The period of my life when I assumed pregnancy could be planned ended only two years ago — but it feels like a distant memory. It’s almost laughable, considering the years I spent worrying about accidental pregnancies. Once I was ready, I thought I would be in control of when and how it would happen. My husband, Mike, and I were both on active duty in the Army, with access to free medical care and paid parental leave. We had served together in two overseas duty stations and planned to start our family when we returned to the United States.
I didn’t know it at the time, but getting pregnant would soon consume all of our time and emotional bandwidth. Infertility can be a challenge for any family, but for active-duty service members, there is an additional set of obstacles, a bureaucratic process about which Mike and I would become experts.
I was about to turn 34 and wanted to get pregnant as quickly as possible. I tracked my cycles to know when our chances of conception would be highest. Each month, an Amazon package of pregnancy tests and ovulation-prediction kits would arrive. I took my temperature with a basal thermometer that tracks the thermal shift that occurs after ovulation and is accurate to a hundredth of a degree. I peed on a stick every single day.
About 90 percent of women under 35 who don’t actively prevent pregnancy are likely to conceive within a year of trying. Every month, I was convinced we had conceived, because I knew our timing was right. And every month I’d be disappointed. I started to wonder whether we should have started trying a year or two sooner, even though we weren’t really ready then.
After seven months of tracking my cycles, I finally had a positive at-home pregnancy test. We were leaving for my brother-in-law’s wedding in a few weeks, so we thought we would use that trip to tell my husband’s family the good news, but the chance never came. I started cramping and bleeding heavily the night before we left and continued to miscarry on our trans-Atlantic flight in basic economy.
When I got back, I went to the doctor, who refused to acknowledge that I had had a miscarriage because I never had a blood test to confirm the pregnancy. The devastation of seeing two pink lines on several home pregnancy tests — and then bleeding heavily two weeks later — seemed like enough evidence to me. After about 10 months, I lied and told my doctor we had been trying for a full year, the point at which we could get a referral to a reproductive endocrinologist in the military medical system. Something had to be wrong, I thought. And if it was, things were going to get a lot more complicated for us, biologically and financially.
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One of the first issues that service members struggling with infertility face is insurance coverage. Tricare, the health insurance provided to everyone in the active-duty military, pays for assisted-reproductive procedures if a loss in reproductive ability is a result of a service-connected injury. Otherwise, military members have to pay out of pocket. Caught up in larger debates about abortion, federal regulations are unfriendly to assisted-fertility techniques that create embryos but also risk destroying some in the process. Tricare will cover infertility assessment and costly testing, monitoring and medications, because those measures can be “combined with natural conception,” but in vitro fertilization (I.V.F.) is not considered “natural.” Intrauterine insemination (I.U.I.), the option that Mike and I chose, isn’t considered “natural” either, according to Tricare’s policies, and that implicit value judgment compounded the feelings of shame and sadness that I already felt from being unable to conceive.
Mike and I decided to use intrauterine insemination to start because I.V.F. was too expensive for us. The out-of-pocket cost for I.V.F. at a military hospital averages around $5,000 for each attempt but can be as much as $10,000 if it includes freezing embryos (a real possibility for couples facing a deployment) or involves a donor (which same-sex couples can scarcely avoid). I.U.I. is a much less expensive procedure: it costs $173 at Walter Reed for each new cycle. Over 18 months, my husband and I spent around $1,000.
Insurance coverage and out-of-pocket expenses are only the first barriers for service members dealing with infertility. Only six military medical treatment facilities in the country offer the full range of fertility procedures. If a service member and their spouse are not located near one of these facilities, they have to travel there using their vacation time or request temporary duty at that location. The service member must get permission from their command to transfer or take leave, which means involving their bosses in what is already a difficult and deeply personal process. Assuming leave is granted, appointments are on a space-available basis and aren’t guaranteed.
At Walter Reed National Military Medical Center in Maryland, near the base where my husband and I were stationed, I.U.I. and monitoring for I.V.F. cycles are readily available and scheduled very early in the morning before the start of the workday. At other military clinics, I.V.F. cycles are offered only a few times a year, and the wait can be up to 12 months long. That doesn’t work for people posted at a particular duty station for a limited time.
On top of the institutional barriers, infertility itself can be difficult to understand. My diagnosis was a mystery to my doctors. I had a battery of tests, requiring so much blood that I needed two appointments at the lab. I endured invasive and painful procedures. All that to come to a diagnosis of “unexplained infertility.” My lady parts were functioning, but they didn’t seem interested in producing a baby. I started to realize how much we still don’t know about women’s bodies, and it made me extremely frustrated.
