Staff Perspective: “Do you have children?” The Milspouse Elephant in the Room
Life as a military spouse is synonymous with frequent moves, starting over, and re-establishing connections. For a large portion of my married life, each PCS (Permanent Change of Station) and the initial social functions that followed brought with it a certain angst related to connecting- especially with other military spouses. Although I knew the intent was to meet, interact, and form connections, there tended to be an “elephant in the room” at each of these gatherings.
Do you have kids? An innocent question most spouses asked as an opener to start conversation. As newlyweds this question was easy to respond to. “No kids, but at some point.” Yet, as newlywed status fades and you have been married 3, 5, 10 years…this question starts to have a different impact- especially when “at some point” has not occurred.
While the military is comprised of ~1.31 million active-duty service members (MilitaryOneSource, 2023), within each of the service branches the subcommunities are not as large as you would think. Most specialty areas, such as aviators/pilots within the Marine Corps, either know each other or of each other from various interactions within their jobs. So, it is inevitable you will cross paths or be assigned to the same duty stations with the same people again. That is where the milspouse elephant in the room begins to become more blatant- it has been several years or duty stations since seeing this spouse and the looming question emerges, “do you have kids?” When the answer is “no” yet again, there exists this comfort to ask more… “do you want kids?” or “when are you going to have them?” For me, these interactions were typically followed by the formation of a knot in my stomach and deciding how to respond. Do I say what is really going through my mind or the practiced generic response. Unbeknownst to those asking, this internal dialogue was my source of angst during these social interactions- and I later learned was shared by others who experience infertility.
Within the general population, it is estimated that one in six people of reproductive age will experience infertility at some point (World Health Organization, 2024). Recent studies within the military community suggest those numbers may be higher. The Blue Star Families 2021 Military Lifestyle Survey found that 67% of respondents have experienced at least one family-building challenge, and the 2024 Military Family Building Survey from the Building Military Families Network found that 70% of respondents identified as having an infertility connection. The more I have learned and been open to talking about my own infertility journey, the more common I have found it to be within the military community.
Despite this occurrence, most military families experience various challenges to accessing fertility treatments. There are only six military treatment facilities (Fort Sam Brooke Army Medical Center, San Antonio, TX; Tripler Army Medical Center, Honolulu, HA; Walter Reed National Military Medical Center, Bethesda, MD; Womack Army Medical Center, Ft. Bragg, NC; Naval Medical Center, San Diego, CA; and Madigan Army Medical Center, Tacoma, WA) that offer Assisted Reproductive Technology (ART) at a reduced rate. For those referred to civilian providers the cost can double, even triple, with one round of In vitro fertilization (IVF) costing between $10,000-$25,000. Currently, Tricare policies only cover some of the expenses related to treating infertility. These consist of diagnostic services (i.e., semen analysis, hormone evaluation, chromosomal studies, immunologic studies, imaging studies, special and sperm function tests, bacteriologic investigation) and treatments to correct an underlying physical cause of infertility or erectile dysfunction stemming from a physical cause- all of which must be deemed medically necessary (Tricare, 2025). While working with a PCM and getting the necessary documentation in your medical record has its own set of challenges, once achieved, these foundational services at minimum provide military families a starting point to understanding their fertility and making an informed decision regarding treatment. While, TRICARE does not cover ART for common causes of infertility like polycystic ovary syndrome (PCOS), endometriosis, low sperm count or, in our case, unexplained infertility; it may cover ART, such as IUI and IVF, if the service member has suffered a documented service-related injury or illness causing their infertility. For service members, proof of service-connected infertility can pose additional challenges. Impacts to reproductive health and fertility is still being researched in terms of what may be causal factors (i.e., exposure to toxins, brain injury/combat injuries, medications, etc.,) and unless infertility is specifically identified through diagnostic testing or medical records, detecting the cause and providing service-connected proof remains a struggle.
