Infertility is 'a special kind of hell' for military couples
By LEO SHANE III | STARS AND STRIPES Published: September 27, 2012
WASHINGTON — Army Maj. Marc Bailey and his wife, Sallie, never thought they’d have to wait this long or spend this much to have a baby.
As of June, the couple had spent three agonizing years and $35,000 unsuccessfully trying to get pregnant. The effort has nearly exhausted their retirement savings and their patience.
“This is hands down the worst thing we’ve ever been through,” Sallie said. “When you start having fertility problems, it consumes your life.”
Since 2009, the couple has gone through seven failed fertility treatments, including three expensive in vitro fertilization cycles. Each one cost thousands of dollars and required months of medications, doctor visits and stressful waits. Each took an enormous emotional toll.
Each left them a little less hopeful.
“We’re young enough that we should not have had these problems,” Marc said. “The first treatment should have been enough. ... We expected each treatment to solve our problems.”
About one in 10 couples under 45 in the United States struggle with infertility, according to statistics from the Centers for Disease Control and Prevention.
Dealing with it can be time-consuming and heartbreaking. For military couples, the demands of service add an extra level of complication.
The Baileys have moved through three duty stations since they were married in 2007 and consulted with doctors in four states. Several times, new treatments had to be delayed because of Marc’s deployments and out-of-state assignments.
Each obstacle meant more delays, more waiting.
Even after three years of heartbreak and frustration, they weren’t ready to give up. In June, they decided to try one more clinic, one last treatment, one final attempt.
“After this, I don’t think there will be any money left to try again,” Sallie said.
Military couples interviewed said much of their motivation to talk about their struggles was to break the taboo surrounding infertility and dispel the myth that the assisted pregnancy procedures are more about convenience than need.
“A lot of insurance companies still compare those procedures to cosmetic surgery,” said Barbara Collura, executive director of the national infertility association Resolve. “It’s not something that people understand, even though the World Health Organization classifies infertility as a disease.”
Part of the silence surrounding infertility comes from religious objections to the in vitro fertilization procedure, which involves manually combining an egg and sperm in a controlled laboratory environment and — if successful — transferring the resulting embryos into a woman’s uterus. The Catholic Church and a number of conservative Christian denominations consider the procedure immoral.
Part of the reluctance to talk about infertility comes from the frustration of multiple failed attempts, and from embarrassment.
Sallie said much of the problem comes from a lack of knowledge among families who’ve never had to deal with infertility.
“I’ve had family ask why I don’t just be patient, or go to adoption,” she said. “A lot of people just see it as an elective thing. It’s not.
“And struggling with infertility as a military spouse is a special kind of hell. Many of the Army wives I’ve met seem to have no idea how to relate to me because I’m not a mom."
Sallie and Marc said their inability to get pregnant has taken a permanent emotional toll.
“I think I put on a good show, but it’s hard,” Sallie said. “I’ve been through self-esteem counseling and been put on antidepressants. I think we’re stronger as a couple, but this is a huge, horrible thing.”
Marc said he has tried to be the calmer one, since Sallie has to endure the trauma that comes with every new clinic visit, whether he’s there or not.
“I can handle the stress of combat much easier than I can seeing what Sallie goes through,” he said. “I try to be there for her, but I feel inadequate in helping to shoulder the burden of all the medical procedures, physical discomfort and loss of dignity.”
The couple met at graduate school in Missouri. He was stationed at Fort Leonard Wood, living as a civilian for a semester to finish a master’s degree. Both were studying environmental engineering and started pairing up on assignments.
Their romance was interrupted by Marc’s yearlong deployment to Honduras a few months later. They did the best they could to keep in touch through email and sporadic phone conversations.
“I’ll never forget when he sent me a picture … showing him and a few friends visiting a local orphanage and handing out candy,” she said. “To see him with those adorable children melted my heart.”
