Veterans with service-connected injuries that have left them infertile can access a range of options to help start a family under a law passed in 2016.
But between 2016 and 2019, just 567 veterans used the benefit, mainly because the rules are so restrictive that few qualify.
During a House hearing Tuesday, members of an appropriations subcommittee that oversees funding for the Department of Veterans Affairs called for changes to the law that governs this benefit, saying the legislation is outdated and "baffling."
The regulations that govern the VA's fertility services are based on a 2012 Defense Department fertility benefit for active-duty service members. The VA rules allow for infertility counseling; laboratory and sperm testing; genetic counseling; medication surgery; donor sperm for intrauterine insemination; and up to three cycles of in vitro fertilization treatment.
But the VA does not cover third-party donations of eggs or sperm for in vitro fertilization, benefits for single or non-married couples, surrogacy; or, in many cases, conditions without a proven link to infertility, such as traumatic brain injury; psychological conditions including post traumatic stress disorder or depression; or environmental exposures.
Members of Congress from both sides of the aisle say change is needed.
"I can't ... wrap my mind around the number of obstacles that are added by the VA, when the heartbreak you go through as a person who wants and dreams of being a parent has your body throwing obstacles in your way and then your government does the same," said Rep. Debbie Wasserman Schultz, D-Fla., who chairs the House Appropriations subcommittee for Military Construction, Veterans Affairs and Related Agencies.
"I know this personally from my own family's experience: Infertility is anything but easy. This is deeply personal and expensive. This can be especially true for wounded warriors. ... I appreciate the opportunity to learn about and discuss the fertility services, including surrogacy, for our veterans," said Rep. John Carter, R-Texas, the subcommittee's ranking member.
According to the VA, roughly 16% of women and 14% of men who served in Iraq or Afghanistan struggle with infertility, compared with 12% of women and 9% of men in the general U.S. population.
Advocates say more should be done to improve the likelihood that veterans can start a family without having to go into debt to do so -- especially when their infertility is service-connected.
Citing the case of Jacob and Ashley Lyerla, a couple who tried IVF three times within the VA before they turned to donor sperm and eggs to create viable embryos, paying $35,000 out of pocket in the process, Paralyzed Veterans of America Associate Legislative Director Maureen Elias said veterans with service-connected infertility should not have to risk financial stability to start a family.
An Army veteran, Jake Lyerla was left paralyzed at age 19 by an IED blast in Afghanistan.
"While we are pleased that procreative services remain temporarily available for catastrophically disabled veterans, there is more to do," Elias said.
"Let's allow VA to offer the best and current care for our veterans wishing to build their families," said Barbara Collura of Resolve: The National Infertility Association. "We must ensure that the care our veterans receive fits their unique needs."
The current rules don't allow single parents or unmarried couples to access fertility care from the VA -- a roadblock to service members who may want to have a child without a partner. The rules also don't allow for surrogates to carry a veteran's baby, a restriction that affects injured female veterans who can't carry their own child and members of the LGBT community.
Objections to changes to the rules have come largely from conservative groups that favor traditional values of marriage between a man and a woman and also object to IVF because it creates embryos that may be discarded, according to a 2019 report from The Associated Press.
Another possible contributing factor is a lack of emphasis on the adoption benefit provided by the VA, which reimburses up to $2,000 in fees, according to Rep. Tony Gonzales, R-Texas.
"People create families in different ways and ... there's less that build their families through adoptions or want to build their family through adoptions, and they just simply feel as if they've gotten roadblocks," Gonzales said.
Surrogacy -- contracting with a third person to carry a fetus to term, created from a couple's own gametes or using donor gametes -- continues to raise concerns for many people.
"I think that when you start getting into same sex [parenting] and surrogates, that's when I think you run into pushback," said Rep. John Rutherford, R-Fla.
"I would ask you to acknowledge that there are same-sex couples, some of whom may have service-connected infertility, who are legally married in this country and are women. And if they also can't carry a baby to term because of their injury, then I would just ask you to think about, wouldn't that be the same thing as a heterosexual couple in the same situation?" Wasserman Schultz asked Rutherford.
Advocates say the current policy precludes service members whose service-connected health conditions are more difficult to link to infertility, including brain injuries, mental health conditions, exposures to chemicals, radiation or other damaging environmental pollutants.
"[There is] a lack of research and understanding of how toxic exposures impact fertility. We also don't have a ton of research on how blast exposures and other conditions relative to military service impact fertility. And so because we don't have that research, getting it tied to that service connection ... is very difficult, especially for women veterans," Elias said.
"Can you imagine being injured in service to our country, having many of your needs met by the VA, then being told the one thing that will make you whole, a family, is out of reach?" asked Collura.
"There's no question these restrictions are baffling. I mean, clearly, they're unfair. Clearly, they're unjust," said Rep. David Trone, D-Md.
The advocates said the VA policy on fertility must be separated from the DoD policy to allow the VA to develop its own benefits package. They added that funding should be made permanent so service members don't worry year to year that the benefit will be revoked.
Wasserman Schultz said she hoped that she can build consensus to at least approve a measure to ensure that the funding becomes permanent. "This has been helpful for us. ... We are going to need to do a little work to win over our Senate colleagues as well," she said.
-- Patricia Kime can be reached at Patricia.Kime@Monster.com. Follow her on Twitter @patriciakime.