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1 1 (April 15, 2020)

handle is hein.crs/govcqzx0001 and id is 1 raw text is: FF. , riE -S .,-- i April 15, 2020 Infertility in the Military Six bills introduced in the 116th Congress aim to expand infertility health care services to servicemembers. Congress has become increasingly interested in this health care benefit, because infertility care is not a TRICARE-covered benefit and an increased number of female servicemembers and members of the public are interested in reproductive care. Some Members of Congress argue that health care coverage for service-connected disabilities and family reproductive care is essential to both recruitment and retention in the armed services. Others say the variety of modern treatments available would make the benefit too costly. The U.S. Centers for Disease Control and Prevention (CDC), defines infertility as not being able to conceive after one year of regular, unprotected sexual intercourse. Some providers, military and civilian, choose to evaluate and treat females over age 35 after 6 months of unprotected intercourse. Any condition affecting the ovaries, fallopian tubes and/or uterus can result in infertility among females. Hormonal disorders or disruptions to testicular function can cause infertility in men. Increased age, smoking, excessive alcohol use, extreme weight gain or loss, sexually transmitted infections, exposure to radiation, exposure to environmental toxins, excessive physical stress, or emotional stress are all risk factors associated with increased infertility. CDC estimates that 6.7% of married females aged 15-44 experience infertility in the United States. In 2015, then-Secretary of Defense (SECDEF) Ashton Carter introduced the Force of the Future (FoTF) initiative aimed at maintaining the Department of Defense's (DOD) competitive edge in bringing in top talent to serve the nation. The goal of the FoTF was to recruit and retain a diverse and talented military. One aspect of the FoTF initiative was improving the quality of life of military parents, including their ability to start and support families. The new benefits included expanded adoption leave and a trial egg and sperm cryopreservation program. The department ended its pursuit of this initiative in 2017. Infertility among female servicemembers garnered attention in 2018 when the Service Women's Action Network (SWAN) reported on the experiences of military females who attempt to access reproductive care. The report was based on a survey that SWAN conducted of 799 military females, including 262 active duty females (<1% of the active duty female population). With regard to infertility, 37% of active duty respondents to the survey said they had trouble getting pregnant when actively trying to do so. In response, DOD reported in June 2019 on the incidence (i.e., rate of new cases) and prevalence (i.e., proportion of cases in military at a given time) of diagnosed female infertility among active duty females. An incident of infertility was defined by having at least 2 outpatient medical encounters with an infertility diagnosis. The report showed that diagnoses of female infertility decreased from 2013 to 2018 despite an increase in the number of females tested for infertility. Of the more than 200,000 total active female servicemembers, 8,744 were diagnosed with infertility from 2013 to 2018. The annual incidence rate of infertility diagnoses decreased by 25.3% (from 85.1 per 10,000 to 63.6 per 10,000) during this five-year period (see Figure 1). From 2013 to 2018, the average annual prevalence of diagnosed female infertility was 1.6% (number of active duty females with infertility at one time). This annual prevalence is considerably lower than what was found by the SWAN survey, which estimated infertility rates based on self-reporting. Figure I. Annual incidence rates of female infertility diagnoses, active component service women of childbearing potential, 2013-2018 ~ t , ........... Source: DOD Report, Female Infertility, Active Component Service Women, U.S. Armed Forces, 2013-2018, June, I 2019. While DOD found the incidence of diagnosed infertility to be decreasing, there were some groups of females found to be at higher risk. Infertility diagnoses were highest among non-hispanic black servicemembers over age 30. The Army had the highest incidence rate (101.7 per 10,000) of infertility diagnoses, while the Marine Corps had the lowest incidence rate (50.4 per 10,000). Active duty female servicemembers in health care occupations had the highest incidence followed by pilots and air crew. Health care personnel may be more likely to seek care, while pilots and air crew may be at higher risk due to radiation or physical job demands. CDC recommends treating infertility with medicine, surgery, or assisted reproductive technology (ART). p\w -- , gnom goo mppm qq\ a , q 's I 11LULANJILiN,

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