After Honduras, Marc deployed to Iraq for a year. The couple decided to call it quits, but that didn’t stick. Within weeks of his returning home, they started seeing each other again. They talked about starting a family.
Within a few months they were married. Three weeks after that, he deployed to Iraq again.
More delays, more waiting.
Hectic schedules and frequent separations have always challenged military newlyweds. In the Baileys case, the demands of military service also put off the discovery of infertility.
“We took some time just to be a couple when he came back from Iraq [the second time],” she said, “but once we started trying [in 2009] it didn’t take me long to figure out my body was going to have trouble.”
They started consulting with specialists, who put Sallie on a hormone stimulant and recommended timed intercourse to increase their odds. Frustration and fear started to creep into their family planning.
“The military makes it worse,” Marc said. “Most of our married [military] friends have children now. You can’t go to a PX or commissary without children everywhere. Posts and units constantly put out programs for families and children.”
Sallie got pregnant in late 2010, but miscarried a few weeks later. Marc was out of town on assignment when she realized what had happened. Both were devastated.
They went back to the fertility specialists. Doctor visits had to be scheduled around Army assignments. New treatments had to be scheduled around station moves.
More lost time, more waiting.
A typical fertility treatment can take two or three months, from pre-cycle preparation to the final test results. Time became a more precious commodity with each failed cycle.
In June, just as they were about to start another IVF cycle, the duty-before-family problem surfaced again. Marc was sent to California on a training assignment. Sallie was left behind in Kentucky.
“I chose the military and I have a great deal of pride in serving,” Marc said, “but damned if nothing seems easy with infertility when you’re serving.”
The latest pregnancy attempt was delayed another month.
More delays, more waiting.
When the Baileys started looking into more invasive infertility procedures, the cost of treatment became a major concern.
Under military rules, Defense Health Systems will pay for diagnostic tests, fertility specialists and certain medications, but not for the costs of IVF or other complex pregnancy procedures.
Many civilian insurance companies have a patchwork of coverage for infertility treatments, but few cover all the costs. A single IVF cycle can run $12,000 to $20,000, including medications, medical appointments and lab work.
In recent months, Congress has considered a measure to cover the full cost of treatments for troops or veterans wounded in combat, and another proposal to offer military and civilian families a tax credit of about $13,000 a year for infertility treatments.
Neither measure has advanced far.
The Defense Department offers advanced fertility treatments, including IVF cycles, at Lackland Air Force Base in Texas, Tripler Army Medical Center in Hawaii, Walter Reed National Military Medical Center in Maryland, Fort Bragg in North Carolina, Naval Medical Center in California, and Madigan Army Medical Center in Washington.
Time on the waiting lists can be up to 12 months, but the facilities provide a great boost for couples who get in.
Susanne Volinski and her Navy lieutenant husband, Walter, went through three IVF cycles at the Fort Bragg clinic before she got pregnant. The total cost for all three cycles was less than $10,000. The total at civilian clinics they had visited would have been more than $30,000.
The military facilities don’t have many of the administrative and operating costs of private clinics, and will cut off a cycle at no cost if no healthy embryos develop. Private clinics, with physicians’ salaries and monthly rent bills to cover, can’t always afford the same generosity.
The Volinskis had to cut off cycles prematurely twice in their efforts to find treatments for her damaged fallopian tubes. Their advanced age was a complicating factor. Both were over 35 when they started treatment.
“We would never have been able to afford it if not for the military options,” she said.
The process wasn’t easy. The couple was stationed in Jacksonville, N.C., about a two-hour drive to Fort Bragg. Susanne had to make the trip alone at least once each week for most of their two-month treatment, totaling more than 1,000 miles for multiple trips in the days leading up to the embryo transfers. “I’d have to leave at 5 a.m. just to get there in time for 7:30 appointments,” she said.
Still, they said they were fortunate to get in the program after only a few months on the waiting list following three years of trying to get pregnant.
They’re trying another cycle at the North Carolina clinic now, hoping for a brother or sister for their 16-month old daughter, Madison.
