https://aub.ie/MilitaryREACH-Buechel2022

Buechel, J., Spalding, C. N., Brock, W. W., Dye, J. L., Todd, N., Wilson, C., Fry-Bowers, E. K. (2022). A grounded theory approach to navigating infertility care during U.S. military service. Military Medicine, usac174. https://doi.org/10.1093/milmed/usac174

Infertility, or the inability to experience pregnancy after one year of unprotected intercourse, is a challenge faced by some military couples. These couples may choose to engage in assisted reproductive therapy (ART) and utilize a range of treatment options (e.g., fertility medication, in vitro fertilization). 25 Service members and 7 partners accessing ART were interviewed about their experiences navigating infertility treatment while managing a military career. A theoretical framework was developed from these interviews to explain the process of engaging in ART and to provide insight into ways to better support these couples. Both facilitators and barriers to ART emerged for these military-affiliated participants.

https://doi.org/10.1093/milmed/usac174

Couples
Parents
Physical health
Other

Navy
Army
Coast Guard
Multiple branches

Active Duty
Reserve
Veteran

Active duty service member
Spouse of service member or veteran
Military medical service providers
Military Leadership
Veteran
Guard/Reserve member

Young adulthood (18 - 29 yrs)
Adulthood (18 yrs & older)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)

Qualitative Study
Cross sectional study

Buechel, Jennifer, Spalding, Carmen N., Brock, Whitney W., Dye, Judy L., Todd, Natalie, Wilson, Candy, Fry-Bowers, Eileen K.

In this study, we aimed to understand how active duty service members and their partners navigate the infertility care process within the Military Health System (MHS) while managing a military career.We obtained Institutional Review Board approval to employ a qualitative design using grounded theory methods. We recruited participants using purposive sampling, followed by theoretical sampling. We derived data from demographic questionnaires and semi-structured interviews. Consistent with grounded theory methods, we began analysis with line-by-line coding and moved to focused coding. We employed constant comparative analysis throughout the process to name, categorize, and conceptualize data and relationships.The participants included 28 patients, five partners, nine health care providers, and two military leaders. The infertility care process began with active duty service members and their partners recognizing the desire to have a child and discovering infertility, followed by deciding to seek infertility care. The experience was temporally bound within the context of the military environment. We identified the following themes, which described facilitators and barriers to accessing care: Duty station location, career stage, military versus the civilian cost of services, command climate, and policy. These facilitators and barriers varied widely across the Department of Defense (DoD), which resulted in fragmented and inconsistent care cycles, contributed to emotional and physical stress, and created tension between career progression and family formation.Understanding how military couples perceive and manage demands of infertility care may enhance access to care, decrease patient costs, improve outcomes, result in better support for military couples who experience infertility, and ultimately improve the health and military readiness of our armed forces. The results support the need for action by providers, policy makers, and military leaders to develop effective infertility treatment programs and policies in the DoD.

Oxford Academic

Article
REACH Publication

Naval Submarine Medical Research Laboratory, JB
Bioskills Simulation Training Center, Navy Medicine Readiness and Training Command San Diego, CNS
Department of Pediatrics, Neonatal Intensive Care Unit, Kaiser Permanente San Diego Medical Center, WWB
University of California San Diego Health, WWB
Rady Children’s Hospital San Diego, WWB
San Diego State University School of Nursing, JLD
The Geneva Foundation, NT
Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, CW
Hahn School of Nursing and Health Science, University of San Diego, EKF