Objective To compare the efficacy of hysterosalpingo-contrast sonography (HyCoSy) using a saline solution with that of radiographic hysterosalpingography (HSG) in the assessment of tubal patency. Method We compared the findings obtained by the 2 methods with those obtained by standard diagnostic laparoscopy with the chromopertubation test in a study with 88 infertile women younger than 40 years. Results The sensitivity, specificity, and diagnostic accuracy of HyCoSy and HSG were similar, and 65 (74%) of the women reported the pain associated with HyCoSy as mild to moderate. Conclusion The HyCoSy procedure is well tolerated and can be used as a primary tool for the evaluation of tubal patency in infertile women.