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Updated May 26, 2021
Infertility in the Military
In recent years, Congress has become increasingly
interested in the provisionofinfertility services and
expanded reproductive care for s ervicemembers. Federal
regulation (32 C.F.R. § 199.4(g)) generally prohibits the
Department ofDefense (DOD) from paying for certain
infertility services for mo s t s ervicemembers and other
beneficiaries eligible for the TRICAREprogram. Some
Members of Congress argue that TRICARE coverage of
infertility services is an essentialbenefit to recruit and
retain an all-volunteer force, while others express concern
that expanded coverage would make the benefit too costly.
This In Focus describes the prevalence of infertility among
servicemembers, available treatment options, and
considerations when addressing expandedTRICARE
coverage of infertility services for servicemembers.
Background
The U.S. Centers for Disease Control and Prevention
(CDC), defines infertility as notbeing able to conceive
after one year ofregular, unprotected sexual intercourse.
Some health care providers, military and civilian, choose to
evaluate and treat females overage 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 cancause infertility in men. Increased
age, smoking, excessive alcoholuse, extreme weight gain
or loss, sexually transmitted infections, exposure to
radiation, exposure to environmentaltoxins, excessive
physical stress, or emotional stress are allrisk factors
associated with increased infertility. CDC es timates that
16.8% of married females in the United States, aged 25-44,
experienced infertility and received infertility services. In
men (of the same age group), CDCestimates that 9.4%
experienced and received infertility services.
In 2015, then-Secretary of Defense (SECDEF) Ashton
Carter introduced the Force ofthe Future (FoTF)
initiative aimed at maintaining DOD's competitive edge in
bringing in top talentto 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 oflife of military parents, including their ability
to start and supportfamilies. The new benefits included
expanded adoptionleave and a trialegg and sperm
cryopreservation program. The department ended its pursuit
of this initiative in 2017.
In June 2019, DOD reported onthe incidence (i.e., rate of
new cases) and prevalence (i.e., proportion of cases in the
military at a given time) ofdiagnosed infertility among
active duty females. An incident of infertility was defined
as having at least2 outpatient medical encounters with an
infertility diagnosis. The report showed that diagnoses of
female infertility decreased from2013 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.
During this s ame time period, the annual incidence rate of
infertility diagnoses decreased by 25.3% (from 85.1 per
10,000 to 63.6 per 10,000 [see Figure 1]); while the
average annual preyalence of diagnosed female infertility
decreasedby 18% (from 173.6 per 10,000 to 142.3 per
10,000 [see Figure 2]).
Figure I. Annual incidence rates of female infertility
diagnoses, active component servicewomen of
childbearing potential, 2013-2018
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Monthly Report, voL. 26, n o. 6 (jun e20 19), p.23.
Figure 2. Ann ual prevale nce rates of fe male infertility
diagnoses, active com ponent servicewomen of
childbearing potential, 201 3-20 18
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2013 2014 2015 2Q16 2017 2018
Source: Ibid, p.25.
Notes: 'Bloc k, occlusion, or stenosis of the fallopian tubes.
bStructural abnormality of the uterus or non implantation (includes
fibroids).
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