What Is HyFoSy And What Speculum Features Does It Require?

HyFoSy, or hysterosalpingo-foam sonography, is a minimally invasive ultrasound procedure used to assess fallopian tube patency in women being evaluated for infertility. A foam contrast medium is introduced through the cervix into the uterine cavity, and its passage through the fallopian tubes is tracked via transvaginal ultrasound. The procedure is typically performed in an outpatient setting and requires a well-designed gynecological speculum to provide reliable access to the cervix without causing unnecessary discomfort.

Poor cervical access is the hidden reason HyFoSy procedures take longer than they should

When the speculum used during a HyFoSy procedure fails to provide stable, unobstructed access to the cervix, the clinician loses time repositioning, adjusting, and compensating for instrument limitations. This directly extends procedure duration, increases patient discomfort, and raises the likelihood of incomplete foam delivery. The fix is straightforward: choose a speculum specifically designed for instrument passage rather than adapting a standard model that was never built with catheter insertion in mind.

Patient tension during fallopian tube patency testing is making the procedure harder than it needs to be

HyFoSy already involves some inherent discomfort for patients, particularly those with anxiety around fertility investigations. When the speculum used produces clicking sounds, has sharp edges, or requires two-handed manipulation, it amplifies that tension. Tense patients contract their pelvic muscles, which increases resistance and makes catheter insertion more difficult. Choosing a patient-friendly speculum with silent operation, softly rounded edges, and single-handed control reduces that tension at the source, which directly eases the procedure for both patient and clinician.

What is HyFoSy and what does it test for?

HyFoSy stands for hysterosalpingo-foam sonography. It is an ultrasound-based procedure that tests whether the fallopian tubes are open and unobstructed. A foam contrast medium is introduced into the uterus through a catheter, and transvaginal ultrasound tracks whether the foam passes freely through both tubes, indicating patency.

Fallopian tube blockage is one of the more common causes of female infertility. HyFoSy offers a way to evaluate this without radiation exposure, making it a preferred alternative to traditional hysterosalpingography (HSG), which uses X-ray contrast. The foam used in HyFoSy, such as ExEm Foam, is well tolerated and provides good echogenicity under ultrasound, making tube visualization reliable in experienced hands.

The test is typically performed in the early follicular phase of the menstrual cycle, before ovulation, to avoid interfering with a potential pregnancy. Results are available immediately during the procedure, which means patients receive actionable information without waiting for laboratory analysis.

How does the HyFoSy procedure work step by step?

The HyFoSy procedure involves inserting a speculum to access the cervix, placing a catheter into the uterine cavity, and then introducing foam contrast medium while a transvaginal ultrasound probe tracks its movement through the uterus and fallopian tubes. The entire procedure typically takes between ten and twenty minutes in an outpatient setting.

Here is a general sequence of how the procedure unfolds:

The patient is positioned, and a gynecological speculum is inserted to expose the cervix.
The cervix is cleaned, and a thin catheter is passed through the cervical os into the uterine cavity.
The speculum may be partially or fully removed, depending on the instrument design and clinical approach.
A transvaginal ultrasound probe is introduced alongside the speculum or after speculum removal.
Foam contrast medium is slowly injected through the catheter while the sonographer monitors its passage in real time.
Tubal patency is confirmed if foam is seen flowing freely from the tubal ends into the peritoneal space.

One practical consideration at step three is that speculum design matters significantly. If the catheter cannot remain in place while the speculum is being withdrawn, the clinician must manage multiple instruments simultaneously, which adds complexity and can increase patient discomfort. An open-sided speculum design addresses this directly by allowing the speculum to be retracted or removed without disturbing the catheter’s position.

What speculum features does HyFoSy require?

A speculum used for HyFoSy needs to provide stable cervical access, allow catheter insertion without obstruction, and ideally permit removal while leaving instruments in place. Standard speculum designs were not built with these requirements in mind, which is why procedure-specific features matter for this type of fallopian tube patency test.

The core functional requirements for a speculum used in HyFoSy include:

Side opening that allows catheter tubing to remain engaged with the cervix during or after speculum removal
Single-handed operation so the clinician can manage the catheter with the other hand simultaneously
Stable bill design that does not flex or collapse under the load of instrument manipulation
Adequate vertical and horizontal opening to accommodate catheter placement without crowding

Beyond these functional requirements, the speculum should also support patient comfort during what is already a procedure associated with some degree of cramping and anxiety. Softly rounded edges, a smooth surface finish, and silent operation all contribute to a more tolerable experience, which in turn helps the patient remain relaxed and cooperative throughout the procedure.

