Family Building 101

Regardless of where you are in your family building journey, we want to empower you with the knowledge and information you need to reach your goals.

Family Building 101 FAQs

  • Family building is an inclusive term used to refer to the various ways a modern family can be built or formed. This includes the actions or steps taken by individuals or couples with the goal of having children. Family building includes trying to conceive naturally, the use of assisted reproductive technologies (ART) like in vitro fertilization (IVF), adoption, surrogacy, or other means of growing ones family.

  • Here is a typical process before seeing a reproductive specialist, as well as overviews of the IUI and IVF processes.

    Before seeing a specialist:

    Try conceiving naturally for 12 months if under 35, or 6 months if over 35. This provides time to conceive and establishes infertility.

    See your primary care doctor for initial evaluations like medical history, exams, blood tests to check for issues like thyroid problems, STD screening, and semen analysis for male partners.

    Discuss lifestyle factors that could be optimized like weight, diet, exercise, smoking and alcohol use, and make appropriate changes.

    Review your insurance coverage for fertility treatments to understand what is covered.

    Get a referral to a reproductive endocrinologist (fertility specialist) for further evaluation and treatment.

    Intrauterine Insemination (IUI):

    IUI is ovarian stimulation with fertility drugs to produce multiple eggs. Frequent monitoring is done.

    A trigger shot of hCG is given to induce ovulation when follicles are mature.

    Semen is washed and concentrated in the lab to separate the best sperm.

    A thin catheter is used to inject the processed sperm directly into the uterus right before ovulation.

    Luteal phase progesterone support is often given.

    A pregnancy test is done around 14 days after the IUI procedure.

    In Vitro Fertilization (IVF):

    IVF is when ovarian stimulation and egg retrieval are done to obtain multiple eggs.

    Eggs are fertilized with sperm in the lab and cultured for 3-5 days.

    The resulting embryo(s) are selected for transfer back into the uterus in either a fresh or frozen embryo transfer cycle. This is dependent on your case and doctor's recommendations. Your doctor may also advise genetic testing of your embryos.

    Additional viable embryos can be frozen for future transfer cycles.

    Progesterone support and bed rest after transfer help implantation.

    A pregnancy test is done around 10-14 days post-transfer to check for successful implantation.

  • According to the Blue Star Families 2021 Military Family Lifestyle Survey 67% of military-connected families struggle with family building. The survey cites fertility challenges, miscarriages, and hormonal imbalances as top causes of family-building struggles. Challenges to family building include the military lifestyle (time apart, PCS, lacking continuity of healthcare), lack of insurance coverage, associated out-of-pocket expenses, and infertility. To learn more view the Blue Star Families Report here: https://bluestarfam.org/research/mfls-survey-results-2021/.

  • According to the TRICARE website the following services are covered:

    • Diagnostics and treatment of an injury or illness of the male or female reproductive systems.

    • Erectile dysfunction if there is a physical cause.

    • Diagnostics services for semen analysis, hormone evaluation, chromosomal studies, immunologic studies, special and sperm function tests, and bacteriologic investigation.

    • Medically necessary coital conception, meaning medicated or timed intercourse.

    TRICARE does NOT cover:

    • Artificial or intrauterine insemination.

    • Costs related to donors or semen banks.

    • Reversal of tubal ligation or vasectomy, unless medically necessary.

    • Non-coital reproductive procedures, services, or supplies, including: in vitro fertilization, gamete intrafallopian transfer, zygote intrafallopian transfer, or tubal embryo transfer.

Ovulation Disorders & Conditions

  • Hyperprolactinemia is a condition that can inhibit ovulation and involves the hormone prolactin.

    Overview: Hyperprolactinemia is a condition where prolactin levels are abnormally high. Prolactin is the hormone responsible for breast milk production.

    Causes: A prolactin-secreting pituitary tumor (prolactinoma) is the most common cause, accounting for over 90% of cases. Other causes include medications, thyroid disorders, kidney disease, or chest wall injury.