In addition to diagnosis, insurance coverage/costs, and treatment, other challenges involve the cost and time to travel to/from multiple doctor appointments (and or military treatment facilitiy (MTF) depending on location), maneuvering schedules of both the spouse and service member, the cumulative costs for each appointment and cycle of treatment, storage fees for reproductive specimens, and access to medications (sometimes covered through MTF pharmacies depending on availability and location). While this may not sound different from a civilian couple seeking fertility treatment, these challenges are amplified when combined with normal military life that involves consistent separation, relocation, limited proximity to support systems, and routine changes to medical providers. The process becomes a revolving door of starting over resulting in delays for beginning a treatment, and ultimately a family. Over recent years, legislation has worked to increase coverage for infertility and ART benefits for military service members and their spouses. Although there have been some improvements, the resources and accessibility of these benefits remain limited, especially in comparison to some private insurance companies.
Navigating the logistics related to infertility treatment was its own set of challenges. What I was not prepared for was the emotional roller coaster that can come with this journey- much of which was experienced alone or only shared with those closest to me. As with all medicine, it is a practicing science, it can take several appointments and “cycles” to figure out what works for your body. This means getting your hopes up, then deflated when told the cycle was cancelled or unsuccessful, and then mentally preparing yourself to do it all again the following month or waiting “x” amount of time before starting again.
When looking at the statistics for successful ART (based on age, clinic, and treatment type) and talking with others who have experienced infertility, my spouse and I were relatively lucky. With our first child, we were able to complete treatment through an MTF. It took a year of diagnostic testing, work-ups, and specialist referrals, followed by four cancelled cycles and, on the fifth cycle and first IUI, success that gave us our son. A few years later, we were referred to a civilian provider for ART that consisted of six months of work-ups, one cancelled cycle, and success on our first IUI that gave us our daughter. Despite asking questions and reading, I felt ill prepared physically, mentally, and emotionally for everything this process entailed. Medical staff were always supportive; yet, in some ways, it was the re-emergence of the “elephant in the room;” an internal feeling of embarrassment, anxiety, and mixed emotions, surrounding the process. An experience I later found to be shared amongst others engaging in infertility treatment.
As I have found my voice and willingness to talk more openly about my infertility journey, I have found that the “elephant in the room” is no longer ignored and the resulting insecurities it caused resolved. I have a stronger sense of community with other spouses that have shared this journey, as well as feel confident that if my spouse and I choose to go through this process again, I am better prepared how to navigate and advocate for my family. In the meantime, my hope is that legislation continues to improve coverage for infertility and ART benefits to service members and their families. As for the milspouse elephant in the room question, “do you have kids”- I can now answer it with a smile and without angst, “Yes, I have two amazing kids” and am comfortable sharing my journey to be able to have them.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Heather Tompkins, Ph.D, MS-ATR, LCMHC, is a Military Behavioral Health Psychologist with the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this role, she provides oversight and fosters collaboration for creative arts related research projects in partnership with the Defense Intrepid Network.
References
Building Military Families Network (2024). 2024 Military Family Building Survey.
https://static1.squarespace.com/static/64aae6434f45553f85234a2d/t/67fea5a58e10245
721eaafce/1744741797850/2024+Military+Family+Building+Survey+First+Look+%281%2
9.pdf
Blue Star Families (2021). Military Family Lifestyle Survey.
https://bluestarfam.org/wpcontent/uploads/2022/03/BSF_MFLS_Results2021_Compreh
ensiveReport_03_14.pdf
MilitaryOneSource. (2023). 2023 Demographics Profile of the Military Community (Department
of Defense).
https://download.militaryonesource.mil/12038/MOS/Reports/2023-demographics-repor
t.pdf
Tricare (2025). Covered Services: Infertility and Diagnosis and Treatment.
https://tricare.mil/coveredservices/isitcovered/infertilitytreatment.aspx
World Health Organization (WHO, 2024). Infertility.
https://www.who.int/news-room/fact-sheets/detail/infertility
Life as a military spouse is synonymous with frequent moves, starting over, and re-establishing connections. For a large portion of my married life, each PCS (Permanent Change of Station) and the initial social functions that followed brought with it a certain angst related to connecting- especially with other military spouses. Although I knew the intent was to meet, interact, and form connections, there tended to be an “elephant in the room” at each of these gatherings.
