Interview transcript:

Terry Gerton Welcome back to this special Veterans Day edition: The best of the Federal Drive with Terry Gerton on Federal News Network. The White House is working to lower the cost of IVF, putting fertility care in the spotlight. But military families often face extra hurdles when trying to start a family, whether it’s deployments, relocations, or the demands of service. New legislation aims to close that gap. To help us understand the medical side of this issue, Federal News Network’s Eric White spoke with Dr. Michael Wittenberger, a reproductive endocrinologist and Navy veteran who spent years treating veterans and their families.

Eric White So obviously, they’re not the only ones that can struggle with infertility, but what is it in particular about military families, where they have even more of an issue getting treatment for it? What are some of the roadblocks of the jobs that they entail that kind of getting in the way? What is what is that you have seen?

Michael Wittenberger The military by its nature is just a different organization completely than what most people are. The military mission takes precedence, and so the military mission often will require that service members are separated from their families. That can be while they are watch-standing, it can be on workups, it can be on deployment. So there’s frequent separations between the partners that are trying to get pregnant. And so using different surveys, there seems to be an increase in the difficulty for military family members in planning and executing a family. And when you look at the prevalence of infertility in the military, it seems like it’s higher than the civilian population. So in addition to these frequent interruptions and the continuity between partners, there’s a number of other things that are inherent to just the military. There’s different jobs that you have, and there’s different expectations for different duty assignment. It’s expected while you’re on sea duty that you don’t try to get pregnant because you’re expected to deploy even though you may be in port and you may not be deployable at that moment. At the time that you’re there, you’re expected not to get pregnant. The other half is okay to get pregnant, but again, there’s other things like access to care. When I retired in 2022, I was one of three active-duty reproductive endocrinologists and infertility specialists in the entire Navy. That’s serving, you know, the approximately 500,000 active-duty Navy and Marines on both coasts and around the world. So you can imagine when there’s just a couple or three specialists that there’s going to be bottlenecks in care. And a lot of times the sailors, the marines, the service members are going to located remotely so there’s not going to a local catchment where they can be seen and taken care of. So another barrier to care is really just a delay in diagnosis for many of them for getting the care, they’ll be out in an area they can’t access care, so they have to wait to come back to a military training facility that actually has a reproductive endocrinologist to try to get access to care. So, you know, a lot of different barriers potentially to care for the military family.

Eric White I guess we can start with your interaction with these patients. Was that a frustration that you heard a lot in treating service members, you know, “it took me two months to get this appointment”? Did some of them seek help outside of their respective military branch?

Michael Wittenberger I would say that’s always been a concern of people trying to access care, is that the delay to get in and see a specialist is hard or that they need to go out and see fertility specialist in the civilian world. The problem with that is that in both cases, TRICARE, they completely covered the diagnostics of trying to diagnose you with infertility, but the treatment options are very limited with TRICARE for active duty. They consist basically of any treatment option that uses coitus as a form of conception. So that means anything with artificial insemination, IVF, fertility preservation in many cases is not covered by TRICARE. So yes, the military members try to access care on the outside. And they find out that they have to cover the bill, and so that’s a huge financial burden for them. Even within the military, there’s a thought that if they can get care at the military treatment facility with a reproductive endocrinologist as active duty, that it’ll be covered. Well, that’s only partially true. So TRICARE has an exception to the lack of coverage that allows them to, for graduate medical education purposes, provide some additional care, like artificial insemination and the monitoring for IVF, the medications for IVF. So it does slightly reduce the cost of IVF, but since there’s no embryology team in any of the military services, there’s still a lot of expenses that the patient needs to contract with the civilian embryology lab or IVF center to actually cover.

Eric White And so let’s finish up here with some of the solutions that have been proposed and other ones that you think could be implemented. There’s legislation in the House from Rep. Sarah Jacobs that is aiming to increase access for military families to this treatment. What do you know about that? And what else could be done to make this an easier process for those that are looking to serve their country, but also want to fulfill their familial wishes?

Michael Wittenberger Sarah Jacobs is a fellow San Diegan, so it’s good to see that she’s really pressing for this. My understanding of the legislation is that it’s been reintroduced in April of this year. It was previously passed through the House, and I think Tammy Duckworth introduced it into the Senate, and both of those were passed and put into last year’s NDAA, the National Defense Authorization Act. And then it was scrubbed at the last minute. And so now they’re reintroducing…and my understanding is that this includes basically standard-of-care treatment for active-duty TRICARE recipients and their dependents, which just means that there’s IVF included in this, there’s artificial insemination included in this. And I think it’s three cycles of IVF, unlimited embryo transfers; it doesn’t matter if you’re single or you’re partnered, it’s inclusive there. Now, the great travesty, I think, here is when you look at what’s currently available to our warfighters that are out there sacrificing their lives potentially to build a country for their families, that maybe they end up sacrificing their families. But as soon as they exit…active duty, if they separate, if they retire, now they’re in the VA system and there’s a huge discrepancy at what’s provided by the VA versus what’s providing for active-duty members. So the VA, if you have a fertility-related diagnosis, if you’re currently experiencing infertility in the active-duty forces and you separate and you have fertility-related diagnosis, now you’re eligible for up to six cycles of IVF. Even if you don’t have a fertility-related diagnosis, you’re automatically eligible for artificial insemination. So, you know, the bottom line really is that if you’re active duty and your priority is to start a family and you have a fertility-related diagnosis, it may actually benefit you to leave active duty and go into the VA system to get that care covered without the financial burdens that it causes.

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