The U.S. Department of Veterans Affairs recently expanded access for veterans to receive a key fertility treatment — a move that comes after lawsuits accusing the VA of discriminating against veterans who are in same-sex marriages, who are unmarried and who cannot produce their own sperm or egg cells.
For years, the VA had limited eligibility for in vitro fertilization services to only married veterans who were capable of producing their own eggs and sperm within that relationship. It was a rule that excluded other veterans in Missouri and across the country who needed the treatment to conceive children.
Under the VA’s policy change, which took effect at the end of March, veterans can receive IVF benefits regardless of their marital status, and they are now allowed to use donor sperm, eggs and embryos.
But there’s a catch, advocates say. A larger, underlying barrier to access remains: To receive IVF benefits, veterans still must prove that their infertility is a disability that was caused by their military service.
Making that case, advocates and experts said, can be more difficult than proving other kinds of service-connected disabilities because fertility can be affected by many factors — and sometimes a cause cannot be determined.
“There are a number of veterans and active-duty service members who need IVF, who could benefit from IVF, but they’re not going to be eligible,” said Alicia Christy, a former deputy director of reproductive health in the Veterans Health Administration’s Office of Women’s Health.
“The question I ask elected officials is, if you’re willing to give your life and service to this country, what kind of medical benefits do you deserve?” said Christy, who also is a retired Army colonel.
Infertility can be caused by physical injury on the battlefield. But officials at Paralyzed Veterans of America, a national veterans advocacy group, have argued that requiring veterans to prove that their infertility is connected to military service penalizes those whose infertility has an undetermined or hidden cause.
“With so many possible causes, proving that infertility is connected to service when the connection is not a physical injury is next to impossible for the average veteran,” the group said in court papers supporting a lawsuit that is seeking to change the policy.
The organization noted that infertility can potentially be caused by exposure to hazardous materials during military service and also by mental health conditions that resulted from the person’s time in the military.
It’s unclear how often veterans have been denied IVF care because the VA does not track claims specifically for infertility connected to military service, the department said. The VA provided IVF services to 697 veterans nationwide during fiscal year 2023, the department said.
In Columbia, the VA’s Truman Veterans’ Hospital has about 3,500 female clients, but only one has been authorized to receive IVF care as of late July.
Jeffrey Hoelscher, a public affairs officer for the veterans hospital, said the VA will likely see an increase in requests for IVF services because of the March policy change. But the VA does not have an estimate of how many additional IVF requests are expected, Hoelscher said.
The VA’s policy change came after two lawsuits were filed in August 2023. One lawsuit, filed on behalf of LGBTQ+ veterans, called for the VA to expand IVF access to same-sex couples, which has since been addressed by the VA’s March policy changes.
The second lawsuit made similar requests, but also called for the court to declare the VA’s service-connection requirement for IVF services “unlawful” and to keep the department from enforcing the requirement. The lawsuit was filed by the Reproductive Rights and Justice Project and Veterans Legal Services Center of Yale Law School. The service-connection requirement was not altered in the VA’s March policy changes to its IVF eligibility criteria.
“The updated policy fixes some of these problems, but the service-connected disability requirement still remains,” said Trudel Pare, a law student intern with the Yale project. “So even if, let’s say you’re a veteran, you have an 100% disability rating, which means that you’re able to access virtually every other service inside the VA, you still wouldn’t have access to IVF.”
When asked to comment on whether it is often difficult for veterans to prove that infertility is connected to their service, the VA said in a written statement that about 5% to 15% of people or couples with infertility may have unexplained infertility.
In these cases, it said, determining whether their infertility is caused by one of the veterans’ service-connected disabilities can be “complex.” Without proof that infertility is connected to service, a veteran is not eligible for IVF care.
However, the VA noted that even without service-connected infertility, veterans are eligible for fertility evaluation and other types of fertility treatments, including intrauterine insemination, under the VA’s medical benefits package.
One IVF cycle can cost $15,000 to $30,000 — a cost that is often not covered by insurance – and women typically need to undergo multiple IVF cycles before conception takes place, according to the U.S. Department of Health and Human Services.
Currently, there is not a national standard for IVF coverage from insurance providers. Fourteen states and the District of Columbia have insurance laws for IVF, according to RESOLVE, the National Infertility Association. Missouri does not have IVF insurance coverage requirements.