Do you have kids? An innocent question most spouses asked as an opener to start conversation. As newlyweds this question was easy to respond to. “No kids, but at some point.” Yet, as newlywed status fades and you have been married 3, 5, 10 years…this question starts to have a different impact- especially when “at some point” has not occurred.
While the military is comprised of ~1.31 million active-duty service members (MilitaryOneSource, 2023), within each of the service branches the subcommunities are not as large as you would think. Most specialty areas, such as aviators/pilots within the Marine Corps, either know each other or of each other from various interactions within their jobs. So, it is inevitable you will cross paths or be assigned to the same duty stations with the same people again. That is where the milspouse elephant in the room begins to become more blatant- it has been several years or duty stations since seeing this spouse and the looming question emerges, “do you have kids?” When the answer is “no” yet again, there exists this comfort to ask more… “do you want kids?” or “when are you going to have them?” For me, these interactions were typically followed by the formation of a knot in my stomach and deciding how to respond. Do I say what is really going through my mind or the practiced generic response. Unbeknownst to those asking, this internal dialogue was my source of angst during these social interactions- and I later learned was shared by others who experience infertility.
Within the general population, it is estimated that one in six people of reproductive age will experience infertility at some point (World Health Organization, 2024). Recent studies within the military community suggest those numbers may be higher. The Blue Star Families 2021 Military Lifestyle Survey found that 67% of respondents have experienced at least one family-building challenge, and the 2024 Military Family Building Survey from the Building Military Families Network found that 70% of respondents identified as having an infertility connection. The more I have learned and been open to talking about my own infertility journey, the more common I have found it to be within the military community.
Despite this occurrence, most military families experience various challenges to accessing fertility treatments. There are only six military treatment facilities (Fort Sam Brooke Army Medical Center, San Antonio, TX; Tripler Army Medical Center, Honolulu, HA; Walter Reed National Military Medical Center, Bethesda, MD; Womack Army Medical Center, Ft. Bragg, NC; Naval Medical Center, San Diego, CA; and Madigan Army Medical Center, Tacoma, WA) that offer Assisted Reproductive Technology (ART) at a reduced rate. For those referred to civilian providers the cost can double, even triple, with one round of In vitro fertilization (IVF) costing between $10,000-$25,000. Currently, Tricare policies only cover some of the expenses related to treating infertility. These consist of diagnostic services (i.e., semen analysis, hormone evaluation, chromosomal studies, immunologic studies, imaging studies, special and sperm function tests, bacteriologic investigation) and treatments to correct an underlying physical cause of infertility or erectile dysfunction stemming from a physical cause- all of which must be deemed medically necessary (Tricare, 2025). While working with a PCM and getting the necessary documentation in your medical record has its own set of challenges, once achieved, these foundational services at minimum provide military families a starting point to understanding their fertility and making an informed decision regarding treatment. While, TRICARE does not cover ART for common causes of infertility like polycystic ovary syndrome (PCOS), endometriosis, low sperm count or, in our case, unexplained infertility; it may cover ART, such as IUI and IVF, if the service member has suffered a documented service-related injury or illness causing their infertility. For service members, proof of service-connected infertility can pose additional challenges. Impacts to reproductive health and fertility is still being researched in terms of what may be causal factors (i.e., exposure to toxins, brain injury/combat injuries, medications, etc.,) and unless infertility is specifically identified through diagnostic testing or medical records, detecting the cause and providing service-connected proof remains a struggle.