    Symptoms: In women, it often causes irregular periods, infertility, and milk discharge from the breasts. In men, it may result in low testosterone and erectile dysfunction. Headaches and vision changes may occur if a large tumor is present.

    Diagnosis: Based on symptoms, medical history, blood tests showing high prolactin levels, and MRI scan of the pituitary gland to look for tumors.

    Treatment: Medications like bromocriptine or cabergoline to lower prolactin secretion from tumors. Surgery or radiation to shrink prolactinomas may also be done.

    Effect on fertility: High prolactin inhibits GnRH secretion from the hypothalamus, preventing normal ovulation. Treating the hyperprolactinemia can restore ovulation, menstrual cycles and fertility in most cases.

    Outlook: With treatment, normal prolactin levels can be restored in 90% of cases, restoring fertility. Untreated, it persistently suppresses ovulation leading to infertility. Monitoring and follow-up is needed.

    Hyperprolactinemia data:

    - Casanueva FF, Molitch ME, Schlechte JA, Abs R, Bonert V, Bronstein MD, Brue T, Cappabianca P, Colao A, Fahlbusch R, Fideleff H, Hadani M, Kelly P, Kleinberg D, Laws E, Marek J, Scanlon M, Sobrinho LG, Wass JAH, Giustina A. Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clin Endocrinol (Oxf). 2006 Aug;65(2):265-73. doi: 10.1111/j.1365-2265.2006.02562.x. PMID: 16846454.

  • Hypothalamic dysfunction happens when the hypothalamus is not functioning properly. The hypothalamus is responsible for releasing hormones that trigger ovulation. When it's not functioning properly, it can disrupt monthly ovulation. Stress, weight issues, other illnesses can cause this.

    Overview: The hypothalamus is a small structure in the brain that helps regulate hormone production from the pituitary gland, including reproduction-related hormones.

    Causes: Hypothalamic dysfunction can be caused by tumors, inflammation, injury, infections, radiation or medications affecting the hypothalamic-pituitary axis. Stress, weight issues, and endocrine disorders can also impact its functioning.

    Effects: When the hypothalamus malfunctions, it fails to adequately stimulate the pituitary gland. This disrupts the signals for hormones that trigger ovulation (GnRH, FSH, LH) leading to irregular/absent periods.

    Symptoms: Absent or irregular periods are the main sign. Headaches, vision issues, sleep problems may also occur with tumors pressing on the hypothalamus.

    Diagnosis: Based on symptoms, medical history, MRI scans to identify tumors or structural abnormalities, and blood tests to measure hormone levels related to the hypothalamic-pituitary-ovarian axis.

    Treatment: Treating any underlying condition causing it. Fertility medications to induce ovulation. IVF with fertility drugs may be needed in severe cases.

    Outlook: Prognosis depends on the underlying cause. Minor causes may be reversible with treatment and allow normal ovulation/fertility. Severe structural defects can permanently impact fertility.

    Hypothalamic Dysfunction data:

    - Burt Solorzano CM, McCartney CR. Obesity and the pubertal transition in girls and boys. Reproduction. 2010 Sep;140(3):399-410. doi: 10.1530/REP-10-0119. PMID: 20802109; PMCID: PMC2936090.

  • PCOS is a hormonal disorder where women develop multiple small cysts on the ovaries and have irregular or prolonged menstrual cycles. It results in irregular/absent ovulation due to hormone imbalances. It can be treated with medications to regulate cycles and induce ovulation.

    Overview: PCOS is a common hormonal disorder affecting up to 10% of women of reproductive age. It causes infrequent, irregular, or prolonged menstrual periods and excess androgen levels.

    Symptoms: In addition to menstrual irregularities, symptoms may include excess facial and body hair growth, acne, thinning scalp hair, weight gain, darkening skin patches, pelvic pain, and difficulties getting pregnant.

    Causes: The exact cause is unknown but is related to hormone imbalances, including elevated testosterone, insulin resistance, inflammation, and genetics.

