In-theater hospitals do not yet have that equipment, however, so many men with these devastating injuries will require assistance with costly fertility treatments to ever have children. One option for funding may be using insurance payouts. Veterans with traumatic genitorurinary injuries now are covered under the Servicemembers’ Group Life Insurance Traumatic Injury Protection (TSGLI). Men can receive a lump-sum payment of $25,000 for each lost testicle and $50,000 for loss or severe damage to a penis.

TRICARE will cover fertility workups and some treatments. The military health plan does not, however, pay for the most-expensive part of in vitro fertilization (IVF), the process of “marrying the egg and sperm,” said Jen Aggers, executive director of the Green Beret Foundation. Her organization offers financial support to members of the Special Forces who need IVF as a result of genital injuries sustained in combat.

“These devastating injuries happen to a lot of our guys; they’ve given up their ability to reproduce for our country.” Financial support gives them the hope of children. “It actually gives them something to live for again,” she said. “It has a huge impact on our community.”

For at least one family, the foundation’s support has made a critical difference. “Our first baby is due next month,” Aggers told U.S. Medicine. “This family required just one round of IVF, which cost about $9,000. Many couples require multiple attempts, and the cost can be overwhelming. We owe them this chance to at least try to have a family.”

Beyond IVF, ongoing work in laboratories today offers hope for restored reproductive function for men with catastrophic GU injuries. In small studies, laboratory-engineered urethras have been successfully used in boys with extensively damaged urethras and are being evaluated in older populations, according to Anthony Atala, MD, co-director of the Armed Forces Institute for Regenerative Medicine (AFIRM) and chair of the Department of Urology at Wake Forest Baptist Medical Center.

“The boys in the study had widespread injury due to pelvic trauma, and two patients had previous urethra repairs that had failed. The engineered tubes were used to replace entire segments of damaged urethra in the posterior section, which is considered the most difficult to repair,” Atala told U.S. Medicine.

Atala also has used tissue engineering techniques to create functional new penises in rabbits using a combination of endothelial and smooth muscle cells and scaffolding from penile cartilage. The team is working toward the next step, applying for FDA approval to evaluate this therapy in men, he said.

The future looks promising: All 12 of the rabbits with penile grafts attempted to mate with females, eight of them successfully ejaculated, and four of them produced offspring. These results “indicate the possibility of using laboratory-engineered tissue in men who require reconstructive procedures. A lack of erectile tissue currently prevents us from restoring sexual function to these patients,” Atala noted.

AFIRM currently focuses on five areas: burn repair; wound healing without scarring; craniofacial reconstruction; limb reconstruction, regeneration or transplantation; and compartment syndrome, a condition related to inflammation after injury or surgery. Atala’s work on restoring genital function may soon be applied to the needs of wounded warriors; DoD has indicated that urogenital research will be a focus of future AFIRM grants, he said.

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