Fertility Treatment When Stationed Overseas: The Questions You Need to Ask

fertility

No one thinks they are going to need help getting pregnant, especially military spouses.

Take a look around; we appear to be a fertile bunch. In my base housing community it’s not unusual to see a pregnant woman with a baby on her hip and another in a stroller.  Playgrounds dot the neighborhood. And our community yard sale is the best place to score pre-loved nursery essentials.

But the fact remains, military affiliated or not, one in eight couples need help conceiving or sustaining a pregnancy. My husband and I were one of them.

In the fall of 2014 I suffered a miscarriage with my first pregnancy. Six months later my husband and I moved to Bahrain, a small island off the coast of Saudi Arabia. We looked forward to exploring a foreign country, finding a home, settling into a routine and welcoming a baby.

But as we acclimated and the months passed without a positive pregnancy test I became concerned. It was only then that I realized how little I knew about fertility care when stationed overseas. I spent the next year in doubly foreign territory, receiving fertility treatments at local hospitals.

Bahrain is a unique situation — a base with a small clinic, no OB/GYN on staff and no military hospital. If you struggle to conceive while living there you are referred to a local OB/GYN, typically practicing at a hospital in the capital city of Manama.

I had done some limited research before we arrived, mostly scanning hospital websites and checking to see that they do provide some fertility assistance, but I quickly realized that this was not enough. I had no idea what it was like to be treated at a local hospital, the role that cultural differences played, capabilities and lack thereof of the doctors, the role of insurance (International SOS) and the out-of-pocket expenses associated with treatment. Having used Tricare Standard (now Select) in the States this was also my first experience at a military treatment facility.

I quickly learned that I would be doing all of the legwork, research and advocacy on my behalf, a situation that came to feel like a part-time (or sometimes even full-time) job. Thankfully I connected with some other spouses going through the same thing and we were able to share information, strategies and support. These connections along with making contact with an American reproductive endocrinologist (RE, fertility specialist) who reviewed my files and treated me on visits back to the States (for which my husband and I paid entirely out-of-pocket) were invaluable.

If you’re considering a move overseas and are currently being treated for fertility challenges or think you may be facing them in the future I encourage you to start researching the options in your potential new home. Most overseas duty stations offer more options for fertility assistance than Bahrain does, but they all have their own quirks. Making contact with women on the ground is the best way to get information and will save your sanity on this journey.

Below are some important questions to ask when considering fertility assistance overseas.

Facilities

  • Is there a military hospital? And if so does that hospital have the capabilities to provide diagnostic testing and fertility treatment?
  • If the answer is yes, to what extent? Perhaps they can dispense drugs and monitor your ovulation but do not offer intrauterine insemination (IUI) or in vitro fertilization (IVF). It’s important to know exactly what capabilities they have before arriving.
  • If there isn’t a military hospital what are the treatment options on the local economy? What level of care is offered? IUI? IVF?

Doctors

  • Is there a military medical clinic where you’re going? Are they open on the weekends or only during business hours (weekend hours are pretty essential for fertility monitoring)? Do they have an OB/GYN on staff? What about a reproductive endocrinologist (RE)?
  • If there is no military medical option what are the options on the local economy? Does the location you’re moving to have REs? If not who is providing fertility care? How are the local doctors accredited or certified? If possible it’s helpful to know how or where the local doctors were trained.
  • What level of English do the local doctors speak and how much experience do they have providing fertility assistance? What kind of support does the base or base clinic provide in directing you to and assisting in your interactions with local doctors?

Insurance/Cost

  • If you’re overseas it is likely that you’ll be dealing with International SOS as your insurance provider. It is worth exploring what tests and procedures they cover and what they don’t. In Bahrain they covered routine fertility monitoring and most medication but not IUI or IVF.
  • Once you know what you’ll be responsible for try to gather information on the local costs for out of pocket procedures, this can vary hugely from country to country and even hospital to hospital in the same country. Many people from the US travel overseas because the cost for fertility procedures (especially IVF) is greatly discounted. Perhaps this is the case in the country you’ll be moving to.

Support

  • Support is crucial when coping with the isolation of infertility (which can feel even more profound in an overseas location). Start scouring your potential new home for sources of support. Is there a Facebook page related to the military community where you could begin to ask these questions? I found support by joining a base affiliated moms Facebook page where women trying to get pregnant and those already pregnant and with children shared vital information on the local OB/GYNs.
  • If you don’t find any support before your arrival, don’t be discouraged. I guarantee other women are struggling with infertility, sometimes meeting them only happens through face-to-face interaction. In my experience if you speak up to a few spouses in your new home, they will connect you with someone they know in the same situation. Until that time RESOLVE: The National Infertility Association provides great online support and in person support groups in certain areas.

I never would have guessed that my road to parenthood would have taken me through a desert island. But it did.

After nearly a year of failed treatments, I developed complications that resulted in the cancellation of my fourth IUI cycle. I walked out of the hospital, put my head on the steering wheel of my car on the side of a dusty desert road and cried. We stopped all treatment and began researching IVF in the US.

And then, an unexpected and early Christmas gift: at the next meeting with my RE during a holiday visit to the States I found out I was pregnant.

My son was born the following August in the United States. His arrival healed much of the struggle, frustration and bitterness that colored my infertility experience and our time in Bahrain. I wish I had the answer for everyone struggling with infertility, especially those spouses overseas, but the best I can offer are the questions that helped me along the way.

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Aimee Lorge is a freelance writer and personal essayist with a focus on family, career and the unique intersection of both in the military spouse experience. After struggling with infertility overseas she is the very thankful mother of two. For more information visit www.aimeelorge.com.

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