Family Building 101

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.