Download PDF
Semin Reprod Med 2019; 37(01): 012-016
DOI: 10.1055/s-0039-1692127
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Infertility Services for Veterans: Policies, Challenges, and Opportunities

Stephanie W. Edmonds
1   Center for Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
,
Laurie C. Zephyrin
4   Manhattan VA Medical Center, New York, New York
5   Department of Obstetrics and Gynecology, New York University, New York, New York
,
Alicia Christy
2   Women's Health Services, VA Office of Patient Care Services, Veterans Health Administration, Department of Veterans Affairs, Washington, District of Columbia
,
Ginny L. Ryan
1   Center for Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
3   Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa
› Author Affiliations
Further Information

Publication History

Publication Date:
11 June 2019 (online)

   Permissions and Reprints

Abstract

Infertility prevalence and care needs among male and female Veterans are understudied topics. The Veterans Health Administration (VHA) medical benefits package covers full infertility evaluation and many infertility treatments for Veterans but not, by law, for their spouses. In vitro fertilization (IVF) is also specifically excluded from this medical benefits package by regulation. Congress passed a law in 2016 that allowed VHA to provide IVF to Veterans and their legal spouses, and broader infertility benefits to the legal spouse, if the Veteran has a service-connected condition associated with his or her infertility, with some limitations. As the Veteran population becomes increasingly female, research efforts in reproductive health, including infertility, are expanding and evolving. This includes a nationwide study currently underway examining infertility among male and female Veterans and associations with military-related trauma, such as injury, posttraumatic stress disorder, military sexual trauma, and toxin exposure. In this review, we describe the state of the science and policy on infertility care in the VHA along with challenges and opportunities that exist within the VHA system.

Keywords

infertility - Veterans - military - in vitro fertilization - reproduction - assisted reproductive technologies - Veterans Health Administration
 

