Infertility Care Among OEF/OIF/OND Women Veterans in the Department of Veterans Affairs

Abstract

Background An increasing number of young women Veterans seek reproductive health care through the VA, yet little is known regarding the provision of infertility care for this population. The VA provides a range of infertility services for Veterans including artificial insemination, but does not provide in vitro fertilization. This study will be the first to characterize infertility care among OEF/OIF/OND women Veterans using VA care. Methods We analyzed data from the OEF/OIF/OND roster file from the Defense Manpower Data Center (DMDC)—Contingency Tracking System Deployment file of military discharges from October 1, 2001–December 30, 2010, which includes 68,442 women Veterans between the ages of 18 and 45 who utilized VA health care after separating from military service. We examined the receipt of infertility diagnoses and care using ICD-9 and CPT codes. Results Less than 2% (n = 1323) of OEF/OIF/OND women Veterans received an infertility diagnosis during the study period. Compared with women VA users without infertility diagnosis, those with infertility diagnosis were younger, obese, black, or Hispanic, have a service-connected disability rating, a positive screen for military sexual trauma, and a mental health diagnosis. Overall, 22% of women with an infertility diagnosis received an infertility assessment or treatment. Thirty-nine percent of women Veterans receiving infertility assessment or treatment received this care from non-VA providers. Conclusions Overall, a small proportion of OEF/OIF/OND women Veterans received infertility diagnoses from the VA during the study period, and an even smaller proportion received infertility treatment. Nearly 40% of those who received infertility treatments received these treatments from non-VA providers, indicating that the VA may need to examine the training and resources needed to provide this care within the VA. Understanding women’s use of VA infertility services is an important component of understanding VA’s commitment to comprehensive medical care for women Veterans.

Infertility Services for Veterans: Policies, Challenges, and Opportunities

“…The limited studies of infertility in U.S. Veterans suggest a prevalence of the disease in Veterans Affairs (VA)-enrolled Veterans that is similar to the general U.S. populations when self-report is used (13.8% in male Veterans and 15.8-19% in female Veterans). 16,17 In contrast, medical record review reveals very low rates of infertility diagnosis in female Veterans (1.9%), 18,19 suggestive of the under identification by health care providers and unawareness and underutilization of VHA infertility care options by both patients and health care providers.…”

“…21 While direct injury to the urogenital region is a clear cause of infertility, research suggests there are other, less pathologically straightforward service-related causes of infertility. For example, studies have shown associations in Veterans between infertility and sexual assault [17][18][19] and posttraumatic stress disorder 17,18 as well as between infertility and other mental health disorders such as depression. 18,19 VHA Policies on Infertility Coverage…”

Australian Veterans of the Middle East Conflicts 2001–2010: Select Reproductive Health Outcomes Part 1 — Maternal and Paternal Outcomes

“…Two large studies utilizing US Department of Defense and Veterans Affairs' (VA) data examined infertility among US servicewomen (Katon et al, 2014;Mattocks et al, 2015). Rivera and Johnson identified that US female veterans of Vietnam and the first Gulf War reported more reproductive and gynaecological problems than the general population (Rivera and Johnson, 2014).…”

Reproductive Health of Women Veterans: A Systematic Review of the Literature from 2008 to 2017

“…Only three manuscripts examined infertility among Veterans (Supplementary Table 3). [41][42][43] None used standard measures of infertility (time to pregnancy). 44 Self-reported lifetime sexual assault was positively associated with involuntary childlessness (aOR, 2.02; 95% CI, 1.39-2.95).…”

“…43 Among Veterans who served during the Afghanistan and Iraq conflict era, women Veterans were more likely to report a lifetime history of infertility relative to their male counterparts (aOR, 1.17; 95% CI, 1.04-1.31), 42 and among those using VA healthcare who had an infertility diagnosis, those who were obese were more likely to receive an infertility assessment or treatment (37.6 vs. 28.5%). 41 Pregnancy.…”