In the military, fertility policies and family building collide

If you’re a service member with a family, the military’s got your back.

If you’re trying to start one, it can be another story. 

Active duty service members unable to conceive children naturally can face significant hurdles as the military health plan doesn’t cover reproductive assistance, such as in vitro fertilization, intrauterine insemination, a surrogate or adoption.

The government will pay for an organ transplant “but if we need help to ovulate we’re on our own,” said Katy Bell Hendrickson, co-founder of the Military Family Building Coalition which works on multiple fronts to help those in the military “build the families they want.”

Two Washington Democrats, Sen. Patty Murray and Rep. Rick Larsen, are among their congressional allies.

The longtime lawmakers have repeatedly proposed bills assisting service members and veterans dealing with challenges of starting a family due to infertility or a combat-related injury.

Murray, for example, authored a comprehensive bill in 2021 that would have ensured fertility treatments, such as in vitro fertilization, or IVF, are covered under the U.S. military health plan known as TRICARE.

At the time, she said thousands of service members suffered injuries in the Iraq and Afghanistan wars that left them unable to conceive naturally. While the Department of Defense and Department of Veterans Affairs  offer some forms of assistance, Murray noted Congress has banned coverage of certain non-coital fertility services like IVF. She’s worked to get the ban lifted.

This year, Larsen is trying to establish a pilot program allowing active-duty service members to freeze their sperm or eggs before deployment to a combat zone or special operations assignment. He requested it be part of the 2024 National Defense Authorization Act.

He’s introduced different versions of the pilot in past sessions and it was an element of Murray’s bill that didn’t pass.

“America’s men and women in uniform sacrifice greatly. They should not have to sacrifice, however, their dreams of having a family,” Larsen said at a congressional hearing. The pilot, he added, “will enable service members to choose to have a family should a traumatic injury occur.”

Ellen Gustafson, co-founder of the family building coalition, lauded the lawmakers’ commitment on this issue.

“Washington state has got our back when it comes to the military families having babies,” she said.

The landscape

Hendrickson and Gustafson are Navy spouses living on the East Coast. They organized the coalition as a result of their own challenging journeys in family-building.

Hendrickson said she and her husband relied on adoption and IVF to build their family of five children. 

“We would not have been able to have our family without cryo,” she said. 

Gustafson said she had a genetic issue dating back five generations where male babies would mysteriously die in utero towards the end of the second trimester. In 2014, Gustafson gave birth to a stillborn.

Her doctors said then to try IVF in order to choose a female embryo. TRICARE wouldn’t cover it.

She told The Nation that she and her husband went through six rounds of IVF and $120,000. During the process, she became naturally pregnant with a girl, who she carried to term, and then used two of her embryos and had twin boys, the magazine reported.

The two formed the coalition in 2020 and are now teamed up with military support and health care advocacy groups. 

One focus is educating members of Congress on fertility challenges in the military’s ranks. For example, there’s a misconception that the problem is with women. Not true. At least half the time the issue is with the man. There’s a higher rate of male infertility among members of special operations personnel than the general population, they said.

“We’ve got to be more upfront about this,” Gustafson said. “No man wants to think their sperm is not capable of doing its job.

Another issue is money. Opponents of expanding service say it will be too expensive to cover fertility-related services and treatments.

Hendrickson said the nation’s defense will suffer a greater hit if the investment isn’t made. It’s going to get more difficult to recruit and retain people into a voluntary military when those wishing to build a family see how much it will cost them to do so while serving.

“If you’re going to make members of the military go out and pay for private care, you will lose them,” she said. 

It’s only a pilot

Larsen’s proposal is an initial step toward offering more support. It calls for reimbursing 500 military members up to $500 per sperm donation or $3,500 per egg donation to cover expenses associated with testing, freezing and storage.

To be eligible, one must have received deployment orders, have a high probability of receiving such orders on short notice, or be a member of the U.S. Special Operations Command.

A report on the program would be due after one year to the House and Senate armed services committees.

Hendrickson called cryopreservation a “game-changer.”

“All we’re doing is freezing cells. It is before conception,” she said. “It gives them the opportunity to do so much.”

Some of those opposed to the pilot, and bills like the ones pushed by Murray and Larsen, view government support of reproductive assistance to be in conflict with their pro-life views, Gustafson said. Discarding IVF embryos is likened to abortion, she said.

What’s needed, she said, is a pro-family, pro-military Republican stepping up to support revising the military’s approach.

“It is very hard to generate full support of Congress to get behind this initiative if you don’t have a Republican sitting with you and helping make it happen,” she said.