A deeply personal look at one firefighter as she tries to navigate the infertility system
“Your 2:30 is here. She’s waiting in exam room 3,” my medical assistant says, poking her head into my office. “Her urine pregnancy test was negative. I uploaded the result.”
I nod and turn to the screen. Her name is at the top of the chart, a familiar presence now. I scan her labs, hormone panels, ovarian reserve, ultrasound notes, pap smear, mammogram, and specialist consults. All puzzle pieces in a journey called infertility.
There’s a heaviness in this kind of silence. The kind that follows another negative pregnancy test. Another miscarriage. An ultrasound with no heartbeat.
And in the fire service, it’s complicated.
How do we begin to talk about infertility in a profession that prides itself on strength, yet carries silent risks that threaten the most human parts of us? Like starting a family?
Infertility affects 1 in 6 people. But among firefighters, the risks run even deeper. This firefighter’s struggle reveals what must change to support those who are silently struggling.
Catie, a career firefighter since 2007, knows this story firsthand. At 41, she began her fertility journey as a single woman. She changed her insurance to gain fertility coverage, fought for referrals, rearranged shifts, and navigated back-to-back specialist appointments. All while remaining operational in a department without a fertility policy.
According to infertility experts, infertility is medically defined asthe inability to conceive after 12 months of unprotected intercourse (or six months if over age 35). It affects one in six people globally. It’s not just a women’s issue. Male factors account for up to half of cases. And infertility is rising. Sperm counts have dropped by more than 50 percent globally since the 1970s. Meanwhile, reproductive health conditions, like PCOS and endometriosis, are being diagnosed earlier and more frequently.
But firefighters face even higher risks.
Research shows both male and female firefighters experienceelevated rates of infertility, miscarriage, menstrual disruption, and hormonal changes. They are routinely exposed to chemicals like volatile organic compounds, heavy metals, and endocrine disruptors. These substances are known to impair sperm quality and reduce ovarian reserve. Chronic heat, sleep disruption, high stress, and physical strain compound the risk.
Catie adjusted everything. She shifted to low-impact workouts, followed a fertility diet, cut out coffee, and took supplements. She transitioned to a straight day firefighter position at the fire academy to improve her chances of conceiving.
Her fertility specialist recommendedintrauterine insemination (IUI). A procedure where sperm is placed directly into the uterus during ovulation. IUI is less invasive and more cost-effective than in vitro fertilization, but still financially burdensome. Each attempt cost Catie more than $1,100. She bypassed donor photos to save money. She picked up her selected sperm donor, No. T14, in a cryogenic tank and drove it to her IUI appointment. She was hopeful. She smiled for a picture, thumbs up.
“Fourteen of the longest days of my life,” she recalls.
After IUI, life doesn’t pause. You carry on, pretending everything is normal, even as every breath is tinged with hope and fear. You talk yourself out of testing too early. You analyze every symptom. You pray.
Then, test day. “You make silent deals with whoever will listen,” she says. It was negative. You grieve. Then try again.
Her second IUI brought joy. A positive test! “I was ecstatic,” she says. There were tears, laughter, and hope. She counted the days until her ultrasound.
And then came the silence.
At eight weeks, no heartbeat. “It was the worst week. Trying to work and pretend like everything was normal,” she says. Catie miscarried. After another unsuccessful IUI, her fertility clinic dropped her, due to her age.
But she wasn’t done. Catie is a resilient firefighter.
She found a new fertility health clinic.Paid out-of-pocket. Started in vitro fertilization. Spent more than $20,000. Six eggs were retrieved. None made it to Day 5.
Most firefighters don’t talk about this. But when Catie finally did, she wasn’t alone. Others – coworkers, wives, partners – were quietly fighting the same battle.
Infertility doesn’t discriminate by rank, gender, or orientation. Yet fire departments rarely address it in benefits, policies, or culture.
Five Things We Can Do
- Acknowledge infertility as an occupational health risk
- Offer health insurance that covers fertility evaluation and treatment
- Provide flexible scheduling for appointments without stigma
- Educate leadership on reproductive health, including shift work and heat exposure
- Support policies for fertility preservation, miscarriage leave, and inclusive reproductive care
Catie’s advice: “If you want a family, freeze your eggs or sperm early. Look at the benefits when choosing where to work. Ask: ‘Does this department support my future?’”
To every firefighter silently carrying this burden:You are not alone. Your story matters. Your grief matters. It’s time for the fire service to make space for both.
