IVF helps military couples grow families

Conception is a miracle. But for some couples, that miracle doesn’t happen naturally. It requires a miracle of science known as in vitro fertilization.

After a year of trying to conceive, Rebecca Smith and her husband Matthew, an Air Force Reserve chaplain, considered IVF through a civilian fertility clinic but opted not to pursue treatments because the price — $25,000 to $35,000 — was out of reach financially for the then newly married couple.

“As an average [cost], it seemed insurmountable,” Smith said. “How do people do that? We weren’t willing to go into that kind of debt to start a family. It was pretty shocking.”

Instead, the Smiths became foster parents and adopted two of the seven children they fostered. They didn’t consider fertility treatments again until 2015 when they were living in Washington, D.C., and became friends with a woman whose two children were conceived through Walter Reed National Military Medical Center’s infertility program.

After two rounds of IVF, Smith became pregnant and gave birth to a daughter in October 2017.

“She’s our miracle baby,” Smith said.

IVF is a process in which eggs are removed from a woman’s ovaries and fertilized with sperm in a laboratory before being transferred to the uterus. The first “test-tube baby” was born in England in 1978. Today, the Centers for Disease Control and Prevention reports about 4 million babies per year are born in the United States through IVF.

Most woman go through at least two treatment cycles to become pregnant, at a cumulative private-practice cost of $40,000 to $60,000. That price includes medications, monitoring, embryology laboratory services, physician, surgery center and anesthesia fees. Those costs typically are not covered by private health insurance, including Tricare, which pays only for Assisted Reproductive Technology services that are “medically necessary and combined with natural conception” unless a service member is “seriously or severely ill or injured” while on active duty and “loss their natural procreative ability,” according WRNMMC’s Office of Command Communications. In 2017, this Supplemental Health Care Program benefit was extended to active duty service members who have undergone cancer therapy that has affected their fertility.

Only eight states — Arkansas, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, New Jersey and Texas — mandate that individual health insurance plans offer IVF coverage. However, six military treatment facilities offer IVF treatment to active duty, reservists called to active duty and retired military and/or their spouses. Additionally, the Department of Veterans Affairs now offers IVF treatment to veterans with certain service-connected conditions.

Brooke Army Medical Center at Fort Sam Houston in San Antonio, Texas
Naval Medical Center San Diego
Madigan Army Medical Center in Tacoma, Washington
Tripler Army Medical Center in Honolulu
ART Institute of Washington/Walter Reed National Military Medical Center in Bethesda, Maryland
Womack Army Medical Center in Fort Bragg, North Carolina

At WRNMMC, IVF costs between $3,642 and $7,306 per treatment cycle, while a less invasive treatment known as Intrauterine Insemination is $173 per attempt, according to Deputy Public Affairs Officer Mary J. Constantino. Although IVF and IUI are not Tricare covered benefits, WRNMMC covers at no expense to the patient all diagnostic tests, monitoring blood work, ultrasounds, reproductive endocrinologist treatment team costs and IVF medications and anesthesia for egg retrieval. Patients pay out-of-pocket for ART Institute of Washington embryology services. IVF and IUI costs at other military medical treatment facilities may vary.

But given the military lifestyle, couples who undergo IVF treatments can experience more than financial challenges. For Navy spouse Casey Jackson, her husband’s promotion to chief petty officer added a wrinkle to the multistep process.

“The timing worked out that I was going to do the [embryo] transfer on the final night of the chief’s season,” said Jackson who administers the “Military Spouse IVF Support Group” Facebook page. “There was no way for Steve to get out of that day. My mother-in-law took me to my frozen embryo transfer and watched me get impregnated, because that’s normal, right? A father not being there when something significant is happening in a pregnancy is not the craziest thing ever, but when the woman is getting pregnant, that is a new one.”

In the midst of their IVF journey, Jennifer Wloch’s husband received orders to Norfolk, Virginia. Though the Marine Corps couple had completed all their initial testing at Naval Medical Center San Diego and had an active referral from the infertility clinic there, Wloch says they had to “start from square one” at Naval Medical Center Portsmouth. That meant finding a new primary care doctor and beginning the referral process again.