Why is an open-sided speculum better for HyFoSy?

An open-sided speculum is better for HyFoSy because it allows the clinician to retract or fully remove the speculum while keeping the catheter in position within the cervix. This is not possible with a standard closed-bill speculum, which would dislodge the catheter on removal and require reinsertion, adding time and discomfort to the procedure.

The open side of the speculum provides both vertical and horizontal access that a standard model cannot match. This matters during HyFoSy because the catheter needs to be positioned precisely, and any lateral movement or crowding from the speculum walls can interfere with that positioning. A robust open-sided design maintains a spacious and stable opening even when instruments are in place, preventing the bills from caving inward under load.

There is also a practical workflow benefit. When the speculum can remain in place while the ultrasound probe is introduced, or be removed cleanly without disturbing the catheter, the transition between procedure steps is smoother. This reduces the total time the patient is in position and minimizes the number of adjustments needed during the procedure.

How does speculum design affect patient comfort during HyFoSy?

Speculum design directly affects patient comfort during HyFoSy through edge profile, surface texture, operational noise, and the clinician’s ability to work with one hand free. Patients who are less anxious and more physically relaxed experience less pelvic muscle tension, which makes catheter insertion easier and reduces procedural discomfort overall.

The tension-pain relationship is well recognized in gynecological practice. When a patient hears clicking or rattling from an instrument, or feels sharp edges during insertion, the body responds with involuntary muscle contraction. That contraction works against the clinician and prolongs the procedure. A speculum with silent, single-handed locking, softly rounded outer edges, and a smooth surface finish removes several of these triggers before the procedure even reaches the catheter insertion stage.

Cervical support is another design factor that matters specifically for HyFoSy. Inward-folded bill edges that gently position and hold the cervix reduce the need for repeated repositioning, which is both more comfortable for the patient and more efficient for the clinician. A backward-angled handle design also allows for deeper insertion with less unintended rectal contact, which is a common source of discomfort during longer outpatient procedures.

What should clinicians look for when choosing a speculum for HyFoSy?

When choosing a speculum for HyFoSy, clinicians should prioritize an open-sided design with a robust bill structure, single-handed operation, and patient-friendly edge profiles. The speculum should allow catheter instruments to remain in place during removal and provide enough lateral access for comfortable foam catheter manipulation.

A checklist approach is useful here. The speculum should meet these criteria:

Open-sided bill design that permits catheter retention during speculum retraction
Structural integrity under load so the opening remains stable when instruments are engaged
Single-handed locking and unlocking to free the other hand for catheter management
Rounded, smooth edges to minimize cervical contact discomfort during a procedure already associated with cramping

Clinicians should also consider the reflective quality of the speculum surface. A white surface reflects external light toward the cervix more effectively than transparent or metal alternatives, improving visibility without requiring an internal light source. During HyFoSy, where precise catheter placement is essential, good visibility of the cervical os from the outset reduces fumbling and shortens the time the patient is in position.

Size selection also matters. Most HyFoSy procedures are performed using a medium or wide speculum, depending on patient anatomy. Having both sizes available and being familiar with the specific instrument’s opening dimensions ensures the clinician can select the right fit without improvising during the procedure.

How Bridea Medical supports HyFoSy procedures

We designed the Orchid Spec Open-Sided speculum specifically for procedures like HyFoSy, where standard speculum designs create unnecessary limitations. Our open-sided range addresses the practical challenges clinicians face during hysterosalpingo-foam sonography, from the first insertion to catheter removal.

Here is what the Orchid Spec Open-Sided brings to HyFoSy procedures:

Side opening that allows instruments and catheters to remain in place while the speculum is retracted, eliminating the need to reinsert or reposition
Robust hinge and bill design that maintains a stable, spacious opening even under significant instrument load
Single-handed operation with silent locking, freeing the clinician’s second hand for catheter management throughout the procedure
Softly rounded edges and smooth surface finish that reduce patient tension, support cervical positioning, and make the overall procedure more tolerable

The Orchid Spec is made in the Netherlands, tested and confirmed as the first unbreakable speculum by the NHS Surgical Materials Testing Laboratory, and is already used across the majority of Dutch hospitals. If you want to see how our open-sided speculum performs in procedures like HyFoSy, explore the full Orchid Spec range or contact us directly to request a sample for your clinic.