Thank you for reading! There are over 1 million military service members in the US right now. Please share this article widely in case it may help one of them. Dr. Kate O’Leary was my special guest for this show. She’s double board certified in OB GYN and reproductive endocrinology and infertility. She completed her fellowship at Stanford University where she also got a Masters in Health Services Research. She graduated Phi Beta Kappa from Rhodes college in Memphis, Tennessee, and earned her medical degree from Northwestern university. She did her OB GYN residency at San Antonio Uniformed Services Health Education Consortium at Lackland Air Force Base. She is the best fertility expert to help us with this topic.
Dr. Aimee: Tells us about yourself and your military career.
Dr. Kate O’Leary: Yes. So, 20 years ago when I got into med school, I investigated the Health Professions Scholarship Program. It’s done by the military, all of the branches [Army, Navy, Air Force]. And it’s a way to help pay for medical school while also serving your country in the military.
And I thought that sounded like a good opportunity. And so I did that. I got accepted. And that started my career in the military. The Air Force paid for my education at Northwestern. I did my OB GYN residency and military training, really great training, in San Antonio with my Army colleagues (joint Army and Air Force program). And then I had an opportunity for further fellowship training that the military also helped pay for. And in return, I served seven years active duty after finishing my training at Wright-Patterson Air Force Base.
Dr. Aimee: And what advice do you have for other physicians who want a medical military career?
Dr. Kate O’Leary: This is a great question. I really wish that someone had kind of walked me through what I should expect. The biggest thing would be to find somebody who is a military doctor or a veteran who served so they can tell you how their experience was. There are a lot of important considerations that you need to remember.
So, first of all, you’re going to go to bootcamp. So that’s hard. You’re going to learn how to be an Officer. You are an Officer first. An officer and then a doctor. It’s just important to realize you have dual responsibilities. And as an Officer, you’re a leader.
Another very important consideration is that if you know that you want to be a doctor that’s super, super sub-specialized, like interventional radiology or something like that, you need to remember that the military will [need to] serve their needs first. They need to fill their military spots, like OB-GYN, general surgery, general practitioners, before all the subspecialties. So you may not have an opportunity to do a fellowship or get that training while in the military. And you may serve as a less specialized physician and then have to do that training later when you separate. So that’s really important. Something I didn’t realize. I got lucky because the military needed reproductive endocrinologists. There’s only a handful of us, but I got a spot, thankfully. And so that is how I got that opportunity.
There are also widespread changes happening in military health care for all branches, so it is key to talk to somebody’s who has been through it or who is serving now.
Dr. Aimee: Are military women at higher risk for suffering from infertility?
Dr. Kate O’Leary: I think so, yes. There are a lot of unique differences in life in the military versus civilian life. And one thing that we do see more of in the military is tubal factor infertility. So a lot of our female active duty soldiers and airmen are younger and move around a lot, and they might be exposed to and get diagnosed with more sexually transmitted infections (STIs).
So we do see more STIs, and as a result, more tubal factor in our young women. That’s one difference. There are other unique exposures in the military that are important as well. One obvious one, you know, with deployments to places where there’s war, there’s always an opportunity to get injured. Post 9–11, we did see a lot more genitourinary injuries. We saw more wounded warriors who suffered from IED explosions who could have their reproductive organs affected.
A third thing to think about is exposures. It does depend on what job you’re going to have in the military. Sometimes we’re exposed to more jet fuels or different vaccines [Anthrax] and organic solvents. Burn pits happened years ago in Afghanistan and Iraq, and those toxins probably affected fertility.
Another thing that’s not talked about as much is PTSD rates. Sexual trauma rates in the military are also very high. And so that affects relationships because of intimacy [problems], erectile dysfunction — all of those things can happen as a result.
Then the last factor I would think about is: what are your career goals? Some of our young active duty women want [the opportunity] to promote, they want further training, and they want to get as high as they can in their chain of command.
And so sometimes, just like when going to med school or law school or business school, there are different goals and hurdles involved, and people might put off having a family until later.
Dr. Aimee: So what can a woman do, let’s say, to get ahead of some of the factors that you brought up?
Dr. Kate O’Leary: There are a lot of things that I think that we can do, and one thing is that when our active duty women or veterans are coming in for their care each year to see their OB GYN, we need to be having the discussions about, ‘what’s your family building plan?’ Maybe you’re only in your twenties. You’re not thinking about that [family building].
But we still need to talk about it. Maybe check your AMH levels. See how your ovarian reserve is. Just get more information so you can make better informed decisions. Also, making sure that we’re having a good lifestyle in terms of diet, eating healthy with a healthful diet, taking vitamins with folic acid, and other supplements like CoQ10, exercise, and decreasing stress.
And then finally, thinking about freezing your eggs or sperm as a part of fertility preservation, especially before deployments. It’s just something to at least think about. We need to do a better job discussing this with our active duty airmen and soldiers.
Dr. Aimee: And that’s a very expensive proposition as well. How can someone in the military find affordable treatment if they choose that that’s something that they want to do?
