How the US Military’s Fertility Policies Are Leaving Women to Suffer

How the US Military’s Fertility Policies Are Leaving Women to Suffer

How the US Military’s Fertility Policies Are Leaving Women to SufferHow the US Military’s Fertility Policies Are Leaving Women to SufferAntiquated and discriminatory rules around fertility treatments are making the struggle to have a child immeasurably more difficult for many military families.

By Britta Lokting

May 18, 2023

May 18, 2023

There are many stories, and almost all of them end the same way.

Laura Flanagan has polycystic ovary syndrome and an irregular period. She’s been trying to conceive with her husband, Adam, a truck driver who’s now in the Army Reserve after deployments in Iraq and Kuwait, for a decade with no luck. Last year, they tried intrauterine insemination (IUI), where sperm is inserted into the uterus during ovulation at a fertility clinic. They’re a one-income household, so Laura’s family covered travel expenses to the Knoxville Fertility Clinic and the $548 for the first round, which failed. They helped at Christmas too, for the second round. It also failed. When the third IUI didn’t take, they decided to weigh their limited options. In vitro fertilisation (IVF) is a logical next step, but it’s too expensive to pay out of pocket.

Erin Bell met her wife through the Air Force four years ago. They are both active duty and in 2021, they decided they wanted a baby. Doing IUI was too pricey. Instead, Bell said they “found sterile syringes literally on Amazon” and used a known donor because Bell, who is based at Royal Air Force Mildenhall in Suffolk, England, said sperm banks there cost about £800. They got pregnant after three months but had to navigate a health care system that largely caters to heterosexual couples.

In 2013, Samantha Shafer married an airman first class making $1,800 a month and spent seven years trying to figure out what was causing their infertility. She had an egg retrieval and two embryo transfers that failed at a cost of about $9,400. “When our first embryo failed, I was like, ‘It’s okay, we have one more chance’ and when the second embryo failed, that was a pain I never thought I’d go through, like, I was on my floor and screaming,” she said. She did another egg retrieval and got two more embryos. In July 2022, she got pregnant but had to terminate the pregnancy at 8 weeks because there was no heartbeat. They relocated to Florida last August on military orders and paid $1,100 to ship their last embryo from Kansas.

Julie Eshelman and her husband, an active-duty serviceman in the Army Reserve, started trying to build their family in 2016 while stationed at Joint Base Lewis-McChord in Washington state. They got on the waitlist at The Madigan Army Medical Center, one of the six military hospitals that offer fertility treatments, but then got called to move to a base in Scottsdale, Arizona. Eshelman waited to get into a local fertility clinic while her husband was deployed. When he returned, their first IUI resulted in a pregnancy, but during another relocation to Chicago, Eshelman miscarried. Two more IUIs had the same results. Finally, in July 2020, they had a successful IVF that cost $20,000 with a military discount.

“We didn’t go out to eat, we didn’t go to the movies,” she said. “We didn’t really do anything for five years so we could afford to do all these treatments. And that’s not easy.”

If the military broadly covered fertility treatments, even in part, each of these couples could have avoided the financial and emotional hardships of family building that are exacerbated by a life of long deployments, constant relocation, and low pay. But in nearly every case, the military wouldn’t help them—because, by law, it doesn’t have to.

The US military’s health care plan, TRICARE, doesn’t cover IUI or assisted reproductive technologies like IVF unless a service member lost reproductive abilities through a deployment-related injury, a circumstance that is hard to prove, and doesn’t consider the needs of LGBTQ couples. The plan covers some services—such as semen analysis or hormone evaluation—but only when “medically necessary and combined with coital conception.” In other words, you have to prove infertility, defined by the Centers for Disease Control and Prevention as not being able to conceive after having unprotected sex for a year or more, before some coverage might kick in.

In a statement, the Department of Defense wrote that by law, “care is authorized to diagnose and treat an illness or injury of the male or female reproductive system to correct the underlying physical cause of infertility, which would then allow for conception through coitus (i.e., heterosexual intercourse).”

Faced with exorbitant costs, military families seeking assisted reproductive technologies have largely been left to pay their own way, even though about 160,000 military service members struggle with food insecurity. An IVF cycle will usually cost between $12,000 and $14,000 depending on the clinic, but the total bill for the process—perhaps including hormone injections or genetic testing—can exceed $30,000. A newly enlisted service member might receive a $25,000 base salary. To offset costs, some military couples have relied on family money, solicited sperm donors from Facebook, taken out loans, sacrificed vacations, or set up GoFundMe accounts.

It’s impossible to know exactly how many military families need assisted reproductive technologies, but a 2018 study by the Service Women’s Action Network (SWAN) found that 37 percent of female active-duty respondents struggled with infertility, a number three times higher than the national average. This might be explained, in part, by recent findings that show aspects of military lifestyles, like PTSD or deployment length, could affect fertility. A 2020 report by SWAN also noted that military occupations like airplane engineers may lead to toxic chemical exposure, which has been shown to also affect fertility. Responding to a 2021 Blue Star Families survey, 27 percent of military spouses said they experienced family-building challenges.

Now, an internal backlash is growing among rank-and-file families against the very “family values” institution they serve. “If we’re supporting the country, how come they’re not supporting us?” asks Brittany Matta, a military spouse who is positive with BRCA1 and considering IVF so that the gene mutation isn’t passed to her child.

Policy change has long been an uphill battle. In 2019, Representative Rosa DeLauro of Connecticut introduced the Access to Infertility Treatment and Care Act to expand coverage, but it didn’t pass. In 2012, Senator Patty Murray of Washington introduced the Women Veterans and Other Health Care Improvements Act to offer assisted reproductive technology to military spouses of a wounded, ill or injured veteran struggling with infertility. It passed the Democratic-controlled Senate but stalled in the Republican-majority House. These pieces of legislation have gone nowhere, said Ellen Gustafson, a cofounder of the Military Family Building Coalition, because “there is a Republican block.” Gustafson explained that “there is some confusion” between legislators and the pro-life movement, meaning some conservatives liken discarding IVF embryos to abortion.

Now, though, the Army is in the midst of a recruiting crisis. Officials told told the Associated Press in October that it fell short of its goal by 15,000 recruits, or 25 percent. It was the Army’s “most challenging” recruiting year since the all-volunteer force began, in 1973, Army Secretary Christine Wormuth told the AP.  » …
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