Created by gynecologists for an improved doctor patient experience
ExEm® Foam used during the HyFoSy procedure was developed by Dutch gynecologists Dr. Niek Exalto and Prof. Dr. Mark Hans Emanuel. The root name “ExEm” is derived by combining the two first letters of the product inventors’ last names, ExEm Foam, Drs. Exalto and Emanuel. Both Dr. Exalto and Prof. Dr. Emanuel envisioned an easier, less-invasive tubal patency procedure with better visualization capabilities, without the burdens which come with HSG (e.g. use of X-ray and iodine, and the need for an additional appointment). First launched in Europe in 2011, ExEm® Foam has been used in over 1 million fallopian tubes worldwide, providing a safe, successful alternative to X-ray HSG, laparoscopy or saline and air.
Publications about Efficacy
Engels V, Medina M, Antolín E, Ros C, Bermejo C, Manzour N, Pelayo I, Amaro A, Martinez-Ten P, De-Guirior C, Rodríguez R, Sotillo L, Brotons I, de la Cuesta-Benjumea R, Martinez O, Sancho J, Alcázar JL. Factors Associated with a Post-Procedure Spontaneous Pregnancy after a Hysterosapingo-Foam-Sonography (HyFoSy): Results from a Multicenter Observational Study. Diagnostics. 2023; 13(3):504. https://doi.org/10.3390/diagnostics13030504
van Welie, N., van Rijswijk, J., Dreyer, K., van Hooff, M. H. A., de Bruin, J. P., Verhoeve, H. R., Mol, F., van Baal, W. M., Traas, M. A. F., van Peperstraten, A. M., Manger, A. P., Gianotten, J., de Koning, C. H., Koning, A. M. H., Bayram, N., van der Ham, D. P., Vrouenraets, F. P. J. M., Kalafusova, M., van de Laar, B. I. G., … Mijatovic, V. (2022). Can hysterosalpingo-foam sonography replace hysterosalpingography as first-choice tubal patency test? A randomized noninferiority trial. Human Reproduction (Oxford, England), 37(5), 969–979. https://doi.org/10.1093/humrep/deac034
Ramos J, Caligara C, Santamaría-López E, González-Ravina C, Prados N, Carranza F, Blasco V, Fernández-Sánchez M. Diagnostic Accuracy Study Comparing Hysterosalpingo-Foam Sonography and Hysterosalpingography for Fallopian Tube Patency Assessment. J Clin Med. 2021; 10: 4169
Melcer Y, Zilberman Sharon N, Nimrodi M, Pekar-Zlotin M, Gat I, Maymon R. Hysterosalpingo-Foam Sonography for the Diagnosis of Tubal Occlusion: A Systematic Review and Meta-analysis. J Ultrasound Med. 2021; 40: 2031-2037
Situmorang H, Tantry HP, Gunardi ER. Hysterosalpingo-Foam Sonography to replace HSG in evaluating Tubal Patency in Indonesian subfertile patients. Open J Obstet Gynecol 2020: 10; 1402-1413
Engels V, Medina M, Antolín E, Ros C, Amaro A, De-Guirior C, Manzour N, Sotillo L, De la Cuesta R, Rodríguez R, San-Frutos L, Peralta S, Martin-Martínez A, Alcázar JL. Feasibility, tolerability, and safety of hysterosalpingo-foam sonography (hyfosy). multicenter, prospective Spanish study. J Gynecol Obstet Hum Reprod. 2020 50(5): 102004.
