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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