Dr. Kate O’Leary: Yeah, that’s tough. And there are only a handful of bases that provide any type of fertility care. And they’re only able to do that because they’re part of a training program for their OBGYN residents. I think that at least go talk to your OBGYN, get a referral to an REI (fertility doctor), whether it’s on base or a local civilian, and ask the clinic: do you provide a military discount? A lot of them do, and they may not be on the Resolve.org website. I know our clinic’s not even on the Resolve.org website, and we provide military discounts. It’s always good to ask about that. You may also sometimes be able to get discounts on medications too. Doing IVF on a military installation can be a little bit more affordable, but it’s hard to get into those places, especially if you’re not stationed at that base. So asking lots of questions is probably the best way to see how you can afford it.
Dr. Aimee: And let’s say you’re not stationed at that base where they’re provided IVF care, can talk me through that process?
Dr. Kate O’Leary: Well, it’s hard. So what I would recommend is talk to your OBGYN, and get a referral to an REI and see if there is an opportunity to travel to a base, one of the bases that’s closest to you, and get on their wait list for IVF.
There are some restrictions and limitations in the military because we have only finite resources. So there are wait lists, unfortunately, and different cutoffs for age and body mass index, that are important to think about. But sometimes you can travel to those bases. And if you can, you can do a remote telemedicine visit initially, and [then] local labs, and then you can potentially travel to one of the bases and stay there for a few weeks for your [ovarian] stimulation. But one thing I will say is that sometimes the travel and the time you need to take away from work, and getting permission from a commander, can be obstacles and can end up being more expensive or more stressful than just staying local with a civilian clinic.
Dr. Aimee: Right. And then if you’re staying local with the civilian clinic, it’s just like coming to see me or you.
Dr. Kate O’Leary: Yes. And sometimes [a little] different depending on the treatment that’s pursued. Sometimes Tricare or the military insurance will cover certain medications, but they usually don’t cover procedures like insemination or IVF.
Dr. Aimee: For those who are listening and watching us who don’t necessarily know what insemination is, can you kind of just take us through what’s an insemination?
Dr. Kate O’Leary: So for someone who is going to undergo an insemination, typically we will want to give some medications, first oral medications, to help time ovulation better.
We want that egg to come out at the perfect time for insemination. This will involve either donor sperm or sperm from a partner, and it gets washed in the lab, and then we take a tiny little catheter that’s put through the cervix. We place a speculum in the vagina. And then put a little catheter through the cervix and basically push the sperm into the uterus, and the sperm typically are moving better after the wash. Hopefully, exposing that egg to millions more healthy sperm than when trying [to conceive] naturally will improve chances.
Dr. Aimee: Do you think if you’re in the military, you would have that time off to get to those appointments? Is that something people are allowed to do?
Dr. Kate O’Leary: You know, it of course depends on what the job is of our soldier or airmen. Commanders are very family friendly and will typically give time off for those appointments. I never had an issue, when I was active duty, getting my patients in on time. Even our active duty doctors who are very busy.
So that can be something that’s helpful. The only trick would be if someone has to travel more than an hour or so to get to the nearest fertility clinics. Sometimes that can get tricky, but commanders are typically very open to that.
Dr. Aimee: Do you recommend that if you’re going through a fertility treatment, to let your commander know? If I had a patient that came to me and she said, you know, I’m planning going through treatment, should I tell my boss? Is it something that you should tell your boss if you’re in the military?
Dr. Kate O’Leary: It’s tricky. I feel like it’s [fertility treatment] very private and you shouldn’t have to tell your boss, but if you know that you are scheduled to deploy soon, it’s hard to do these types of treatments without notifying somebody or prior planning. Because if you get sick or if you have a complication, that has implications for the mission. I think many working patients, military or not, find themselves in a similar position while undergoing fertility treatment. Sometimes you need to find coverage at work or be allowed time off for appointments, and having a flexible supervisor helps. My personal opinion is that I feel like it [fertility treatment] should be private if the patient wants it to be private but, in my experience, supervisors and commanders have always been supportive.
In fact, a few years ago, I was tasked by my flight commander to work on the Force of the Future Initiative introduced by Secretary Carter for the Department of Defense. The program sought to expand fertility benefits to active duty members, specifically fertility preservation, as part of a broad program to strengthen comprehensive family benefits. Through a pilot program, TRICARE would cover the costs of egg or sperm freezing for active duty service members with the goal of potentially increasing recruitment and retention of service members. It is known that active duty members need better balance to start and support a family while in uniform. The stresses of the military on families is a main reason that members exit the military. While this part of the Force of the Future Initiative did not ultimately get approved, it did show that there is real work being done in the Department of Defense to support family building and fertility preservation as a priority for service members.
Dr. Aimee: Great advice. And so how can someone in the military maximize their chances of getting pregnant naturally?
Dr. Kate O’Leary: Well, the things I tell all my patients, you know, mentioned a little bit earlier, healthful diet.