In addition to diagnosis, insurance coverage/costs, and treatment, other challenges involve the cost and time to travel to/from multiple doctor appointments (and or military treatment facilitiy (MTF) depending on location), maneuvering schedules of both the spouse and service member, the cumulative costs for each appointment and cycle of treatment, storage fees for reproductive specimens, and access to medications (sometimes covered through MTF pharmacies depending on availability and location). While this may not sound different from a civilian couple seeking fertility treatment, these challenges are amplified when combined with normal military life that involves consistent separation, relocation, limited proximity to support systems, and routine changes to medical providers. The process becomes a revolving door of starting over resulting in delays for beginning a treatment, and ultimately a family. Over recent years, legislation has worked to increase coverage for infertility and ART benefits for military service members and their spouses. Although there have been some improvements, the resources and accessibility of these benefits remain limited, especially in comparison to some private insurance companies.
Navigating the logistics related to infertility treatment was its own set of challenges. What I was not prepared for was the emotional roller coaster that can come with this journey- much of which was experienced alone or only shared with those closest to me. As with all medicine, it is a practicing science, it can take several appointments and “cycles” to figure out what works for your body. This means getting your hopes up, then deflated when told the cycle was cancelled or unsuccessful, and then mentally preparing yourself to do it all again the following month or waiting “x” amount of time before starting again.
When looking at the statistics for successful ART (based on age, clinic, and treatment type) and talking with others who have experienced infertility, my spouse and I were relatively lucky. With our first child, we were able to complete treatment through an MTF. It took a year of diagnostic testing, work-ups, and specialist referrals, followed by four cancelled cycles and, on the fifth cycle and first IUI, success that gave us our son. A few years later, we were referred to a civilian provider for ART that consisted of six months of work-ups, one cancelled cycle, and success on our first IUI that gave us our daughter. Despite asking questions and reading, I felt ill prepared physically, mentally, and emotionally for everything this process entailed. Medical staff were always supportive; yet, in some ways, it was the re-emergence of the “elephant in the room;” an internal feeling of embarrassment, anxiety, and mixed emotions, surrounding the process. An experience I later found to be shared amongst others engaging in infertility treatment.
As I have found my voice and willingness to talk more openly about my infertility journey, I have found that the “elephant in the room” is no longer ignored and the resulting insecurities it caused resolved. I have a stronger sense of community with other spouses that have shared this journey, as well as feel confident that if my spouse and I choose to go through this process again, I am better prepared how to navigate and advocate for my family. In the meantime, my hope is that legislation continues to improve coverage for infertility and ART benefits to service members and their families. As for the milspouse elephant in the room question, “do you have kids”- I can now answer it with a smile and without angst, “Yes, I have two amazing kids” and am comfortable sharing my journey to be able to have them.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Heather Tompkins, Ph.D, MS-ATR, LCMHC, is a Military Behavioral Health Psychologist with the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this role, she provides oversight and fosters collaboration for creative arts related research projects in partnership with the Defense Intrepid Network.
References
Building Military Families Network (2024). 2024 Military Family Building Survey.
https://static1.squarespace.com/static/64aae6434f45553f85234a2d/t/67fea5a58e10245
721eaafce/1744741797850/2024+Military+Family+Building+Survey+First+Look+%281%2
9.pdf
Blue Star Families (2021). Military Family Lifestyle Survey.
https://bluestarfam.org/wpcontent/uploads/2022/03/BSF_MFLS_Results2021_Compreh
ensiveReport_03_14.pdf
MilitaryOneSource. (2023). 2023 Demographics Profile of the Military Community (Department
of Defense).
https://download.militaryonesource.mil/12038/MOS/Reports/2023-demographics-repor
t.pdf
Tricare (2025). Covered Services: Infertility and Diagnosis and Treatment.
https://tricare.mil/coveredservices/isitcovered/infertilitytreatment.aspx
World Health Organization (WHO, 2024). Infertility.
https://www.who.int/news-room/fact-sheets/detail/infertility