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Bill would expand fertility coverage for veterans

MSNBC,  Aug 20, 2012

A bill being considered in the Senate would expand the VA's medical benefits package so other veterans, and their spouses or surrogates, don't have to bear the same expense. The department currently covers a range of medical treatment for veterans, including some infertility care, but the legislation specifically authorizes the VA to cover IVF and to pay for procedures now provided for some critically injured active-duty soldiers.

The bill's meant to help wounded veterans start families as they return home from war and to address a harrowing consequence of combat that can radically change a couple's marriage but receives less attention than post-traumatic stress disorder and brain injuries.

In vitro fertilization, the process of mixing sperm and eggs in a laboratory dish and transferring the resulting embryo into a woman's uterus, costs thousands of dollars and each cycle can take weeks. It's physically taxing too, requiring hormone injections and other invasive steps, and can take multiple tries to produce a viable pregnancy. For many wounded veterans, it represents the most promising option.

More than 1,830 veterans of the wars in Iraq and Afghanistan have suffered pelvic fractures and genitourinary injuries since 2003 that could affect their abilities to reproduce, according to Pentagon figures provided to Sen. Patty Murray, the bill's sponsor and chairwoman of the Senate Veterans Affairs Committee.

Combat injuries can dampen a soldier's ability to have children in any number of ways, said Mark Edney, a Maryland urologist and Army reservist who treats veterans. For men, a blast to the genitalia can harm sperm-producing testicles, while a spinal cord injury can cause erectile dysfunction or ejaculatory problems. For women, shrapnel can injure the pelvis and fallopian tubes, preventing fertilization.

Although expertise exists to help them become parents, Edney said veterans with fertility problems form a "relatively small subset of patients that are just forgotten in terms of policy."

The legislation would likely have helped spouses like Brenda Isaacson, who said the VA's insurance plan covered the cost of recovering sperm from her husband, Chuck — an Army staff sergeant paralyzed by a 2007 helicopter crash in Afghanistan — but not the more than half-dozen IVF attempts the couple underwent before finally having a daughter nearly a year and a half ago. She bristled at being told by officials that infertility services were not medically or psychologically necessary.

The proposal comes as technological improvements have made IVF a more common — and reliably successful — way to have children, with the number of births as a result of it and similar procedures rising in the past decade. It's more openly discussed in popular culture, too, from television talk shows to celebrity magazines. And the VA is becoming more sensitive to family health concerns as it encounters younger veterans trying to start post-war lives, said Patty Hayes, the agency's chief consultant for women's veterans' health.

The VA says it already covers some fertility services, including counseling, diagnostic tests and intrauterine insemination — a method of artificial insemination — for the veteran. But that leaves out many veterans and their spouses whose best hope for pregnancy is the more physically rigorous, but also more reliable, IVF process, where the average cycle costs $12,400, according to the American Society for Reproductive Medicine.

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