By the end of July, Marc returned to Kentucky and the Baileys finally started their next IVF cycle with a private clinic. Marc said they had looked into the military options, but decided against them.
“A major concern for us was the travel and separation for treatment,” he said.
They were far from the military clinics — they’ve moved from New York to Kansas to Kentucky in the last three years — and missing duty for elective procedures was a concern.
After the years of failure, the couple was forced to travel anyway. The New Jersey clinic they selected was more than 700 miles away from Fort Knox, but offered some new approaches and cutting-edge research that the military clinics did not.
The bills and the frustration began to pile up.
Marc said he had to fight with Tricare to get reimbursed for basic diagnostic tests, and to get records shifted between the different regional health care systems. It took weeks of phone calls and red tape to get a $1,000 bill covered for blood work.
When Sallie was diagnosed with polycystic ovary syndrome — a severe imbalance of female sex hormones — it was somewhat of a relief.
“At least we felt like we were getting answers,” she said.
A little more than a week into the new cycle, the Baileys received more bad financial news. Tricare officials told them that even though the costs of fertility medications had been covered in past cycles, they shouldn’t have been.
Sallie had to scramble to find $3,800 to continue their latest IVF attempt. They still worry that military health officials might try to revisit past reimbursements.
At the same time, the couple started talking more seriously about using donor eggs or pursuing adoption, but Sallie said that would be admitting defeat.
“I’m not ready to let go of that genetic link. I’m only 32,” she said. “I want to be a mother to my husband’s child.”
The American Pregnancy Association says about one-third of all women under 35 who go through a single IVF cycle get pregnant. It approaches 90 percent for those who endure multiple cycles, as doctors address hormonal imbalances and identify pregnancy roadblocks.
It’s a draining process for the women. Doctors prescribe medications to adjust body chemistry, medications to stimulate egg production, medications to trigger ovulation, medications to help the body accept transferred embryos.
Most have to be taken through injections. Sallie said she has become an expert at giving herself the shots, some of which are required more than once a day during an IVF cycle.
“It’s tough, but I can psych myself up to get it done,” she said.
The only one she hasn’t been able to handle without Marc’s help is the “trigger” shot just before the egg extraction, because doctors require that oversize intermuscular injection to go deep into her lower back.
In a cruel twist, the side effects of the treatments — morning sickness, fatigue, abdominal pain — can mirror the early aches of pregnancy.
Collura’s group runs online support groups for couples struggling with infertility, including military families. They trade tips on medications that have shown promise, warnings about false positives from pregnancy tests, and encouragement after frustrating failures. Those message boards have been invaluable for Sallie.
“It helps to know that you’re not the only one dealing with this,” she said.
The Baileys’ grueling wait ended mid-September.
The cycle failed. There were no embryos to transfer.
“We’ve had healthy embryos in the past, but this time, there was nothing,” Sallie said.
Marc had taken leave to travel to New Jersey for the cycle, and the hotel and travel costs added to their mounting expenses. The latest failure added to their mounting disappointment.
“It has just been exhausting for both of us,” Sallie said. “To travel all the way to New Jersey and not even get a chance ...”
They have now spent more than $50,000 on failed fertility treatments. Despite the cost, despite the sadness, the couple has decided to try one more IVF cycle.
“Marc says we can afford one more, although I’m not really sure I believe him,” Sallie said. “This really will absolutely have to be our last.”
They will have to make arrangements soon — Marc is expecting to deploy overseas again next year. If he gets the call early, that could mean more delays, and more waiting.
“The feeling that time is against us eats at me,” he said.
Sallie Bailey pushes the air out of her Follistim pen, a syringe containing fertility drugs, before giving herself an injection as part of an in vitro fertilization cycle. Bailey and her husband, Marc, an Army major, have worked with numerous doctors over the last three years in an attempt to have a child, but so far have had no success.
COURTESY OF SALLIE BAILEY