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Health Services Research & Development

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2023 HSR&D/QUERI National Conference Abstract

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4116 — Examining Veterans’ Experiences with In Vitro Fertilization Provided Under P.L. 114-223

Lead/Presenter: Kristin Mattocks,  COIN - West Haven
All Authors: Mattocks KM (VA Central Western Massachusetts Healthcare System), Kroll-Desrosiers, A: (VA Central Western Massachusetts Healthcare System, Leeds MA) Mengeling, M: (Center for Access & Delivery Research and Evaluation (CADRE) and Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, IA)

Objectives:
Until recently, the Department of Veterans Affairs (VA) medical benefits package has expressly excluded in vitro fertilization (IVF) services for Veterans experiencing fertility problems. However, P.L. 114-223 (2016) allows VHA to provide Assisted Reproductive Technology (ART), including IVF, to certain eligible Veterans. Little is known regarding Veterans experiences accessing IVF through VA Community Care contracts with IVF providers. Thus, the objective of this study was to examine Veterans’ experiences with IVF services provided under the auspices of P.L. 114-223.

Methods:
Telephone or video interviews were conducted with 116 Veterans and/or spouses of Veterans who had been approved for IVF through the VA Office of Community Care. Interviews were recorded, transcribed, and analyzed using content analysis techniques. Major themes and representative quotes were derived from the analyses.

Results:
Of the 116 interviews we conducted, 82 were Veterans, 20 were spouses, and 14 interviews included both Veteran and spouse. Sixty-five percent of the Veterans interviewed were female, white (58%), and had served in the Army (34%). Veterans included in these interviews represented 62 VA medical centers (VAMC) across 18 Veterans Service Integrated Networks (VISN). Five major themes arose from these interviews, including: (1) need for improved communication regarding IVF benefits; (2) need for expanded IVF benefits; (3) lack of a comprehensive care coordination program; (4) poor access to IVF providers in some areas of the country; and (5) special services needed for Veterans with spinal cord injuries.

Implications:
Many Veterans have taken advantage of the IVF benefit, and in our study, 35% of the Veterans we interviewed had successfully conceived via IVF. Further attention needs to be paid to improving communication and coordination of IVF services with ongoing VA care and to ensure special populations, including those living in rural areas and Veterans with spinal cord injuries, have access to IVF services as needed.

Impacts:
This evaluation was requested by Congress to examine the implementation of P.L. 114-223 for Veterans. Our research suggests that there are areas of improvement needed regarding IVF care coordination and communication that would greatly enhance Veterans' ability to access and utilize IVF benefits. The Office of Integrated Veteran Care (IVC) should work closely with other VA program offices (e.g. Women's Health, Specialty Care) to ensure Veterans have sufficient access to IVF benefits and community IVF providers.