VA Disability Benefits for Male Infertility

What is Male Infertility?

 Up to 15 percent of heterosexual couples are infertile, meaning they are unable to conceive a child despite having frequent, unprotected sexual intercourse for a year or longer.  In over a third of these couples, male infertility plays a role.  Male infertility is often due to one or more of the following factors:

• Low sperm production
• Abnormal sperm function
• Blockages that prevent the delivery of sperm
• Illnesses
• Injuries
• Chronic health problems
• Lifestyle choices (smoking, drinking, drug use, etc.)

The main sign of male infertility is the inability to conceive a child.  Although most men with male infertility do not notice symptoms other than the inability to conceive a child, signs and symptoms associated with male infertility can include:

• Problems with sexual function (e.g., difficulty with ejaculation or small volumes of fluid ejaculated, reduced sexual desire, or difficulty maintaining an erection)
• Pain, swelling, or a lump in the testicle area
• Recurrent respiratory infections
• Inability to smell
• Abnormal breast growth (gynecomastia)
• Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality
• A lower than normal sperm count (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate)

Potential Causes of Male Infertility

Medical Causes

 Problems with male infertility can be caused by a number of health issues and medical treatments, some of which include:

• A swelling of the veins that drain the testicle.  It is the most common reversible cause of male infertility.
• Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm.
• Cancer and nonmalignant tumors can affect the male reproductive organs directly, through the glands that release hormones related to reproduction or through unknown causes.
• Undescended testicles. In some males, during fetal development one or both testicles fail to descend from the abdomen into the scrotum.  Decreased fertility is more likely in men who have had this condition.
• Celiac disease. A digestive disorder caused by sensitivity to gluten (celiac disease) can cause male infertility.  Fertility may improve after adopting a gluten-free diet.

Environmental Causes

In addition to medical causes, overexposure to certain environmental elements such as heat, toxins, and chemicals can reduce sperm production/function and lead to male infertility.  Examples include exposure to industrial chemicals, heavy metal, radiation or X-rays, etc.

Relationship Between Military Service and Male Infertility

 A 2017 study examined the associations between military service and semen quality among US veterans of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND).  Researchers of the study believed that previous research conducted to assess the prevalence of reproductive health-related treatment and diagnoses among OEF/OIF/OND veterans focused primarily on female veterans.  As such, this study expanded that body of research.  Semen quality parameters (semen volume, total sperm count, sperm concentration, and percentage of total motile sperm) measured at fertility clinics in the VA Healthcare System were analyzed.  The study found that veterans who were older, Hispanic or Black, or diagnosed with post-traumatic stress disorder or major depression were more likely to have lower sperm quality.  However, further research is still needed to better characterize the influence of military-specific exposures on semen quality parameters.

While the study did not specify a direct relationship between military service and male infertility, it did find a connection between other potential service-related conditions (e.g., PTSD, depression) and male infertility.  This is important to keep in mind when considering the various paths to establishing service connection.

Prevalence Rates of Male Infertility Among Veterans

The National Health Study for a New Generation of U.S. Veterans, a study of 60,000 OEF/OIF/OND veterans took place between 2009 and 2010.  The purpose of this study is to (1) provide insight on the overall health of recent veterans; (2) improve VA’s understanding of what health services veterans need; and (3) maximize the quality of care that VA offers.  Researchers continue to analyze data from this study and share their findings in publications.  In regards to male infertility, the study found that 13.8% of OEF/OIF/OND veterans reported that they experience infertility.

What Services Does VA Offer for Male Infertility?

 VA infertility services are available to help eligible veterans.  Through VA health care, enrolled veterans have access to many different types of fertility treatments, procedures, and services, including infertility counseling, laboratory blood testing, genetic counseling, sperm testing, ultrasounds, surgery, reversal of a vasectomy, medication, and more.  Veterans with certain service-connected conditions that result in infertility, and their spouses, may be eligible for in vitro fertilization (IVF) or another form of assisted reproductive technology (ART) services.  Coverage is determined on a case-by-case basis, based on an infertility evaluation at a VA medical center.  Qualified veterans or their spouses may be eligible for up to three IVF treatment cycles.  To qualify for this benefit:

• The veteran must be legally married
• The veteran must have a service-connected condition causing infertility
• The veteran or spouse must have an intact uterus and at least one functioning ovary or own cryopreserved eggs
• The veteran or spouse must be able to produce sperm or own cryopreserved sperm.

Importantly, the IVF/ART benefit does not cover surrogacy, donor eggs, donor sperm, or donor embryos.  To receive treatment for male infertility, veterans enrolled in VA health care can start by scheduling an appointment with a VA provider for an evaluation.  At the evaluation, the VA provider will identify the cause of infertility in order to determine eligibility for the benefit.  If the veteran is found to be eligible for the IVF/ART benefit, VA will refer them to a Reproductive Endocrinology and Infertility (REI) specialist in the community.  From there, medical care is provided based on the treatment plan developed by the veteran and the REI specialist.