    Diagnosis: PCOS is diagnosed based on Rotterdam criteria - having two of the following three: irregular periods, excess androgens, and polycystic ovaries on ultrasound. Blood tests help rule out other conditions.

    Treatment: Lifestyle changes like weight loss, diet, and exercise can help manage PCOS. Birth control pills can regulate menstrual cycles. Fertility medications like clomiphene may be used to induce ovulation. Metformin may be prescribed for insulin resistance.

    Fertility Impact: PCOS makes ovulation less frequent or absent, leading to infertility. Treatment can improve ovulation and chances of conception. Some may need advanced treatments like IVF.

    Long Term Risks: PCOS increases risks for type 2 diabetes, heart disease, endometrial cancer if not properly managed. Monitoring health and follow-up with doctors is important.

    Polycystic Ovary Syndrome (PCOS) data:

    - Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, Piltonen T, Norman RJ; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018 Sep 1;33(9):1602-1618. doi: 10.1093/humrep/dey256. PMID: 30060021.

  • Primary Ovarian Insufficiency, also known as premature ovarian failure is when the ovaries stop functioning normally before age 40. It causes low estrogen levels, irregular periods, and reduced egg numbers. Usually requires donor eggs to achieve pregnancy.

    Overview: POI, also known as premature ovarian failure, is when a woman's ovaries stop functioning normally before the age of 40. It results in infertility and early menopause.

    Causes: Genetics play a major role, such as chromosomal defects or autoimmune disorders. Other causes include previous surgery, chemotherapy/radiation, or infections damaging the ovaries. In about 25% of cases, no cause is identified.

    Symptoms: Irregular periods, hot flashes, night sweats, vaginal dryness, mood changes, difficulty conceiving. Periods become infrequent and eventually stop.

    Diagnosis: Based on abnormal hormone levels - high FSH, low Estradiol levels - before age 40. Antral follicle count shows very few follicles remaining. Karyotype testing checks chromosomes.

    Treatment: Hormone replacement therapy helps with symptoms but won't restore fertility. Donor eggs are usually required to achieve pregnancy. Adoption or childfree living are options.

    Outlook: Spontaneous conception is very unlikely with POI. With donor eggs, success rates are comparable to other women in that age group. Early menopause risks (osteoporosis, heart disease) need to be monitored.

    Support: POI diagnosis can be emotionally difficult. Counseling, connecting with support groups, and relying on family can help cope with the effects on relationships, self-esteem, and grief over fertility loss.

    Primary Ovarian Insufficiency data:

    - Jameson JL, De Groot LJ, de Kretser DM, Giudice LC, Grossman AB, Melmed S, Potts JT Jr (eds.): Endocrinology: Adult and Pediatric. Saunders Elsevier, Philadelphia, PA, 2016, pp 2200-2205.

Thyroid Disorders & Conditions

  • Both hyperthyroidism and hypothyroidism can lead to irregular ovulation and menstrual cycles, resulting in difficulty getting pregnant. Thyroid hormones directly impact reproductive health.

    Overview: The thyroid gland produces hormones like thyroxine and triiodothyronine that regulate metabolism. Both hypothyroidism and hyperthyroidism can disrupt normal menstrual cycles and ovulation.

  • Overview: Hyperthyroidism is an overactive thyroid leads to excess thyroid hormone levels. This can cause irregular, light, or absent periods. Ovulation may still occur but at an increased rate less favorable for conception. It is associated with decreased fertility.

    Diagnosis: Thyroid disorders are diagnosed by blood tests measuring TSH, T4, and T3 levels. Anti-thyroid antibodies may also be tested to check for autoimmune causes like Hashimoto's or Grave's disease.

    Treatment: Hyperthyroidism is treated with anti-thyroid medications, radioiodine, or surgery.

    Fertility Impact: With proper thyroid treatment and hormone levels normalized, fertility can improve and women can conceive and have healthy pregnancies. Doctors monitor thyroid levels closely.

