“This is a multifactorial issue,” says Nasir Rana MD, MPH, a Reproductive Endocrinologist and Infertility specialist (REI) with Reproductive Medicine Institute and a retired Colonel from the U.S. Air Force Reserve with a rating of Chief Flight Surgeon. “The issues that affect active-duty women (and men) are not only physical and environmental but psychological, financial and professional in terms of their limitations.”
Rana points to the statistic of ‘war footing’, that is the condition of operating as if in a wartime environment as a key factor. “Our military has been continuously deployed since 2001, immediately following the 9/11 attacks. These absences from family and the opportunity to focus on conceiving a child are significantly affected by time and distance. If an individual is already experiencing subfertility and is not strategically located near their partner or an REI physician/practice, they are missing the window to conceive.”
Whether the issue is deployment and the stress that this can create for individuals and families or the difficult conditions that a soldier is living under, stress can also play a factor in a women’s ovulation cycle and consequently, her fertility. “Stress is an element that is difficult to quantify and qualify when trying to conceive,” says Rana. “We know it plays a part, but it is difficult to measure.”
Active military may also be subject to exposure to environmental chemicals/factors that may exist. “Unfortunately, we often determine this after the time of exposure,” says Rana, “but we know that there are things that active military may come in contact that do not occur in the civilian population.” Active military are also at risk of a higher rate of divorce than their civilian counterparts, particularly prior to the age of 30, prime reproductive years. If children already exist (from an early marriage), vasectomy may be considered and would need to be surgically altered in order to allow for future pregnancies.
While Assisted Reproductive Technology (ART) can help single women and men achieve a pregnancy through donor sperm, donor eggs and surrogacy, the issue of practicality and accessibility can play a significant role. “Military personnel do not have the same flexibility as those working in the civilian sector,” says Dr. Rana. “Most people take for granted the ability to run out for a doctor’s appointment etc. while the military has a highly structured schedule which doesn’t allow for the (often) multitude of appointments for monitoring and bloodwork that may be necessary as part of fertility treatments. Furthermore, many military bases are not located near major population centers, restricting access to specialized care.”
Isolation and stress can also lead to a higher rate of depression among military personnel, further complicating fertility issues. “While military personnel tends to be of more optimum weight and fitness, psychological problems can be a contributing factor,” says Rana.
Finally, health coverage, or the lack thereof for Infertility coverage offered by Tricare, the insurer for military personnel, can present a major financial barrier for those trying to conceive. “It may be difficult for enlisted to initiate treatment due to limited financial resources,” says Dr. Rana. “Fertility treatment can be cost-prohibitive in these instances, particularly without the benefits of insurance. Our goal at Reproductive Medicine Institute, and my personal goal as a Veteran, is to help military personnel create or expand their families regardless of the issues are physical, psychological, or financial. To this effect, we work with a number of Fertility assistance programs such as WINfertility to help serve those brave women and men who serve us every day.