partner's semen analysis. If tubal disease is found, a specialist will discuss options such as surgery or IVF. Sometimes a tubal test is combined with looking at the womb cavity, and laparoscopy may be chosen when a direct view of the pelvis is also needed.

Follow-up & long-term care

After the test you should be told the result and what it means for your fertility plan. If the tubes appear open, attention turns to other parts of the couple's assessment. If a tube looks blocked or the result is unclear, you may be offered a repeat test, a different test such as laparoscopy, or a discussion about treatment options including IVF. Report any signs of infection promptly in the days afterwards.

Repeat, follow-on and what comes next

An unclear result, for example from tubal spasm, may need a repeat or a different test such as laparoscopy.
Tubes can block later, so a normal result is not a permanent guarantee.
If the test cannot be completed, for example if the catheter cannot be passed, it may be repeated or an alternative used.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

Clear advice on cramping, expected light bleeding and when it should settle.
Written warning signs for infection and a contact number if they occur.
A clear explanation of the result and what it means for your fertility plan.
A sensible plan for any repeat or alternative test if the result is unclear.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

Which test is used (HyCoSy, HSG or laparoscopy), as costs and settings differ greatly.
Whether infection screening and a consultation are included in the price.
Who performs and reports the test, and their level of expertise.
Whether contrast, dye and any sedation are included.
For laparoscopy, the costs of theatre, anaesthetic and a hospital stay.
Follow-up consultation and any onward treatment, such as surgery or IVF.

Make sure your written quote includes

Which test the price covers and what setting it is done in.
Whether infection screening beforehand is included.
Whether a consultation to explain the result is included.
The cost of contrast or dye and any sedation.
Follow-up consultation costs after the test.
What happens, and what it costs, if the result is unclear or a different test is then needed.

On the NHS? A tubal patency test is usually available on the NHS when fertility is being investigated, but who qualifies and what is funded is decided locally by NHS or HSC commissioners and can differ across England, Wales, Scotland and Northern Ireland, and change over time. NICE guidance sets out the clinical recommendations but does not by itself decide what your area funds, so check current eligibility with the relevant NHS or HSC fertility service or clinic. A self-requested test is often private, and the choice of test depends on your situation and local expertise.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Choosing a specialist safely

Check the specialist is on the GMC Specialist Register for this area.
Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Questions to ask your medical professional

Take this to your consultation. A good specialist will welcome every one of these.

Which test do you recommend for me, HyCoSy, HSG or laparoscopy, and why?
How will you reduce my risk of pain and infection?
Have I been screened for infection before the test?
What happens if the result is unclear or a tube looks blocked?
When can I try to conceive again, and does this cycle change anything?
What will this result change about my treatment options?
Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
Will you be the specialist who carries out my test, and who looks after me afterwards?
What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
What does a realistic result look like — and what can this test not achieve?
What are my options, including waiting, doing nothing for now, or choosing a different approach?
Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Frequently asked questions

Does a tubal patency test hurt?

Many people feel period-like cramping as the fluid passes, which usually settles soon afterwards. Taking simple painkillers about an hour beforehand helps. Tell the team if the pain is severe, as the test can usually be paused.

What is the difference between HyCoSy and HSG?

HyCoSy uses an ultrasound scan with a contrast fluid and no X-rays, and can also show the womb and ovaries. HSG uses an X-ray with an iodine-based dye. Both check whether the tubes are open; HyCoSy tends to be better tolerated.

When in my cycle is it done?

Usually after your period has finished and before you ovulate, so you are not pregnant. You should avoid unprotected sex from the start of that period until after the test.

Could I have it if I might be pregnant?

No. The test should not be done if there is a chance you are pregnant, which is why it is timed early in the cycle and you are asked to avoid unprotected sex that cycle until afterwards.

Does a normal result mean I will conceive?

No. Open tubes are reassuring, but the test cannot prove the tubes work perfectly or guarantee a pregnancy. It is one part of a couple's assessment, alongside ovulation, ovarian reserve and sperm tests.

Is the test available on the NHS?

Often, yes, when fertility is being investigated, but who qualifies and what is funded is decided locally by NHS or HSC commissioners and varies across England, Wales, Scotland and Northern Ireland. NICE sets out the clinical recommendations but does not by itself decide what your area funds, so check current eligibility with the relevant NHS or HSC fertility service or clinic. A self-requested test is often available privately, and your GP or specialist can advise which test is most appropriate for you.

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NICE NG257 — Fertility problems: investigation and management Leeds Teaching Hospitals NHS — Hysterosalpingography (HSG) Oxford University Hospitals NHS — HyCoSy patient information HFEA — A-Z fertility glossary HyCoSy vs HSG pain and tolerability — study (PMC) NHS inform (Scotland) — Infertility and fertility access NHS Wales — Specialist fertility services commissioning policy (CP38) Belfast Trust — Northern Ireland Regional Fertility Centre

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.