Combating Infertility during Military Service: A Grounded Theory Approach

Background: In the United States, one out every six couples of childbearing age experiences infertility. Advances in medical science, have motivated many military couples who experience infertility to pursue the option of utilizing assisted reproductive therapy (ART). Although advances in ART allow for increased chance of conception, they require patients to engage in rigorous medical evaluations, invasive procedures, and lengthy treatment cycles. Many patients who undergo ART are challenged with complex decisions about treatment options and can endure financial hardships. There are numerous factors that can disrupt, delay, or limit active duty service member’s (ADSM) access to available ART services such as Permanent Change of Station, Temporary Duty, and deployment orders. The perceptions and behaviors of military leaders and healthcare providers may also influence the decision-making processes and experiences of ADSM and their families who seek ART. Overall, these factors can cause emotional and physical crises that can affect many aspects of the lives of military couples. Despite the potential impact on the health and military readiness of our armed forces, to date there is a paucity of studies that have been conducted among this unique population.
Specific Aims: The long-term goal of this study is to understand how ADSM and their partners navigate the infertility healthcare process within the military healthcare system while managing a military career. The specific aims are the following: 1) elicit ADSM's and their partner's experiences of seeking treatment for infertility within the military healthcare system; 2) illustrate examples of ADSM's and their partner's information-seeking behavior, participation in treatment decision-making processes, and health system navigation; 3) explore ADSM's and their partner's expectations while seeking infertility care; and 4) identify facilitators or barriers to effective infertility care while maintaining a military career and its impact on career progression.
Methods: A qualitative design using grounded theory methods for data collection and analysis will be employed. Participants will be recruited using purposive sampling followed by theoretical sampling. Data will be derived from the following: 1) demographic questionnaires; 2) semi-structured, in-depth interviews; 3) field notes; and 4) literature. Quantitative data from collected from the demographic questionnaires will be organized and analyzed using Statistical Package for Social Sciences. Qualitative data will be managed and examined using NVivo (QSR International). The researchers will employ constant comparative analysis - the practice of analyzing, comparing, and coding data in order to name, categorize, and conceptualize the data and relationships among data.
Implications: An understanding of how military couples perceive and manage rigorous ART demands may enhance access to care, decrease patient costs, improve outcomes, and provide better support for military couples who experience infertility. This may ultimately improve the health and military readiness of our armed forces. In addition, the results may assist health care professionals, congressional and military leaders, and policy makers understand the content needed to develop effective infertility treatment programs and policies in the Department of Defense.