In early 2016, Defense Secretary Ash Carter announced that the Pentagon would cover the cost of freezing sperm or eggs for service members who wanted to preserve them for future use.
The benefit, part of the Obama administration's ambitious "Force of the Future" personnel efforts, was to be rolled out as a pilot program as the Defense Department explored additional options for providing fertility services to troops. The move was intended to convince service members to serve longer, expanding the window to have children.
But the program never got underway, first facing opposition in the U.S. Senate and then dropped completely after the election of President Donald Trump.
But service members' interest in proactive fertility measures has not waned, and now military family advocates have stepped up to fill the gap, starting with a vulnerable subset of personnel: the Naval Special Warfare and Army Special Operations communities.
The goal, organizers say, is to provide sperm-freezing services and counseling, a relatively low-cost option, to a population that is highly susceptible to injury and stressful operations tempo. At the same time, supporters are lobbying the Defense Department and Congress to do more, pushing for broader access to infertility treatment, adoption fee coverage and surrogacy support for all members.
"Military life is specifically challenging for coital reproduction. The one thing that's really hard to do is physically be together with your partner," said Katy Bell Hendrickson, cofounder of the Military Family Building Coalition, which offers the service to Navy SEALs, explosive ordnance disposal technicians and members of the Naval Special Warfare community.
A 2021 survey of active-duty personnel and spouses by Blue Star Families found that 64% of responding service members reported having challenges starting their families. More than four in 10 active-duty families said the military made it hard to plan for their desired number of children or space their births. And the challenges were even more significant among female service members, who reported family building challenges at nearly double the rate of their male counterparts, 57% versus 28%.
According to the survey, obstacles included not only physical infertility, but related financial constraints such as the cost of medical treatments, adoption fees or surrogate salaries.
To help ease the challenges, Hendrickson's group, the Military Family Building Coalition, and the Green Beret Foundation, an organization that supports Special Forces troops, have partnered with Legacy, a Boston-based startup that provides sperm testing, analysis and storage to servicemen, while also offering counseling and referrals.
The goal is to bolster family planning and improve recruitment and retention, said Hendrickson and Military Family Building Coalition cofounder Ellen Gustafson.
"If I'm a female pilot and I'm seeing absolutely no resources or hope on how to build a family and stay in service, it's much more attractive for me to step out and go work for, say, American Airlines because they give great family building benefits," Gustafson said.
Most military personnel are in prime parenting years: 45% of active duty personnel are under age 26, while 21% are between the ages of 26 to 30, according to DoD data.
But more than 26% are 31-40 years old, a decade when they are likely to be financially secure and want children but may face difficulties given that the risk of infertility increases with age.
Getting treatment within the military health system is a challenge: While the DoD covers the cost of fertility counseling, in vitro fertilization and other advanced reproductive services to married, severely injured service members, others must go to one of seven military treatment facilities that offer in vitro fertilization, artificial insemination and other fertility services and pay the cost.
They also can use Tricare, the military's civilian health benefits program, for limited services that include diagnoses of conditions that cause infertility and correction of medical issues that may be the source.
But Tricare does not cover IVF, artificial insemination or any other advanced services. And no service member can access any of these benefits if they are unmarried.
Hendrickson and Gustafson, both of whom faced difficulties having children, say the Defense Department should provide what they call "baseline reproductive health care."
"We don't want to be running a nonprofit for the rest of our lives. We want to see that Tricare is expanded to include what we believe is very much attached to readiness and retention of an all- volunteer force and really, economics," Hendrickson said.
Military Family Building Coalition has launched several initiatives to assist service members with fertility decisions, beginning with the Legacy partnership that now offers sperm freezing for Navy SEAL/BUDS candidates. The first time they offered it, they had six takers of the cadre of 33.
"All jokes aside, try telling a bunch of 23-year-old future Navy SEALs how important their sperm is. But they love [hearing it]," Hendrickson said. "These guys are at risk their entire time of service, right?"
"The goal is to socialize this, normalize this," Gustafson added.
The Military Family Building Coalition also has seen success through its Aviatrix program, which provides fertility counseling and referrals to female military pilots, and Tadpole program, which provides counseling and cryopreservation to all active-duty members of the Navy special warfare community.
A Navy couple who met in their late 30s said the organization's Tadpole program and sperm analysis helped them determine that the husband's fertility was low, and they would likely need to rely on in vitro fertilization to grow their family.
The spouse, who asked that her name not be used to protect the couple's privacy, suffered a miscarriage after getting married. She later delivered a healthy son but she has had several subsequent miscarriages. Her husband's deployment schedule and his fertility issues haven't made it any easier.
"We looked at the military health system, but right now on the East Coast, it's a year to two-year wait. It depends on if people are willing to do the waiting. We just can't. We are hitting the upper limit right now," the wife said.
She estimates that they have spent $25,000 trying to grow their family.
"It's not just getting injured or shot in the genitals. It's the stress they are under, the sleep schedule, the toxins they are exposed to. We actually did a semen analysis after deployment, and the numbers had dropped drastically," she said. "If we had my husband's sperm from 15 years ago, we might be having a much higher success rate than what we are having right now."
The current version of the House National Defense Authorization Act includes a provision that would create a pilot program for 1,000 service members to preserve their sperm or eggs prior to a combat deployment.
Rep. Rick Larsen, D-Wash., has proposed the program every year since 2017, and each year, it has been stripped from the bill, not making it past the objections of conservative senators who generally oppose fertility services, as they could result in the creation of unwanted embryos.
Hendrickson notes that cryopreservation of sperm or eggs may prevent the need for service members to use fertility treatments like in vitro fertilization that would yield multiple embryos.
"Within our service efforts, we get support. The harder thing is making sure that this is understood to not be [a] Democratic or Republican issue, but simply a military need that has gotten lost along the way," Hendrickson said.
A spokesman for the Defense Health Agency said the Defense Department currently has no plans to offer cryopreservation for members beyond covering it for severely injured or ill married service members.
Hendrickson and Gustafson hope this is the year DoD or Congress will change this.
"Our force of the future is 100% forward facing: 'We're going to plan our family. We are going to wait until we have the financial resources, the career timing, the educational goals.’ All of those things are good for creating resilient military families. But we aren't giving them any resources to do that," Hendrickson said.
-- Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter @patriciakime.