Military Families Face a Fertility Coverage Gap — and Congress Is Taking Notice

A new Congressional Research Service report is putting military infertility benefits back on the legislative agenda, documenting a persistent gap between what the military's health care system covers and what servicemembers actually need to start families.

Why It Matters

The central tension is straightforward: federal regulation generally bars TRICARE from covering assisted reproductive technology services, including in vitro fertilization, for most servicemembers and their families. That means a service member seeking IVF must pay out of pocket, and the costs are steep. The Department of Health and Human Services has estimated that each IVF cycle can range from $15,000 to $20,000 and can exceed $30,000. Given that the average number of cycles needed to conceive successfully is 2.5, the total cost can easily surpass $40,000.

That financial burden falls on the same population that faces deployment cycles, geographic separations, and occupational hazards that can themselves contribute to infertility.

The Big Picture

The CRS report, updated this month, traces more than two decades of congressional interest in military reproductive health policy. The Military Health System administers health benefits through TRICARE, which covers diagnostics and some medically necessary infertility treatment. What it does not cover is the category of care many infertile couples ultimately need: assisted reproductive technology, including IVF, intrauterine insemination, cryopreservation, and related procedures.

Under 32 C.F.R. §199.4(g)(34), TRICARE is generally prohibited from paying for those services. The carve-out for seriously or severely injured active duty servicemembers and their spouses exists, but it is narrow. For everyone else, fertility coverage in the armed forces stops well short of the treatments most likely to result in a successful pregnancy.

The scale of the issue is not trivial. The CDC estimated that between 2015 and 2019, 8.5 percent of married women ages 15 to 49 experienced infertility, and 11.4 percent of men in the same age range had some form of infertility. Within the military specifically, the Department of Defense estimated that between 2013 and 2021, the overall infertility prevalence rate among active duty servicemembers was 1.54 percent. A 2025 DOD report found that between 2019 and 2023, the incidence rate of new infertility diagnoses among active duty women of childbearing potential was 77.5 per 10,000 person-years, declining from 89.2 per 10,000 in 2019 to 69.5 per 10,000 in 2023.

Congress has not been idle. The Fiscal Year 2025 National Defense Authorization Act included a provision requiring the Secretary of Defense to establish a three-year demonstration program reimbursing eligible servicemembers for gamete retrieval, testing, cryopreservation, shipping, and storage. The program authorizes up to $500 per year for sperm preservation and up to $10,000 per year for egg preservation. Eligible servicemembers include those awaiting or who have received orders to hazardous duty locations, those facing geographic separation from a spouse or partner for more than 180 days, or those otherwise approved to participate.

That program represents a step, but it falls short of comprehensive TRICARE infertility coverage. The more sweeping proposal currently in play is H.R. 3838, Section 703, which would require TRICARE to cover certain ART services for servicemembers and their dependents. The Congressional Budget Office estimated that provision would cost approximately $1.8 billion over the 2028 to 2030 period, while cautioning that actual costs could be significantly higher or lower given the difficulty of predicting beneficiary utilization. DOD's own estimate was more expansive, ranging from $4.9 billion to $8.7 billion between 2025 and 2030.

Political Stakes

The Administration's Unresolved Position on Military Infertility Benefits

The Trump administration's posture on this issue is defined less by what it has done than by what remains undone. On February 18, 2025, President Trump signed Executive Order 14216, "Expanding Access to In Vitro Fertilization," directing the administration to ensure reliable access to IVF treatment and to ease what it called "unnecessary statutory or regulatory burdens" to make IVF "drastically more affordable." The order directed the Assistant to the President for Domestic Policy to develop policy recommendations on protecting IVF access and reducing out-of-pocket costs.

Whether servicemembers will be included in those recommendations remains, as the CRS report puts it, "to be seen." DOD has responded to the executive order by stating it "will continue to assess available options to support family building, including by easing unnecessary burdens to make in vitro fertilization more readily available." That is a commitment to assess, not to act.

The gap between the administration's stated pro-IVF posture and the continued absence of TRICARE infertility coverage is a pressure point. The administration's broader emphasis on reducing federal spending creates additional friction, given the cost estimates attached to any comprehensive expansion.

For Congress

Proponents of expanding fertility coverage in the armed forces have framed the issue around equity and readiness. Some members have argued that expanding TRICARE coverage would reduce the "sacrifices" of military service and bring servicemembers into parity with civilian employers who now routinely offer fertility benefits as a recruitment and retention tool.

DOD has pushed back on the retention argument specifically, noting there is "no clear, data-driven link between family building challenges and retention," in part because there is no required exit survey documenting why servicemembers leave the military.

The moral and religious dimension of the debate also complicates the politics. The CRS report notes that some religious organizations oppose IVF on grounds that it is "contrary to the human dignity proper to the embryo," while others raise concerns about the disposition of unused embryos. Those objections have surfaced in broader congressional debates over ART policy and are not absent from the military context.

For the Public

Servicemembers and their families navigating infertility today are largely on their own financially, unless they qualify for the narrow exception available to seriously injured servicemembers. The FY2025 NDAA demonstration program offers modest reimbursement for gamete preservation but does not cover the full range of ART services. Anyone outside that program who pursues IVF through a civilian provider pays out of pocket.

The Bottom Line

The CRS report documents a durable mismatch between the fertility care needs of military families and what the federal government currently provides. Executive Order 14216 created an opening for the administration to address that gap, but DOD's response has been cautious and noncommittal. With H.R. 3838 carrying a billion-dollar-plus price tag and moral objections still present in the debate, comprehensive military infertility benefits face real obstacles even among supporters of broader IVF access. What Congress does with the FY2026 NDAA process may be the clearest near-term signal of where this issue is actually headed.

Access the Legis1 platform for comprehensive political news, data, and insights.