After my fallopian tubes were examined for any blockages — there were none — my husband and I were approved to proceed with intrauterine insemination. At this point, patients like me are given a round of oral medication to stimulate the ovaries, forcing the body to mature one or more ovarian follicles to increase the chances of conception. The side effects can range from bloating and irritability to abdominal pain and severe diarrhea. I experienced them all.
Thirty-six hours before the insemination procedure, my husband would do the honors of injecting me with hormones in the buttock with a sturdy inch-and-a-half-long needle. “It’s OK, I’m a doctor,” he would say with confidence as he jabbed me. Technically true; he is a doctor of musical arts in saxophone performance.
We had to arrive at Walter Reed by 7 a.m. to sign into the clinic on the day of each insemination. It was usually packed with other sad and infertile people, so Mike and I tried to get there 30 minutes early to be first on the list. We would sit there with all the other couples and awkwardly avoid eye contact. About an hour later, the nurse would start calling names for the male partners to give their samples. I always wondered if hearing the national anthem over the loudspeaker, a common practice on military installations for raising the flag and starting the day, hindered Mike’s process.
We made a ritual of it. My husband would perform his sacred duty while I waited in the lobby, and then we would head to the hospital cafeteria. We would joke and speculate about the other couples over burnt coffee and powdered eggs, while the clinic prepared the sperm sample and removed the least promising swimmers. The idea behind I.U.I. is to insert the high-performing sperm directly into the uterus via catheter so the sperm and egg virtually have no barriers to their rendezvous. How could it not result in a pregnancy — it’s science, right?
After each insemination, I would put on my uniform and go back to work like nothing happened. But my mind would be racing as I sat at my desk, wondering if we had just conceived our first child. What if I didn’t lay there on the table long enough, I would think. The fourth time, Mike came into the room with me. It seemed like a good opportunity for him to observe what a gynecological exam is really like. His eyes widened at the sight of the forceps. But really I wanted him there in case it worked. Then we could say we were both in the room when we finally conceived.
We did this six times. Every month my period came was devastating. I had two more early miscarriages, while it seemed as if everyone I knew was becoming pregnant, and with the greatest of ease. Mike and I debated whether we should stop trying with I.U.I. and opt for the more expensive I.V.F.
I was emotional and bloated all the time, barely able to make weight and maintain the Army’s fitness standards because some days I couldn’t get out of bed from months of fertility drugs. Whenever I stumbled on an internet troll suggesting that women use pregnancy to get out of a deployment, I would be sent into a blind rage. I tried my hardest to plan a pregnancy while on active duty, to be able to use the benefits I had earned, but it never happened. I left the Army in January.
Shortly after, the first cases of the novel coronavirus were confirmed in the United States. The decision of whether to move forward with I.V.F. was made for us. Walter Reed paused most fertility treatments. I became mostly concerned with how to keep from getting sick and how the radio show I helped produce would continue if the station had to close. Pregnancy drifted further and further from my mind every day.
The last day before our radio station went totally remote, I was rummaging through my medicine cabinet for a new tube of toothpaste when the bright pink wrapper of my last pregnancy test caught my eye. It was a reminder of our infertility, so I wanted it gone. But I also didn’t want to waste it, so I peed in a cup, dipped it in and hopped in the shower.
Rushing around the bathroom to get ready, I glanced down at the test. It read “Yes” in all capital letters, and I gasped. This had to be a mistake, I thought. The whole bus ride to work I frantically Googled articles about false positives and convinced myself the results were not reliable.
I went into the pharmacy next door to my office and bought a few more tests. During a break from broadcasting our show, I took them in the bathroom at work. They were all positive.
I don’t really believe in miracles — but I’m struggling to come up with another explanation for how this happened, after our last doctor visit had given us less than 1 percent chance of conceiving without assisted reproductive technology.
Nothing about this pregnancy happened the way we planned, and the pandemic has presented a lot of challenges like finding prenatal care and assessing the risk of seeing a doctor in person. My history of miscarriages has left me with an ever-present, low-level of anxiety and reminds me that this could all end at any moment.
But for now, we’re expecting our baby boy in November.
Victoria Chamberlin served in the Army for seven years and is now a reporter for the Guns and America public media collaborative at WAMU, Washington D.C.’s NPR partner station.