The primary difficulty in establishing a SS service is the requirement for a multidisciplinary approach. The services and expertise of a gynaecologist, radiologist and medical physicist are all required. It may well be possible once the service is established for only the gynaecologist or the radiologist to perform the procedure with a technician in attendance for the pressure measurements. However in the initial stages of the development of the technique all have a valuable contribution to make. The second problem is one of time.
Many gynaecologists assess the uterus and tubes during their operating sessions.
There is limited time outside of this for the further evaluation of the pelvis. As a result hysterosalpingograms tend to be performed by junior doctors on rotation. For this reason they are often poorly performed, even for diagnostic purposes let alone for treatment. A further difficulty is the availability of and access to suitable equipment. Gynaecologists have been in the forefront of advances in endoscopic surgery, both in developing equipment as well as techniques.