Women’s health. Who cares?  Historically very few people, but over the past 20 years we’ve seen more and more energy going towards health issues that (predominantly) impact (cis-)women.  Breast cancer research, HPV vaccination for cervical cancer, heart disease in women, and other work.

We still see challenges in access to women’s health care and many of them are subtle.  One of these challenges is access to hysterosalpingogram (HSG) for women being assessed for infertility.  One of the best tests of a uterine cavity and the status of the Fallopian tubes is an HSG.  In BC HSGs are covered by MSP.  The procedure involves a radiologist putting a tube into the cervix and then pushing dye up through the uterus and out the Fallopian tubes.  As the dye travels x-rays are performed. The radiologist then reads the x-rays and provides infertility specialists a report.  

An HSG not only lets us know the status of the uterine cavity and tubes, but also can improve fertility by “flushing” the tubes.  There are many babies born just because an HSG was performed!

If you are an infertility patient in the lower mainland of BC you likely already know how difficult an HSG appointment is to get.  Appointments are booked on a first-come-first-served basis and booked around menstrual cycle day 8-12.  The person calls on cycle day 1 and they are booked. So often no answers the phone when you call to book and if you did get through there is an 80% chance you will be told there is are no appointments left this month.

Why are HSG appointments so scarce?

The COVID pandemic limited appointment times and then the major provider of HSGs is restricted their practice.  There is no one else to fill their role so we do not anticipate more HSG spots becoming available.

This is a crisis.  The single best tool to assess a woman’s infertility is not accessible.  The reasons are complex I’m sure but my belief is there are two main reasons: HSGs do not pay radiologists and hospitals enough to make it worthwhile to do them. The rate they pay I think hospitals and radiologists would actually lose money in providing them.  The second reason is that infertility is not a priority in BC. 

At Olive we have started to provide sono-HSGs which are done by also putting fluid (saline) into the uterus and then an ultrasound is performed. They are great but not covered by MSP and only about 90% accurate for assessing the Fallopian tubes.

We are filling the gaps left by dropping HSG appointments and doing several sono-HSGs every day.  It’s barely enough. I’d like to see HSG appointments increase back to pre-COVID levels or more, but unless the funding and access model changes, that will not happen.

How can you help get access?  The short answer is it’s multiple levels of bureaucracy who determine how such tests are funded but the Ministry of Health  and the Medical Service Plan seem like good places to start.