Examining Veterans’ Experiences with In Vitro Fertilization Provided Under P.L. 114-223

Med Care, 2023 · DOI: 10.1097/MLR.0000000000001831 · Published: April 1, 2023

Simple Explanation

This study explores the experiences of Veterans using in vitro fertilization (IVF) benefits provided by the VA under Public Law 114-223. Researchers conducted interviews with Veterans and their spouses to understand their perceptions, challenges, and recommendations for improving access to and utilization of the IVF benefit. The study identified several themes related to communication, benefit limitations, care coordination, geographic accessibility, and specific needs for Veterans with spinal cord injuries.

Study Duration

May-September 2021

Participants

96 Veterans and 14 spouses

Evidence Level

Qualitative study based on interviews

Key Findings

1
Many Veterans experienced poor communication regarding the scope of IVF benefits, including cryopreservation, pharmacy medications, genetic testing, and mental health support.
2
Limitations on the IVF benefit, such as the number of embryo transfer cycles and restrictions on using donated eggs or sperm, left some Veterans unable to conceive.
3
Geographic inaccessibility to IVF clinics is a significant problem for some Veterans, especially those in rural areas, requiring extensive travel for treatment.

Research Summary

The study evaluated Veterans’ experiences with the IVF benefit under P.L. 114-223, revealing challenges in communication, benefit limitations, care coordination, and geographic accessibility. Veterans reported a need for improved communication regarding the full range of IVF benefits and expanded benefits to include donated eggs/sperm and additional embryo transfer cycles. The research highlights the importance of addressing these issues to ensure equitable access to IVF services for all eligible Veterans, including those in rural areas, with spinal cord injuries, and LGBTQ+ individuals.

Practical Implications

Improve Communication

The VA should provide clear and comprehensive information regarding IVF benefits to Veterans and VA providers.

Expand Benefit Coverage

Consider expanding IVF benefits to include donor eggs/sperm and allow for more embryo transfer cycles.

Enhance Care Coordination

Establish a comprehensive care coordination program with specialized knowledge in IVF to support Veterans throughout the process.

Study Limitations

1
Recall bias among Veterans who received IVF services shortly after the passage of P.L. 114-223.
2
Potential loss of non-verbal cues during telephone interviews compared to video interviews.
3
The study focused narrowly on IVF, limiting generalizability to other forms of ART.

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