Fertility treatments that could increase the possibility of pregnancy are being debated by the Senate and could potentially be added into the must-pass annual defense policy bill – making them available to active-duty troops and their dependents .
The treatments and services under consideration include fertility testing and intrauterine insemination, or IUI, a type of artificial insemination that can increase the likelihood of a successful pregnancy by as much as 20%.
The Senate's proposed fiscal 2024 National Defense Authorization Act calls for including the benefits in the basic health services provided to uniformed service members and their dependents. They would not be available to former troops -- career retirees or those medically retired from the service -- or their family members under Tricare, according to the legislation.
The provision also does not include in vitro fertilization. However, the bill would require the Department of Defense to review its policies on all of its fertility benefits, along with estimated costs associated with expanding care to include IVF.
In a report accompanying the bill, Senate Armed Services Committee members noted that troops face many barriers to family planning, such as the risk of injury and separation from their partners, and said they had concerns that DoD policies don't meet members' needs.
"The committee is accordingly concerned that current policies may have unintended consequences, including shorter-than-average service time and lower recruitment rates, particularly for female service members," they wrote.
In a 2021 survey by Blue Star Families, 10% of active-duty respondents said that problems encountered when deciding to build a family are a reason they would leave the military.
The survey also found that 64% of respondents said they faced challenges in starting their families, with female service members reporting more barriers than men, 57% to 28%.
At military treatment facilities and through Tricare, DoD beneficiaries have access to fertility services such as hormone treatments, diagnostics, corrective surgery for infertility related to a physical condition, and treatment for erectile dysfunction.
Advanced reproductive treatments, such as IVF, are covered for married service members who have experienced an injury or illness that caused them to lose their reproductive abilities.
And couples also can receive IVF at six military treatment facilities at an average cost of $5,000 per cycle -- much less than they might pay at a civilian clinic. But the wait lists are long, and travel costs add to the expense for those who aren't stationed near one of these major medical centers.
The House's version of the defense bill also contains provisions pertaining to fertility services, although it stops short of expanding these benefits to service members.
Instead, it asks the DoD to study the issue and report back to Congress. An amendment sponsored by Rep. Chrissy Houlahan, D-Pa., would require the DoD to furnish a report on its policies regarding the cryopreservation of troops' sperm and eggs as a tool for family planning and a safeguard against injury.
Another amendment offered by Rep. Jim Banks, R-Ind., would require the DoD to provide a report on the feasibility of providing baseline fertility testing services for Tricare beneficiaries.
Ellen Gustafson, co-founder of the Military Family Building Coalition, an advocacy group that seeks to improve service members' access to fertility treatments and services, was among those who lobbied Congress for the provisions.
Her group has largely pressed for approaches to care and treatment that include fertility screening and testing; cryopreservation of gametes; intrauterine insemination; other medical care; and adoption, with an understanding that some fertility services, such as IVF, which includes the creation of embryos, and using a surrogate to have a baby, are objectionable to some people.
Gustafson said she is thrilled to have bipartisan support for providing new fertility benefits.
"Military life adds unique challenges for some service members in building families. We're glad that Congress is trying to make sure we have the medical care we deserve to have the next generation of kids who grow up to serve," Gustafson said in a statement to Military.com.
The Senate is expected to vote on its version of the bill next week. The two versions must then be reconciled before being passed again by both chambers. The conference to craft a final bill is likely to be contentious, given that the House version contains several provisions that address controversial issues such as abortion, medical care for transgender troops, and diversity initiatives.
The House bill, which passed largely along party lines, 219-210, with four Democrats voting "yes" and four Republicans voting against it, would bar the Pentagon from paying for travel for service members to get an abortion or fertility treatments; restrict troops' access to gender confirmation surgery; and put an end to some of the DoD's diversity, equity and inclusion programs.
-- Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter @patriciakime