“There was no continuity of care,” Wloch maintained. “That set us back an additional six months.

“People erroneously view infertility not as a disease or a condition but as an inconvenience almost,” added Wloch, whose daughter was conceived through the Walter Reed IVF program. “If this was cancer or a chronic health condition, would the process have been so disjointed and would there have been such a huge lapse in care?”

For couples seeking to have children through assisted reproductive treatments, time is of the essence since women under age 30 experience the best outcomes. Furthermore, military treatment facilities have an age cutoff for starting an IVF cycle of the patient’s 43rd birthday.

Like many women who struggle with infertility, Smith, 37, had hoped her successful IVF journey would ease the pain caused by being unable to become pregnant naturally.

“Once I had my daughter, I thought infertility would no longer be something I struggled with,” she said. “When somebody would announce their pregnancy for a fourth or fifth child, I thought it would hurt less because I had a child, and it didn’t. Because it seemed so easy for everyone else, it still hurt. I struggle with that to this day. For families that struggle with infertility, it is a process even after success.”

IVF grows families — Photo by Andreas Wohlfahrt.

Retired Navy Capt. Larry Laufer, MD, head of the Reproductive Endocrinology and Infertility Clinic at Naval Medical Center San Diego, points out that the odds of becoming pregnant through fertility treatments are similar to those of becoming pregnant naturally.

“Human fertility is relatively inefficient,” explained Laufer, who recommends couples under age 35 seek help if they do not conceive after trying for 12 months while older couples should see a fertility specialist after failing to conceive for six months. “In young, fertile women, the chance of live birth per menstrual cycle is going to be about 25%. This is different than other fields of medicine. You need to have a mind frame that any one treatment is unlikely to work. It may have to be done multiple times for the desired result.”

According to the CDC, military treatment facilities in 2016 performed 1,427 IVF cycles, of which 57 cycles were performed with the intent to “bank” all resulting eggs or embryos for future transfer. In total, 592 women became pregnant, resulting in 462 deliveries of one or more infants.

Beginning in September 2019, Constantino said WRNMMC will increase patient access to IVF by performing the procedure year-round. With that change, Walter Reed anticipates performing 900 IVF treatment cycles in 2020, compared with the 646 cycles performed in the last reporting year.

For couples seeking to have a child, “success rates” can be a key factor when selecting a fertility clinic. But not all fertility procedures that result in pregnancy lead to a live birth, so “success” needs to be clearly defined. The Society for Assisted Reproductive Technology reports that nearly one in five ART pregnancies in 2016 failed to result in a live birth. Outcomes vary greatly based on a woman’s age, type of infertility diagnosis and other factors.

“I feel like IVF, no matter what your circumstance, is a very tumultuous, crazy experience,” said Wloch, an administrator for the “Military Connected Infertility Support” Facebook page. “There is so much that can go wrong and you literally have all your eggs in one basket.”

While comparing IVF clinics is difficult, SART’s preliminary 2017 data shows how IVF live birth rates per egg retrieval cycle at military treatment facilities compare to national averages:

Nationwide: 38.6% for women under 35, 29.5% for women 35-37, 19% for women 38-40, 9.4% for women 31-42 and 3% for women older than 42.
Brooke Army Medical Center: 44.8% for women under age 35, 31% for women 35-37, 14.8% for women 38-40 and zero of two for women 41-42.
Madigan Army Medical Center: 54.2% for women under 35, 31.8% for women 35-37, two of six for women 38-40, one of 12 for women 41-42 and zero of one for women over 42.
Tripler Army Medical Center: 42.6% for women under 35, 30.2% for women 35-37, 23.3% for women 38-40, and one of nine for women 41-42 and zero of two for women over 42.
WRNMMC: 43.8% women under age 35, 25.9% for women 35-37, 22.2% for women 38-40 and 17.4% for women 41-42.

Naval Medical Center San Diego and Womack Army Medical Center are not members of SART and report success rate data only to the CDC.