  • References

  • 1 Zegers-Hochschild F, Adamson GD, Dyer S. , et al. The International Glossary on Infertility and Fertility Care, 2017. Hum Reprod 2017; 32 (09) 1786-1801
    CrossrefPubMedGoogle Scholar
  • 2 Zegers-Hochschild F, Adamson GD, de Mouzon J. , et al; International Committee for Monitoring Assisted Reproductive Technology; World Health Organization. The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009. Hum Reprod 2009; 24 (11) 2683-2687
    CrossrefPubMedGoogle Scholar
  • 3 Berg S. Ama Backs Global Health Experts in Calling Infertility A Disease. American Medical Association, Ama News; 2017
    PubMedGoogle Scholar
  • 4 Thoma ME, Mclain AC, Louis JF. , et al. Prevalence of infertility in the United States as estimated by the current duration approach and a traditional constructed approach. Fertility And Sterility 2013; 99: 1324-1331.e1
    CrossrefPubMedGoogle Scholar
  • 5 Louis JF, Thoma ME, Sørensen DN. , et al. The prevalence of couple infertility in the United States from a male perspective: evidence from a nationally representative sample. Andrology 2013; 1 (05) 741-748
    CrossrefPubMedGoogle Scholar
  • 6 Hanson B, Johnstone E, Dorais J, Silver B, Peterson CM, Hotaling J. Female infertility, infertility-associated diagnoses, and comorbidities: a review. J Assist Reprod Genet 2017; 34 (02) 167-177
    CrossrefPubMedGoogle Scholar
  • 7 Mi C, Se T, Lv D. , et al. The sixth vital sign: what reproduction tells us about overall health. Proceedings from the NICHD/CDC Workshop. Human Reproduction Open 2017. Available at: https://academic.oup.com/hropen/article/2017/2/hox008/3957910 . Accessed May 30, 2019
    PubMed
  • 8 Tarín JJ, García-Pérez MA, Hamatani T, Cano A. Infertility etiologies are genetically and clinically linked with other diseases in single meta-diseases. Reprod Biol Endocrinol 2015; 13: 31
    CrossrefPubMedGoogle Scholar
  • 9 Parikh NI, Cnattingius S, Mittleman MA, Ludvigsson JF, Ingelsson E. Subfertility and risk of later life maternal cardiovascular disease. Hum Reprod 2012; 27 (02) 568-575
    CrossrefPubMedGoogle Scholar
  • 10 Ethics Committee of the American Society for Reproductive Medicine. Disparities in access to effective treatment for infertility in the United States: an Ethics Committee opinion. Fertil Steril 2015; 104 (05) 1104-1110
    CrossrefPubMedGoogle Scholar
  • 11 World Health Organization. Sexual And Reproductive Health: Infertility. World Health Organization; 2018
    Google Scholar
  • 12 Peterson MM. Assisted reproductive technologies and equity of access issues. J Med Ethics 2005; 31 (05) 280-285
    CrossrefPubMedGoogle Scholar
  • 13 Chandra A, Copen CE, Stephen EH. Infertility service use in the United States: data from the National Survey of Family Growth, 1982–2010. Natl Health Stat Report 2014; ;(73): 1-21
    PubMedGoogle Scholar
  • 14 Chambers GM, Sullivan EA, Ishihara O, Chapman MG, Adamson GD. The economic impact of assisted reproductive technology: a review of selected developed countries. Fertil Steril 2009; 91 (06) 2281-2294
    CrossrefPubMedGoogle Scholar
  • 15 American Society for Reproductive Medicine. Quick Facts About Infertility. 2017
    PubMed
  • 16 Katon J, Cypel Y, Raza M. , et al. Self-reported infertility among male and female veterans serving during Operation Enduring Freedom/Operation Iraqi Freedom. J Womens Health (Larchmt) 2014; 23 (02) 175-183
    CrossrefPubMedGoogle Scholar
  • 17 Ryan GL, Mengeling MA, Booth BM, Torner JC, Syrop CH, Sadler AG. Voluntary and involuntary childlessness in female veterans: associations with sexual assault. Fertil Steril 2014; 102 (02) 539-547
    CrossrefPubMedGoogle Scholar
  • 18 Cohen BE, Maguen S, Bertenthal D, Shi Y, Jacoby V, Seal KH. Reproductive and other health outcomes in Iraq and Afghanistan women veterans using VA health care: association with mental health diagnoses. Womens Health Issues 2012; 22 (05) e461-e471
    CrossrefPubMedGoogle Scholar
  • 19 Mattocks K, Kroll-Desrosiers A, Zephyrin L. , et al. Infertility care among OEF/OIF/OND women Veterans in the Department of Veterans Affairs. Med Care 2015; 53 (04) (Suppl. 01) S68-S75
    CrossrefPubMedGoogle Scholar
  • 20 Department of Veterans Affairs. Fertility counseling and treatment for certain Veterans and spouses. Fed Regist 2017; 82 (Suppl. 12) 6273-6276
    PubMedGoogle Scholar
  • 21 Murray CK, Wilkins K, Molter NC. , et al. Infections complicating the care of combat casualties during operations Iraqi Freedom and Enduring Freedom. J Trauma 2011; 71 (Suppl. 01) S62-S73
    CrossrefPubMedGoogle Scholar
  • 22 VHA Directive 1332. Infertility Evaluation and Treatment ; 2017 . Available at: https://www.va.gov/vhapublications/publications.cfm?pub=1 . Accessed May 30, 2019
    PubMed
  • 23 Callegari LS, Borrero S, Reiber GE. , et al. Reproductive life planning in primary care: a qualitative study of women Veterans' PERCEPTIONS. Womens Health Issues 2015; 25 (05) 548-554
    CrossrefPubMedGoogle Scholar
  • 24 Gelbaya TA, Potdar N, Jeve YB, Nardo LG. Definition and epidemiology of unexplained infertility. Obstet Gynecol Surv 2014; 69 (02) 109-115
    CrossrefPubMedGoogle Scholar