VA Should Fund Fertility Treatments for Injured Servicemembers, Spouses, According to New Bill

by U.S. Medicine

August 13, 2012

By Sandra Basu

WASHINGTON — Only weeks after Tracy Keil and her husband, Matt, were married in 2007, he was shot in the neck while on patrol in Ramadi, Iraq.

“The bullet went through the right side of his neck, hit his vertebral artery, went through his spinal cord and exited through his left shoulder blade,” Mrs. Keil told the Senate Committee on Veterans’ Affairs. “Matt instantly became a quadriplegic.”

The couple still wanted children together, she said, but were not going to be able to do it the usual way.

“I researched everything I could about how to get TRICARE to cover some of the costs, but they couldn’t because it was a direct result of my husband’s injury, and that fell under the VA. The VA said that they had no programs in place for this sort of thing.”
– Tracy Keil testifying before the Senate Committee on Veteran’s Affairs

Physicians told them that in vitro fertilization was their best bet. The problem was that, while the VA would cover the cost of the sperm withdrawal from Matt Keil and would store the sperm at no charge, the rest of the assisted reproductive technology treatment was not covered. The couple ended up paying out of pocket to have the fertility treatments done in the private sector and were rewarded with the birth of twins in 2010.

“I researched everything I could about how to get TRICARE to cover some of the costs, but they couldn’t because it was a direct result of my husband’s injury, and that fell under the VA. The VA said that they had no programs in place for this sort of thing,” Keil said.

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Keil testified at a recent Senate hearing where a bill under consideration would authorize VA to provide advanced fertility treatment to severely wounded veterans.

Supporters of the legislation have said that veterans who have severe reproductive and urinary tract injuries and spinal cord injuries often need highly specialized treatments and procedures, such as IVF, to conceive. Under current law, however, IVF is not offered by the VA to veterans or their spouses.

The bill, introduced by Sen. Patty Murray (D-WA), would expand the reproductive treatment and care options available to severely wounded veterans, including assisted reproductive technology. It also would make an eligible family member or surrogate of a severely wounded veteran eligible for the same fertility treatment as a veteran.

“While the Department of Defense and TRICARE are now able to provide advanced fertility treatment to injured servicemembers, today VA can only provide limited treatment. VA’s services do not even begin to meet the needs of our most seriously injured veterans or their families,” Murray said at a Senate Committee on Veterans’ Affairs hearing.

An Army report last year drew attention to the increase in the number and severity of genitourinary injuries, particularly injury to the external genitalia. The report stated that at Landstuhl Regional Medical Center, the GU injury incidence among U.S. casualties was 19% in October of 2010, 10% in November 2010 and 13% in December of 2010.

Mark T. Edney, MD, a urologist who is a member of the Legislative Affairs Committee for the American Urological Association, treated genitourinary trauma in Iraq as an Army reservist and told the committee that a number of different types of injuries on the battlefield can threaten fertility. The most common types of male genitourinary injuries seen, sometimes in isolation, but commonly in combination, are: testicular rupture (unilateral or bilateral), penile shaft/pendulous urethral injury, posterior urethral injury and bladder injury, he said.

VA Should Fund Fertility Treatments for Injured Servicemembers, Spouses, According to New Bill

More than Urological Injuries

Fertility problems in troops are not limited, however, to those with urological injuries. Spinal cord injury and traumatic brain injury are two major classes of non-urological injury that can impede fertility through ejaculatory dysfunction, he said.

For women, blast or gunshot wounds can also result in a variety of fertility-impairing injuries when the pelvic area is involved.

“Though genitourinary trauma is not publicly visible, it is no less physically or psychologically debilitating than loss of limb or other overtly disfiguring injury. Professionals who specialize in fertility will attest to the intense psychological pain and suffering endured by infertile couples who will go to great financial and emotional extremes in order to conceive a child,” he said.

Edney noted that intrauterine insemination (IUI) and IVF may provide the needed help for fertility-impaired veterans and their spouses but pointed out that these couples now must seek IVF in the private sector, where it is much more expensive.

“It is noteworthy that the substantial cost of an IVF cycle in the private sector, where battle-injured infertile VA couples now must turn, is on the order of $20,000 to $30,000 per cycle with success rates of 20% to 40% per cycle, and multiple cycles are often necessary,” he said. “The expertise and technology exists within the VA and DoD for a fraction of the cost.”

VA Reviewing Issue

Madhulika Agarwal, MD, VHA deputy undersecretary for health for policy and services, told the committee that the VA has not taken a position on whether IVF could be offered to severely injured veterans and their spouses, as the bill stipulates, but is reviewing its “regulatory options.”

“Consistent with VA’s goals to improve health and quality of life for veterans, we do offer certain fertility treatments and diagnostic tests, including genetic testing. However, regulations in 1999 did exclude IVF services from VA’s defined medical benefits package,” she explained.

Some groups argued that the bill did not go far enough, however. The American Society for Reproductive Medicine, for example, wrote in a statement that the bill should “specifically include furnishing of services to those affected by infertility to exposure to toxins during their deployment as these exposures can also compromise one’s ability to reproduce.”

Advocates also would like to see the passage of a House bill introduced by Rep. Brett Guthrie (R-KY) to establish a commission to study the long-term effects of combat-related genitourinary injuries.

The bill “would bring together DoD, VA, HHS, the surgeon generals of each of our armed services and civilian expertise to create a plan to care for these wounded warriors,” Guthrie told the House Armed Services Committee in April in written testimony.

Murray’s bill also would require VA to facilitate more research on the long-term reproductive healthcare needs of veterans who experience severe reproductive and urinary tract trauma on the battlefield.

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