Riganelli, L., Casorelli, A., Caccetta, J., Merlino, L., Mariani, M., Savone, D., Carrone, A., Franceschetti, S., Aragona, C., Pietrangeli, D., Aragona, A., Capri, O., & Piccioni, M. G. (2018). Ultrasonography reappraisal of tubal patency in assisted reproduction technology patients: Comparison between 2D and 3D-sonohysterosalpingography. A pilot study. Minerva Ginecologica, 70(2), 123–128. https://doi.org/10.23736/S0026-4784.17.04161-2
Ludwin, I., Ludwin, A., Wiechec, M., Nocun, A., Banas, T., Basta, P., & Pitynski, K. (2017). Accuracy of hysterosalpingo-foam sonography in comparison to hysterosalpingo-contrast sonography with air/saline and to laparoscopy with dye. Human Reproduction, 32(4), 758–769. https://doi.org/10.1093/humrep/dex013
Link: Sonohysterosalpingography: Comparison of foam and saline solution – PubMed (nih.gov)
Piccioni, M. G., Riganelli, L., Filippi, V., Fuggetta, E., Colagiovanni, V., Imperiale, L., Caccetta, J., Panici, P. B., & Porpora, M. G. (2017). Sonohysterosalpingography: Comparison of foam and saline solution. Journal of Clinical Ultrasound, 45(2), 67–71. https://doi.org/10.1002/jcu.22412
Exacoustos, C., Pizzo, A., Lazzeri, L., Pietropolli, A., Piccione, E., & Zupi, E. (2017). Three-Dimensional Hysterosalpingo Contrast Sonography with Gel Foam: Methodology and Feasibility to Obtain 3-Dimensional Volumes of Tubal Shape. Journal of Minimally Invasive Gynecology, 24(5), 827–832. https://doi.org/10.1016/j.jmig.2017.04.007
Link: https://pubmed.ncbi.nlm.nih.gov/25092501/
van Schoubroeck, D., van den Bosch, T., Ameye, L., Boes, A. S., D’Hooghe, T., & Timmerman, D. (2015). Pain during Fallopian-tube patency testing by hysterosalpingo-foam sonography. Ultrasound in Obstetrics and Gynecology, 45(3), 346–350. https://doi.org/10.1002/uog.14646
Link: The use of a new gel foam for the evaluation of tubal patency – PubMed (nih.gov)
van Schoubroeck, D., van den Bosch, T., Meuleman, C., Tomassetti, C., D’Hooghe, T., & Timmerman, D. (2013). The use of a new gel foam for the evaluation of tubal patency. Gynecologic and Obstetric Investigation, 75(3), 152–156. https://doi.org/10.1159/000345865
Publications about Safety
Serrano González, L., Pérez-Medina, T., Bueno Olalla, B., Royuela, A., de La Cuesta, M. de los.R., Saéz de la Mata, D., Domínguez-Franjo, E., Calles-Sastre, L., & Engels, V. (2022). Is hysterosalpingo-foam sonography (HyFoSy) more tolerable in terms of pain and anxiety than hysterosalpingography (HSG)? A prospective real-world setting multicentre study. BMC Women’s Health, 22(1).
Boned-López J, Alcázar JL, Errasti T, Ruiz-Zambrana A, Rodriguez I, Pascual MA, Guerriero S. Severe pain during hysterosalpingo-contrast sonography (HyCoSy): a systematic review and meta-analysis. Arch Gynecol Obstet. 2021 Dec;304(6):1389-1398.
Link: Pain during Fallopian-tube patency testing by hysterosalpingo-foam sonography – PubMed (nih.gov)
van Schoubroeck, D., van den Bosch, T., Ameye, L., Boes, A. S., D’Hooghe, T., & Timmerman, D. (2015). Pain during Fallopian-tube patency testing by hysterosalpingo-foam sonography. Ultrasound in Obstetrics and Gynecology, 45(3), 346–350. https://doi.org/10.1002/uog.14646
Exalto, N., Stassen, M., & Emanuel, M. H. (2014). Safety aspects and side-effects of ExEm-gel and foam for uterine cavity distension and tubal patency testing. In Reproductive BioMedicine Online (Vol. 29, Issue 5, pp. 534–540). Elsevier Ltd. https://doi.org/10.1016/j.rbmo.2014.07.015
Dreyer, K., Out, R., Hompes, P. G. A., & Mijatovic, V. (2014). Hysterosalpingo-foam sonography, a less painful procedure for tubal patency testing during fertility workup compared with (serial) hysterosalpingography: A randomized controlled trial. Fertility and Sterility, 102(3), 821–825. https://doi.org/10.1016/j.fertnstert.2014.05.042
General Publications
Abdennebi, I., Pasquier, M., Vernet, T., Levaillant, J. M., & Massin, N. (2022). Fertility Check Up: A concept of all-in-one ultrasound for the autonomous evaluation of female fertility potential: Analysis and evaluation of first two years of experience. Journal of Gynecology Obstetrics and Human Reproduction, 51(9). https://doi.org/10.1016/j.jogoh.2022.102461
Link: Technical Tips and Tricks after 10 Years of HyFoSy for Tubal Patency Testing – PubMed (nih.gov)
Bohîlțea, R. E., Mihai, B. M., Stănică, C. D., Gheorghe, C. M., Berceanu, C., Dima, V., Bohîlțea, A. T., Neagu, S., & Vlădăreanu, R. (2022). Technical Tips and Tricks after 10 Years of HyFoSy for Tubal Patency Testing. Journal of Clinical Medicine, 11(19). https://doi.org/10.3390/jcm11195946
Devine, K., Dolitsky, S., Ludwin, I., & Ludwin, A. (2022). Modern assessment of the uterine cavity and fallopian tubes in the era of high efficacy assisted reproductive technology. In Fertility and sterility (Vol. 118, Issue 1, pp. 19–28). NLM (Medline). https://doi.org/10.1016/j.fertnstert.2022.05.020
Ramos, J., Pellicer, N., & Fernández-Sánchez, M. (2022). Hysterosalpingography (HSG) is obsolete: Hysterosalpingo-contrast foam sonography (HyFoSy) should be the alternative. Reproductive BioMedicine Online.
