WASHINGTON, DC — Veterans who have service-connected infertility issues should have access to the full range of fertility services science now available, especially in vitro fertilization, without the constraints imposed by antiquated and sometimes nonsensical regulations, legislators and veterans’ advocates argued last month.
VA has found that, among post-9/11 veterans, 15.8% of women and 13.8% of men have reported infertility issues. Only about 500 families have taken advantage of VA’s IVF services since 2017, however. Advocates say this has less to do with lack of interest and more with how narrow the rules are for determining who qualifies.
VA’s current assisted reproductive treatment (ART) and IVF benefit is limited to married, opposite-sex couples who are able to use their own sperm, eggs and uterus. These restrictions mean that VA will not cover donor sperm, eggs and embryos or gestational surrogacy.
“The current policy assumes a rather antiquated approach on how to make or build a family,” declared Rep. Debbie Wasserman Schultz (D-FL), chair of the House Appropriations Subcommittee on Military Construction, Veterans Affairs and Related Agencies, at a hearing last month. “It limits the IVF benefit to only married opposite sex couples who are able to use their own sperm, eggs and uterus. That’s a pretty narrow population that doesn’t reflect the world we live in today. Many veterans have injuries or illnesses who can’t use their own sperm, eggs or uterus or cannot carry to term.”
The reason for the restrictions is that VA coverage is tied to a 2012 benefit for wounded active duty servicemembers covering limited infertility services. This effectively makes the VA benefit “frozen in time” and forever out of date, explained Barbara Collura, president and CEO of RESOLVE: The National Infertility Association.
“Medical treatments improve and advance, yet this linkage to DoD precludes any changes or improvements in the benefit the VA can offer,” Collura told the subcommittee. “Why would we want our veterans to receive subpar care? Let’s allow the VA to offer the best and most current care to our veterans wishing to build their families.”
Once decoupled, VA can widen the benefit to include third-party donors. In addition to decoupling the benefit from the 2012 DoD regulation, Congress should move to make the benefit permanent, Collura said. Currently, it is refunded year to year.
“VA can provide better care if this is a permanent benefit, and veterans have certitude that access to care exists, no matter when they are ready to build or grow their family.”
Collura also pointed out that DoD’s policy might have a too-narrow definition of service connection.
“It’s probably narrower than what VA would look at,” she said. “For example, a traumatic brain injury has been known to be very impactful on people’s fertility. But when you’re looking at the reproductive system, you’re not thinking that’s all connected.”
In the past, expansion of reproductive health and infertility treatments has received opposition from conservative legislators, partly because fertility treatment is still somewhat viewed as unessential care and partly because they have expressed concern that loosening regulations will allow the benefit to be used by same-sex or unmarried couples.
“I think when you start talking about couples being able to use a surrogate, a third-party person, to create a baby for them, I think that’s where you start getting into some of the pushback. That’s where I start having some problems with it, quite frankly,” explained Rep. John Rutherford (R-FL). “I think when you start getting into same-sex surrogacy and those things, that’s where you get the pushback.”
A brief exchange with Wasserman Schultz demonstrated that Rutherford was not intransigent in his opposition, however.
“Setting aside the same sex issue, the fastest growing population of patients at the VA are women,” Wasserman Schultz said. “If you’re a woman veteran who is heterosexual and your fertility is impacted from a service-connected condition—you’re unable to carry a baby to term—then surrogacy, even with your own egg implanted in a surrogate, is not covered by VA.”
Rutherford conceded that surrogacy should certainly be allowed in such a case.
“Now imagine the exact same situation but you have two women,” Wasserman Schultz said. “If you acknowledge that there are same-sex couples, some of whom have service-connected infertility, are legally married in this country and are women, and they also can’t carry a baby to term because of their injury. I would just ask you to think about that. Wouldn’t that be the same thing?”
Rutherford conceded, saying, “I would agree that, if their inability to have a baby is tied directly to their service, then I’m fine with that.”
Wasserman Schultz said she hopes there will be enough of a consensus in the committee and in Congress as a whole to make the benefit permanent.
As for the other changes that advocates are seeking, Rep. Julia Brownley (D-CA), chairwoman of the Women Veterans Task Force, reintroduced legislation last month that would effectively decouple VA benefits from DoD regulations, as well as broaden the number of veterans who would qualify. The bill, The Veteran Infertility Treatment Act of 2021, would make infertility care, including IVF, available for all veterans, regardless of marital status, service connection or need for donated material.