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.
FAQs
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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.
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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.
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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/.
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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.
Common Disorders & Medical Conditions
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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.
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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.
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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.