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Ultrasound examination of the patency of the fallopian tubes HyCoSy

The cause of infertility in 10-30% of couples is obstruction of the fallopian tubes and irregularity of the uterine structure. Fallopian tubes are most commonly caused by the effects of bacterial inflammation (chlamydia), adhesions caused by endometriosis, or previous small pelvic surgery (laparotomia / laparoscopia).

Congenital uterine anomalies (double uterus, unicorn uterus, double uterus, septated uterus), tumors of the uterus (endometrial polyp, submucosal myoma ...), and intrauterine attachments also create obstacles in the process of fertilization. If the fallopian tubes and uterus are damaged or altered, fertilization cannot occur. Spermatozoids from the vagina enter the uterus through the cervical canal, then into the fallopian tubes and fertilize. Fertilized Oocyte - The early stage of the embryo passes through the fallopian tubes to the uterus, during which proper development of pregnancy continues. There are several ways to test for fallopian tubes.
Laparoscopic surgery - check of the fallopian tubes with methylene blue is the safest method, but it belongs to invasive methods that can have complications like all surgeries, requires hospitalization, sickness - the period of post operative recovery and healing of abdominal wounds, is the most expensive method of checking ovarian patency. Since laparoscopy cannot show the inside of the uterus, usually another surgery is planned in the same act.

Hysteroscopy - surgery that enters the uterine cavity with special optics to inspect and diagnose an endometrial polyp, submucosal myoma or septum ... The experienced operator ideally needs ½ up to 1 h longer to perform surgery, which implies that is a patient under general anesthesia who also has its risks. The advantage of operative diagnostics is multiple, if diagnosed (polyps, myoma, septum, appendix ...) in the same act can be resolved.

HSG (hysterosalpingography) radiological method of iodine contrast imaging in the developed world has been abandoned due to harmful radiation and allergic reactions.

2D HyCoSy (2D Ultrasound Hystero-Salpingo-Contrast Sonography) 2D ultrasound ovarian patency test using a sterile saline solution is good but not reliable enough due to difficult visualization of the fallopian tube solution. It is the cheapest of all methods but also the least effective in making a safe diagnosis.

HyCoSy is the latest method of checking the fallopian tubes and diagnosing congenital malformations of the uterus. Ex-Em gel is used as a contrast medium. This method is among the safest in making an accurate diagnosis of fallopian tubes and changes in the uterus. HyCoSy is recommended for all patients who have been trying to stay pregnant for more than 1 year without success.

Contraindications
- pregnancy
- carcinoma of the female reproductive organs
- Acute inflammation in the pelvis
- vaginal infection
- patients with risk factors such as heart disease, drug allergies ...
- vaginal bleeding

Preparing for HyCoSy
 
- vaginal and cervix swabs (aerobi, CB - clamydia, mycoplsma and ureaplasma) and PAP swabs should be taken before the scheduled examination. Recording is done in the first proliferative phase of the menstrual cycle of 5-12 days. It is advised to avoid relationships before searching or to use protection. Procedure:
- urinate before use
- the patient is introduced to the venous path - browning
- a gynecological table shows a cervix with a sterile cusco speculum
- the vagina and cervix are washed with a disinfectant solution
- the cervix is ​​gripped, the uterus is probed
- a special catheter is inserted from the Ex-Em kit and if parathyroid blockage is required (1 amp lydocain), if required dilation of the cervical duct of the rat
- after catheter placement, ultrasound examination begins, an Ex-Em gel contrast agent is slowly given which, when passing through narrow channels, has a foam transition feature which facilitates ultrasonic contrast visualization. Occasionally moderate contrast may be due to fallopian tubes when contrast is administered, then the process is briefly interrupted and continued after the pain has stopped.
- After the examination, the catheter is removed, a possible watery discharge from the vagina for another day or two.
- The brawn was removed 1 hour after the search
The procedure is performed on an outpatient basis, during the procedure the patient must feel discomfort, mild pain. After the search, he must stay for 1 hour in the office for monitoring. Administration of analgesics in severe pain is indicated - an individual approach. The patient is able to perform her daily activities immediately after the examination.

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34
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