Link: HyFoSy for Fallopian tube test, the how: Sonographic signs and standardization with a simple classification – PubMed (nih.gov) Levaillant, J. M., Rabourdin, A., Pinto, M., Hurteloup, E., Vernet, T., Pasquier, M., Moquet, P. Y., & Massin, N. (2022). HyFoSy for Fallopian tube test, the how: Sonographic signs and standardization with a simple classification. Journal of Gynecology Obstetrics and Human Reproduction, 51(3). https://doi.org/10.1016/j.jogoh.2021.102307
Zajicek M, Kassif E, Weisz B, Berkovitz Shperling R, Lipitz S, Weissbach T, Barzilay E, Orvieto R, Haas J. “One-stop shop” for the evaluation of the infertile patient: hystero-salpingo foam sonography combined with two- and three-dimensional ultrasound and sonohysterography. J Obstet Gynaecol. 2021 Aug 27:1-5.
Link: Evaluating Fallopian Tube Patency: What the Radiologist Needs to Know – PubMed (nih.gov)
Grigovich M, Kacharia VS, Bharwani N, Hemingway A, Mijatovic V, Rodgers SK. Evaluating Fallopian Tube Patency: What the Radiologist Needs to Know. Radiographics. 2021; 41: 1876-18961
Link: ACR Appropriateness Criteria® Female Infertility – PubMed (nih.gov)
Wall, D. J., Reinhold, C., Akin, E. A., Ascher, S. M., Brook, O. R., Dassel, M., Henrichsen, T. L., Learman, L. A., Maturen, K. E., Patlas, M. N., Robbins, J. B., Sadowski, E. A., Saphier, C., Uyeda, J. W., & Glanc, P. (2020). ACR Appropriateness Criteria® Female Infertility. Journal of the American College of Radiology, 17(5), S113–S124. https://doi.org/10.1016/j.jacr.2020.01.018
Link : Clinical Aspects of HyFoSy as Tubal Patency Test in Subfertility Workup – PubMed (nih.gov)
Exalto, N., & Emanuel, M. H. (2019). Clinical Aspects of HyFoSy as Tubal Patency Test in Subfertility Workup. In BioMed Research International (Vol. 2019). Hindawi Limited. https://doi.org/10.1155/2019/4827376
Tubal patency assessment procedures timeline
1910
Laparoscopy: Jacobaeus (1910), Palmer (1947).
1914
First HSG is performed (Carey).
1966
Emergence of ultrasound based techniques with saline infusion sonography (SIS) (Corfman and Taylor).
1993
Introduction of Hysterosalpingo Contrast Sonography (HyCoSy) (Deichert), a patient friendly ultrasound technique. However, the common contrast medium Echovist® (Schering AG, Berlin, Germany) was taken out of market and replaced by saline and air. Saline and air which accuracy is not comparable to HSG, is now the mostly used alternative.6
2011
Introduction of Hysterosalpingo Foam Sonography (HyFoSy) (Exalto and Emanuel), an in-office procedure for tubal patency testing in women with known or suspected infertility or subfertility. ExEm® Foam is the medium used in HyFoSy.
2017
HyFoSy proven accuracy and minimum invasiveness. Studies suggested that, with proper imaging technique, HyFoSy with ExEm® Foam does not significantly differ from laparoscopy with dye and has the ability to achieve significantly higher accuracy than 2D saline and air7.
2022
HyFoSy, the future of tubal patency assessment.
The foam study, a large randomized control study found that HyFoSy leads to similar pregnancy outcomes, compared with HSG as first-choice patency test. Then it also found that HyFoSy is experienced as significantly less painful than HSG.5
