Military Genitourinary Trauma: Policies, Implications, and Ethics

Abstract

The men and women who serve in the armed forces, in the words of Major General Joseph Caravalho, "sign a blank check, co-signed by their families, payable to the Army, Navy, Air Force, or Marines, up to and including their lives." It is human nature to consider such a pact in polarized terms; the pact concludes in either a celebratory homecoming or funereal mourning. But in reality, surviving catastrophic injury may incur the greatest debt. The small but real possibility of losing the ability to bear biological children due to genitourinary combat injury has been a topic of discussion in hushed tones, behind closed doors. But as policy changes move the conversation into the open, we must be fully aware of the far-reaching and long-term impacts of decisions on those who have sustained genitourinary injury. In January 2016, Secretary of Defense Ashton Carter outlined a set of reforms that would improve the quality of life for military families by recognizing the importance of maintaining fertility, even in the face of severe injury. This first promising step could build a solid foundation of insuring fertility preservation for wounded service members with genitourinary injury, and it could set a precedent beyond the military for insuring treatment for people who have lost their reproductive capacity. Thus, the ethical challenges raised by the new policy require careful analysis.

The efficacy of antioxidants in sperm parameters and production of reactive oxygen species levels during the freeze‐thaw process: A systematic review and meta‐analysis

“…Freezing spermatozoon is performed before intracytoplasmic sperm injection (ICSI) to rule out cycle cancellation for failure to collect semen specimen on the day of the in vitro fertilisation/ICSI attempt (Montagut et al, ). It also can be a helpful technique for fertility preservation in men serving in the military and travelling husbands (Dean, Caplan, & Parent, ).…”

Fertility Preservation Before Deployment: Oocyte and Sperm Freezing in Members of the Active Duty Military

“…40,41 Evidence from UK servicemen who experienced GU injury suggested that men in whom fertility persisted had better injury recovery and quality of life. 42 Despite the encouraging success rates and multiple benefits to be gained, very few men actually pursue fertility preservation when appropriate. Barriers to fertility preservation include lack of interest, cost of freezing and storage, and most strikingly, not being discussed or offered by their provider.…”

“…Once a program supporting clinical care is in place, it will require effort by the DoD to ensure soldiers are properly educated on such programming, cryopreservation storage limits and ethical considerations. 42…”