  • Overview: Hypothyroidism When the thyroid is underactive and thyroid hormone levels are low. This causes irregular periods, anovulation, increased prolactin levels - all contributing to infertility. It also raises the risk of miscarriage and birth defects if pregnant.

    Diagnosis: Thyroid disorders are diagnosed by blood tests measuring TSH, T4, and T3 levels. Anti-thyroid antibodies may also be tested to check for autoimmune causes like Hashimoto's or Grave's disease.

    Treatment: Hypothyroidism is treated with levothyroxine supplements to restore thyroid hormone levels.

    Fertility Impact: With proper thyroid treatment and hormone levels normalized, fertility can improve and women can conceive and have healthy pregnancies. Doctors monitor thyroid levels closely.

    Thyroid Disorders data:

    - Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev. 2010 Oct;31(5):702-55. doi: 10.1210/er.2009-0041. Epub 2010 Jun 22. PMID: 20573783.

Other Disorders & Conditions

  • Overview: Diminished ovarian reserve (DOR) is when the ovaries have a reduced number and quality of eggs available compared to normal reproductive-aged women. It indicates declining fertility.

    Causes: The most common cause is advanced maternal age. The natural aging process depletes eggs over time. Other causes can include genetics, prior ovarian surgery, pelvic infections, endometriosis, smoking, and chemotherapy.

    Symptoms: Irregular periods, infertility, and early menopause can occur, but sometimes there are no obvious symptoms. Many only discover when trying to conceive.

    Diagnosis: DOR is diagnosed through blood tests for FSH and AMH levels and antral follicle count via ultrasound. Abnormal results indicate DOR.

    Risks: DOR lowers the chances of conception with natural or assisted reproduction. It may indicate early menopause as well. There is also an increased risk of miscarriage. Donor eggs improve success.

    Treatment: Options include IVF with maximal fertility drugs to harvest any remaining eggs, donor eggs, embryo adoption, or child-free living. Supportive care is recommended.

    Outlook: With DOR, chances of conception and live birth using a woman's own eggs is lower. Donor eggs can greatly improve success rates. Early detection and intervention is optimal.

    Diminished Ovarian Reserve data:

    - Committee on Gynecologic Practice. Committee opinion no. 618: Ovarian reserve testing. Obstet Gynecol. 2015 Jan;125(1):268-73. doi: 10.1097/01.AOG.0000459864.68372.ec. PMID: 25560136.

  • As women near menopause, cycles become irregular and ovulation is unpredictable. Egg quality also declines. This starts several years before menopause.

    Overview: Perimenopause refers to the transition period leading up to menopause, when reproductive hormones start to decline. It usually begins 4-5 years before menopause.

    Causes: The ovaries start producing less estrogen and progesterone as a woman's egg supply declines. Follicle stimulating hormone (FSH) levels also start to rise.

    Symptoms: Irregular periods are the main sign. Other symptoms include hot flashes, night sweats, vaginal dryness, mood changes, trouble sleeping, decreased libido. Periods become increasingly irregular.

    Diagnosis: Based on symptoms and hormone tests showing elevated FSH and low anti-mullerian hormone (AMH) levels for the woman's age.

    Fertility Impact: Ovulation becomes more unpredictable and fertility declines significantly. The remaining eggs are lower in quality, increasing chances of chromosome abnormalities.

    Treatment: No treatment can stop perimenopause progression. For symptoms, hormone therapy, birth control pills, or fertility drugs may provide temporary relief. Use of donor eggs improves IVF success.

    Outlook: Pregnancy is still possible in perimenopause but chances are lower with each passing year. Freezing eggs or embryos earlier on for future use is an option. The average age of menopause is 51.

    Perimenopause data:

    - Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM, de Villiers TJ; STRAW+10 Collaborative Group. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause. 2012 Apr;19(4):387-95. doi: 10.1097/gme.0b013e31824d8f40. PMID: 22343518; PMCID: PMC3340904.