That’s one of the biggest things to at least start with. Sometimes when we’re young, we, we can eat whatever we want and you know, it doesn’t harm us. But in the end, we need to really be thinking about cutting out processed foods and trans fats and all those bad high-glycemic index carbs. I tell my patients to make sure that they’re exercising. You want to try to get into that healthy fertility zone for your BMI. Make sure that you’re taking a prenatal vitamin with folic acid, and iron. Also consider CoQ10 and fish oil. Stop smoking and make sure you use protection if you have more than one sexual partner to help decrease STIs. Those are a few maintenance things that I always talk about.
Each year when you come in for your annual exam, we should be talking about your reproductive goals. It’s not only about putting you on birth control pills and putting pregnancy off. We really need to be talking about your goals and maybe checking levels of AMH to see what your ovarian reserve is before you get on a birth control pill. We want to make sure you don’t miss your window of opportunity to have the family that you desire, even if it’s a long ways away. Asking questions and really trying to stay healthy in the meantime is important.
Dr. Aimee: That’s great that those conversations are happening in the military.
Dr. Kate O’Leary: I think we’re getting better and better. I know that a lot of providers in the past were afraid to just check a random AMH, but now we’re more open to it. And I think that we should — especially for our young women , who are going to deploy, or maybe you’re approaching 32 and you haven’t had your family yet — at least talk about egg freezing and fertility preservation because we don’t want to have that conversation five years down the road when you wish you had done something earlier.
Dr. Aimee: So you mentioned an acronym for a hormone, AMH. For people listening who don’t know what that is, can you tell us a little bit about it?
Dr. Kate O’Leary: So AMH stands for Anti-Mullerian Hormone, and this is a test that we can do that gives us an estimate of how many eggs you have left. It’s normal for that number to go down with age, so that when we are in menopause, we basically have an AMH of zero. It’s an important predictive tool, though, at least in helping us predict how many eggs we might get from an IVF cycle.
It’s not a predictor of fertility per se, but knowing your number is empowering because, if for some reason you’re younger and you have very low AMH, this might be the time to think about fertility preservation, so that we don’t miss an opportunity maybe later. We’re only born with so many eggs and they go away throughout our life. AMH can be helpful in counseling patients.
Dr. Aimee: What advice do you have for a family who was serving and who needs fertility care? What can they do to be proactive?
Dr. Kate O’Leary: Don’t be afraid to ask for a referral. Even when I was an active duty reproductive endocrinologist, people didn’t even know I was on the base and would just struggle silently or be told, “oh, you’re young, just wait.” So, be proactive. Ask for that referral.
If there’s not a reproductive endocrinologist on the base, ask for a referral off base. You’re allowed to do that. And that is covered by Tricare. Tricare will cover your diagnostic testing and some treatments. So that’s probably the most proactive thing to do. And the other thing that I keep harping on is just really talk to your doctor every time you go to see them for primary care. So really talk to your doctor, not just about birth control, but talk about long- term goals. Or if they’re not answering your questions or can’t, ask for that referral. Feel empowered to get the information that you deserve to have now.
A Note about In Vitro Fertilization Treatment for Veterans:
Our veterans with certain service-connected conditions that result in infertility may be eligible for in vitro fertilization (IVF), or another form of assisted reproductive technology (ART) and other infertility services. The VA can provide these services if:
- The patient has a service-connected condition that causes infertility
- The patient is legally married
- Male spouses can produce sperm
- Female spouses have an intact uterus and can produce eggs
Donor sperm, eggs and embryos, gestational surrogacy, or obstetrical care for non-Veteran spouses are not covered under this benefit.
As a part of the VA medical benefits package, the VA provides many different types of fertility treatments and procedures to Veterans. These include infertility counseling, laboratory blood testing, genetic counseling, sperm testing, ultrasounds, surgery, medication, and other treatments. To learn more about these types of services, the first step is to call (both females and males) the Women Veterans Health Care at 855–829–6636. If the patient is eligible for ART or IVF, the VA will then refer the couple to a Reproductive Endocrinology and Infertility (REI) physician in the community for treatment planning.
More information is available here.
Dr. Aimee: Thank you for being on our show. I really appreciate all the advice you’ve given us about fertility care for military families. I also love your posts on Instagram. Your meal planning posts are so inspiring.
Dr. Kate O’Leary: That is a new thing. I used to hate to cook and I couldn’t [cook]. I used to just eat Ramen noodles when I was in medical school, or even worse, McDonald’s. I can’t believe I’m admitting that here!
But I recently just started reading more about eating more vegetables and just trying to be healthier because I just felt gross. I’ve got joint pains. I’m getting older. Now blood pressure issues. And so I thought maybe I [should] look into eating a little bit healthier [more vegetables!], a little bit less processed food, less red meat, and less meat in general. I just started reading all of these books, and the recipes looked good. And it’s fun. [And the family likes most of them.]
Dr. Aimee: For people who want to follow you, where do they find you?
Dr. Kate O’Leary: You can find me on Instagram[@drkateoleary].
Dr. Aimee: Well, thank you for all you’ve done for our country. Thank you for what you do for your community and for everyone who’s following you. You have to follow her you will be inspired.
Dr. Kate O’Leary: Thank you so much for that.
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