The Department of Veterans Affairs has announced an expansion to in vitro fertilization (IVF) benefits for veterans that will mean more LGBTQ veterans (among others) have access to this treatment—but not all.
Previously, the VA only covered IVF for legally married veterans and those able to produce their own gametes (both eggs and sperm) within that relationship. Going forward, it will cover the treatment for unmarried veterans and for veterans using donor sperm, eggs, or embryos, including those in same-sex marriages—but it still requires that the cause of infertility be a service-related health condition. This means that any veteran whose infertility is for medical issues unrelated to their service, plus same-sex couples and single people whose infertility is simply because they lack both of the needed gametes (egg and sperm), are still not eligible.
Rachel Branaman, executive director of the Modern Military Association of America (MMAA), the nation’s largest organization of LGBTQ+ service members, military spouses, veterans, their families, and allies, confirmed to me in an e-mail that even under the new policy, “Any veteran (regardless of gender identity or sexuality) who has a non-service-related reason for infertility is not eligible for IVF. Their only option would be to get up to $2K of adoption expenses covered as surrogacy is also not covered.”
Nevertheless, the new policy is a step forward. The MMAA noted in a statement that the change was motivated by two lawsuits filed against the VA in 2023: “One sued on behalf of a proposed class of veterans—those within a same-sex marriage or if the sperm is donated from someone other than a male spouse—excluded from IVF care. The second is based on IVF eligibility policies which prevented single or unmarried heterosexual veterans from accessing the benefit.”
MMAA also asserted, “While MMAA is pleased that the VA is expanding IVF access, there are still significantly more hurdles for LGBTQ+ couples to overcome when starting a family. Ultimately, we would like the VA to expand IVF to any veteran seeking IVF care regardless of the cause of infertility and expand coverage to include surrogacy and a higher coverage rate for adoption expenses.”
That vision of a further expansion to IVF benefits would be in alignment with the new definition of infertility promulgated last fall by the American Society for Reproductive Medicine, which explicitly includes those who need donor gametes for any reason, either as an individual or with a partner, and affirms the need for fertility care regardless of sexual orientation or relationship status. While the definition in itself carries no legal weight, ASRM guidelines nevertheless have clout and are often used as guidelines in statutes and policies.
Only 21 states plus D.C. have laws mandating any kind of fertility coverage, with only Maine, Illinois, Colorado, and D.C. using definitions clearly and fully inclusive of LGBTQ and single people.
Outside the U.S., the U.K. government announced in 2022 that female same-sex couples and trans people will no longer have to pay for expensive rounds of assisted insemination to prove infertility before accessing IVF. The government will now fund six cycles of intrauterine insemination (IUI) prior to covering IVF if needed.
Despite the limited expansion of IVF that the VA’s new policy offers, four House Republicans have sent a letter to the Biden administration protesting the change, part of an ongoing attempt by the far right to define embryos as people in the wake of the rollback of abortion rights.