ART and the Military

This guest post is from Mary Claire Taylor, Regent Family Law student:

One of the newest fields of family law revolves around artificial reproductive technology (ART), a method to help build families. Lawyers, clients, and courts are being forced to address controversial questions that meddle with rights of parents, marital property, and even contract law. A prominent arena where this is being played out is within the United States Military. Recently, the Army and Air Force created cause for celebration for sisters-in-arms with a change in dress and appearance standards – a new era of pony tails, earrings, and lipstick. After addressing the appearance of female members, will the military be able to address a female’s reproductive nature as well?

ART is being used more frequently than ever before to help women who struggle to conceive. Generally, ART encompasses different procedures with the end goal being to help give an infertile woman a child by joining an egg and sperm together. The military, through TRICARE regulations, uses the term Assisted Reproductive Services. By that definition, TRICARE will cover diagnostic services for infertility. However, TRICARE will not cover the technological processes that help a woman conceive, unless infertility was caused by an illness or injury while on active duty, which can be difficult to prove a direct causation. Even with that small exception, full coverage is not guaranteed. However, TRICARE does cover male and female sterilizations.

To cover or not to cover? The debate against TRICARE covering ART creates controversy. Economically, if the military considers ART to be an elective procedure, then there is opposition to using tax dollars to pay for unnecessary medical procedures. Morally, objectors to ART do not want frozen embryos to be destroyed – a possibility for those undergoing In Vitro Fertilization (IVF) where an egg is fertilized outside the woman’s body. Additionally, if a couple uses IVF and later divorce, it may not be clear how the leftover embryos are treated – are they subject to marital property or contract law or both? Another moral objection may come from those who oppose same-sex couples to use ART procedures when conception cannot happen naturally.

Women who need ART to conceive, however, are left to face costly procedures. The average cost of an IVF cycle – the most common form of ART – is $23,000. The reality is that most couples need multiple cycles bringing the cost close to $50,000. TRICARE and money aside, the climate of the military has not yet gotten up to speed with how to approach this medical and emotional endeavor. Misunderstandings compound an already challenging procedure for women.

Infertility is not easily diagnosed, and there are many factors which contribute such as age, stress, and hormone imbalances. Private issues of family planning may become public and uncomfortable. A member may have to explain to superiors the reasons for requesting leave or coming in late, but not actually know “why” she is having infertility problems. Women have started to speak up about how the military can make an already difficult treatment feel impossible. High stress jobs, maintaining weight and fitness standards while using fertility medication, involving Chain of Command in an emotional process, having to use leave in order to attend treatments, and as discussed above, the high cost of treatments. Not only do these factors impede infertility treatment, but they also can contribute to infertility.

Finally, the regulations within each branch are likely not up-to-date on addressing ART. Specifically, the Air Force Instructions (AFIs) address pregnancy and post-partum. These include exceptions to maintaining weight and fitness standards, getting temporary job assignments for safety measures, and physical training (PT) exemptions.

The Air Force is just now getting used to females wearing ponytails in uniform. It may be a while until the service branches are ready to fully address reproductive issues for women to help them build their families.